Barrow Hill Vets – 18th February 2013

Today was my first day at Barrow Hill Veterinary Hospital on a work experience placement lasting 1 week. I am working from 9.00 am until 4.00 pm, allowing me to gain the view of an average working day of a vet. A few weeks ago I had an induction session and a surgery tour in which I was shown around and some general rules were considered. During this time I was able to compare Barrow Hill Vets, Ashford, to Cinque Ports Vets, Kingsnorth, where I did work experience last year. The first thing that struck me was the difference in size between the two surgeries. Barrow Hill was a lot bigger and as a result, calls itself a veterinary hospital, whilst Kingsnorth is only a centre. At Barrow Hill, there is separate accommodation for dogs and cats with air conditioning, and although these rooms are smaller than the kennels at Kingsnorth, the blood tests and other small procedures are completed in the very large prep room, rather than the kennels. In this prep room, there are three tables and endless storage space providing opportunity to complete dentals and cat castrations as well as the routine blood tests etc. At Barrow Hill there are two operating theatres and an imaging room for ultrasound and chemotherapy. Both Kingsnorth and Barrow Hill have an x-ray room, which are very similar. Interestingly, Kingsnorth has a larger staff room. Despite these differences, including the more staff at Barrow Hill, I don’t pass judgement as to which is better for they both accommodate similar services and use the site they have to their greatest advantage. Most importantly, they both have brilliant morals behind what they do and an excellent team of staff to ensure that everything is done considering both the animal and its owner.

I had a chance to watch some consultations both this morning and this afternoon, observing different vets. I could see some differences in how they worked, especially in their interaction with the client, but overriding this, I could see the similarities in how they affectionately treated all of the animals, encouraging the owner to have pride and love for their pet. I first saw two cats and a dog having routine vaccinations. Dogs should be routinely vaccinated against:
•Canine parvovirus
•Canine distemper virus
•Leptospirosis
•Infectious canine hepatitis
•Canine parainfluenza
Whilst cats should be regularly vaccinated against:
•Feline infectious enteritis
•Feline herpes virus
•Feline calicivirus
•Feline leukaemia virus
It was brilliant being able to compare the fuss humans make at having injections to simple naivety of the animal who has not a care in world as to the needle being stuck in their back.

A dog was brought in who had being having occasional seizures in which his front leg would freeze until this would shake down to the back leg. We were told that it had been having them about twice a day with no obvious indicators as to what caused them. However, the vet reassured the owners that random was almost a routine in itself. It is really hard diagnosing problems such as these as the pet rarely shows symptoms at the vet, so the owners were told to try and film the seizure when it next happened as well as keeping a diary as to possible connections which could be associated with them happening. This could give the vet a clue as to whether it is muscular or neurological and depending upon this, the right course of action can be decided on.

Next, a cat with a limp was brought in. After feeling the leg and paw, the vet decided that it had broken its toe as she could feel the two pieces moving within the foot. The owner had two options as to what could be done and although this is initially their decision, I could see the way in which the vet presented the two ideas was leading so the most appropriate option would be chosen. The first option was for the cat to have an x-ray so that the break could be confirmed and the alignment would be known. If this was out of place, it could be operated on to insert a screw to hold it in place and aid healing. However, this would be very expensive and as most owners are cost concerned, the second option was chosen as the vet advised that it could be perfectly adequate. This was to leave the toe untouched, give the cat metacam as a painkiller and ensure that it is kept indoors and left quietly to heal by itself. In a situation such as this clean break of one toe, it is unnecessary to do expensive and time consuming procedures.

The last consult of the day, was a cat brought in because it had stopped miaowing. A cat miaows using its larynx, but this could not be easily seen whilst the cat was conscious and fidgeting. Therefore, the owners have to admit it to the hospital tomorrow. During the time it is in the surgery, it will be put under anaesthetic so that the larynx can be sufficiently examined. If the larynx looks abnormal, a swab will have to taken and sent to a laboratory for investigation. Although this will give results as to whether it is cancerous or not, it will not be very reliable. This is because the sample is too small to be a valid representation of all the cells in the larynx, however there is nothing more that can be done a the larynx of a cat is too small to have a biopsy taken from it, which would be the chosen and most reliable method in other areas of the body. The vet explained to me afterwards, the importance of weighing up the cost and implications of obtaining a diagnosis and the cure which will be able to result from this. For example, if the examination of the larynx was not conclusive, more procedures could be carried out. But these would be very expensive and potentially dangerous. If the only information which was obtained was that the problem was superficial, it would be a waste of time, money, and most importantly, it would unnecessarily put the cat’s life at risk as the cure would be no different to if these procedures had not been carried out. This cat also needed a dental, which will be carried out tomorrow if no swab is taken from the larynx, for a cat’s larynx is too sensitive for any other procedures to be carried out once it has been touched.

A boxer had been in a road traffic accident, though luckily it was not too hurt, with only a few cuts and bruises which although would have been painful they will heal quickly. The cuts were cleaned thoroughly using hibiscrub (skin disinfectant used for many purposes throughout the surgery) and the dog was given medicam as a painkiller to help the dog recover as quickly and as comfortably as possible.

One of the most enlightening patients in today, was a fox terrier whose foot had been stood on accidentally. It was in to be sedated and x-rayed. It was found that the metacarpal bones had all become dislocated from the dog’s ankle. This was a serious incident and meant that all the ligaments would also be torn through and the foot would not heal itself. This left the vets with only the choice to operate, with the easiest option being to amputate the leg from above the knee. However, alternatively, a complex operation could be undertaken to fuse the bones in place meaning that although the joint would not work, the dog would adjust and learn to walk ably again. But this procedure would be very expensive as the dog was not insured, it would also have many risks associated to it and be a very long operation. Contrary to the beliefs of the vet, when the owner was phoned they proclaimed that they would rather the dog was euthanized than three-legged, this was because of the sadness they would feel at seeing their dog without a leg, and knowing that it was because they had stepped on it. However it was only an accident and many of the vets admitted that they had trodden on animals many times. This lead the conversion on to a survey done in America where over 60% of people with three-legged dogs had been confronted in public as to the cruelty they were putting their dog through. Nevertheless, all the vets agreed that young dogs, such as this 18 month old fox terrier, coped extremely well when missing a leg, especially if it was a hind leg – and it was. After consideration, the owners decided that they would pay for the long and complicated operation as they believed that this would give their dog the best quality of life. This causes me to question opinions of amputations and what it is best for the dog, owner, and vet in a situation such as this.

A very similar accident happened to a cocker spaniel in which a log was dropped on its foot. But luckily the break was lower down and meant that the bones had not dislocated and the ligaments were less damaged. The foot would heal by itself, however, it needed bandaging. This would be done every two weeks although the dog would have to be brought in every week to have the wound checked. This is because when cuts and grazes are covered for long periods of time by a bandage, they can become easily infected without anybody realising, leading to many more problems.

During today’s events I saw how much harder cats are to work with than dogs. This was clearly seen when a cat needed dematting. Its fur was in a terrible state because of its thick density. The owner had been brushing it but only the very top and because there was just so much of it, the cat could not keep itself groomed, and neither could its owner. This cat hadn’t visited the vets for a year, and during this time its fur had become one huge mat, covering its entire body. It was so great that when holding on to the cat’s ‘leg’, I suddenly realised that this was a mat, not a leg. As the vet tried to shave off its fur with a nurse clinging on to the cat, it became more and more stressed. For every 10 minutes it was groomed, it had to be left for half an hour to recover. They realised that this procedure could not be completed in one day with a cat of this temperament. Therefore, it either had to be given many ‘minors’ over a series of days, or be sedated and given a ‘major’, in which all the fur which needed removing would be done so. From this, I was able to see the need for sedatives in animals and how this contrasts so greatly to the use of them in humans.

An English Bull Terrier was in the kennels who was suffering with mange. To treat this he had to be given a minimum of four baths in a chemical which kills the mites, once every week. This chemical was very dangerous and although I was not allowed in, I could see the precautions the vet and nurse had to take, dressed in disposable aprons to cover their entire bodies and masks covering their face and hair. On asking, I found out that a dog with mange can have up to 6 baths in total and it is important to take a skin scrape before stopping the treatment to ensure that there are no mites left. If there were mites left which caused the mange to worsen again, the whole process would have to be repeated from the beginning once again.

Also in the kennels was another terrier but this was a Staffordshire Bull Terrier, renowned for their fighting personalities cultured through English history, this dog, although mild and friendly, proved that some of these connotations are true. This dog lived with her son and although they had had many scraps in the past, this was by far the worst. Having been brought into the surgery yesterday, she had sutured scars covering her body. She was exhausted and could hardly move so was attached to an intravenous drip in an attempt to keep her alive and recovering. However, if she did not improve she would have be put down.

Although during parts of the day, the surgery became very quiet with few consultations and surgery finished, everyone always has something to be doing. This gave me the opportunity to accompany a nurse in one of her jobs. This was the first time I had seen inside a veterinary laboratory, and although it was on site so it was very small, it was fascinating. Its primary purpose was analysing blood samples which I had seen taken during the day. To begin, the test tube of blood was put into a centrifuge which spun it very quickly until the plasma separated from the red blood cells. The plasma was a pale yellow colour which is surprising as it makes up the liquid of blood, but actually the red colour comes from the pigment haemoglobin, used to transport oxygen around the body in the red blood cells. Two different machines were then used, with probes being placed in the plasma, testing for the amounts of a variety of minerals and substances. It astonished me just how many different mineral ions we have in our blood and how the imbalance of any of them can be potentially fatal. For the cat whose blood this was, the only indicator to why it was ill was a high white blood cell count. This suggested that it had an infection and as a response, its body was fighting the infection by producing more white blood cells. This was positive news as an infection could be treated with antibiotics, and the information gained from the blood tests assured the vets that there was very little other concern.

Another piece of interesting equipment I saw today was an ultrasound machine. By emitting ultrasound waves and detecting the reflections, this machine can construct an image of the inside of the animal’s body. Ultrasound is reflected at boundaries between different density media so the time the wave takes to be partially reflected is recorded and because the speed of the ultrasound wave is known, the distance these boundaries between media are from the transducer can be calculated, forming an oscilloscope which in turn constructs the image. With the use of saline gel, the air boundary between the emitter and the dog’s skin does not reflect back all of the ultrasound, meaning that we could see inside the sedated dog’s chest to observe what was causing the heart murmur, heard through the stethoscope. Using the ultrasound, the vet revealed that there was a leak in a heart valve. This meant that whenever the heart contracted, there was a high pressure jet of blood going from the left ventricle to the left atrium, which the valve should have prevented. With this knowledge, the vets could consider what to do. However, with heart surgery not at a pinnacle in veterinary medicine, there was very little that could be done to cure the heart murmur and as a result the dog would suffer with a weak heart and increased risk of heart failure.

I have really enjoyed today, and with so much happening, it has been brilliant to document it and save everything that I have learnt.

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