Monica Endy Daily Log 3/5/12-3/9/12 Food Animal Externship at New Bolton Center

3/5/12 New Bolton Center Purpose of Visit: Day one was all about exploring the facility and a wide variety of cases. Our job was to shadow fourth year veterinary students as they worked with their patients to discover proper diagnosis and treatment. Outcome: Many patients are recovering from treatment and surgery while others still need further testing to define a diagnosis. What was learned from this experience: I learned many new things about large animal medicine today and will explain these findings case by case. The day started out with a meeting in Barn D, which was where most of the large animal patients were held. The vet students and professors spoke about the cases and possible testing and treatments that were to be performed throughout the day. Once the meeting was over everyone went their separate ways to work on individual cases. Some of the cases we decided to follow included: A calf recovering from Polio A Long horn with an abscess on his face. There was thought that this could have been Lumpy Jaw. This bacterial infection was new to me but was not confirmed as the final diagnosis Sweet Pea who came in for a hernia but after a physical exam a heart murmur was also confirmed. This case was brought to ultrasound which was very interesting for me since I have never seem an ultrasound done on such a large animal. To my surprise it was very similar to a small animal ultrasound except everything was on a larger scale. Between the ECO, ultrasound, and physical exam it was concluded that the murmur was being created by a flux of blood between right and left ventricles. Something new I learned today was how murmurs are graded on severity. One thing they looked for was the velocity of the blood flowing through the vessel. They also try and determine how large the vessel is. It was concluded that it was a small vessel with a high velocity, which I found out, was preferred and may not be as terminal as a large vessel with low velocity. A brown swiss came in due to reproduction complications. From my understanding the cow was brought in because when a breeder was trying to artificially inseminate her he noticed an abnormality. This case was also brought to ultrasound where the mass was further analyzed. One of the students talked to us a lot while this was going on and I learned a few new things from him. One being quite simple, the left kidney of a cow is more centered in the abdomen due to the rumen, which takes up a lot of space on the left side. Also the right kidney

stretches further to the rostural part of the animal. Another difference between bovine kidneys and others is that they are lobular rather than perfectly bean shaped. The student also explained that there are 25 weeks of clinical rotation and each is 2 weeks long. He said about 5 are mandatory while others can be chosen based on animals of interest. RDA (right displaced abomasums) in a cow was concluded based on physical exam. Pinging was a simple test we even got to perform where you used a stethoscope to here the different sounds of liquid and gas throughout the abomasums. This case was an emergency since it was on the right side rather than left which was more common. The cow was brought to surgery where we were able to observe. The cow remained awake and standing and only locally was numbed with lytocaine. Once the students got the cow open the procedure was not too complicated. It appeared all they did was allow gas to leave the abomasums and them placed it where it was supposed to be and sutured it secure. This reminded me of bloat in dogs. While in surgery we also observed a castration of a bilateral criptorchid goat Another goat that was in for a blockage needed to be checked on and given a physical exam. The students let us do the physical exam. A sick alpaca was brought in that needed a blood transfusion. One main thing I learner today that seemed to be a constant theme was that what the animal actually comes in for is usually not the only problem Around midnight a horse came in with colic. Its colon was kinked in between its spleen and kidney. I cannot believe it is only Monday!! We got exposed to so many procedures and the students and faculty have been so enthusiastic about our involvement. Cannot wait for the rest of the week

3/6/12 New Bolton Center Purpose of visit: Follow up on Mondays cases, mainly surgery Outcome: First thing in the morning we met for a meeting focused on lameness cases. All of the cases were equine but still very interesting. At 9:00am we all met for rounds just like we did the first day. This is when all of the cases were reviewed and some new cases were assigned to students. The first patient we observed in surgery was Sweet Pea who was getting her body wall hernia removed. There was another hernia in a younger calf that was an umbilical hernia. Both of these procedures went smoothly and were done the same way. There was also a potbelly big that got castrated. The castration was fairly simple since the testicles were not chriptorchid. Later in the afternoon two Jersey heifers had to be dehorned. They were placed into the shoot without being sedated at all. The students blocked the area around the horns hoping the procedure would be painless. The cows did not cooperate very well so this procedure took longer than estimated. It was the first time I had seen a dehorn so everything was new for me. We are still waiting on two heifers to go into labor. They were induced yesterday morning with PGF2alpha and it is estimated they will calf within 36 hours. What was learned from this experience: Since we were in surgery most of the day we were educated on surgery prep and the proper sanitation needed before each procedure. I also questioned why the dehorning was necessary and a student explained that if within a herd only a few have horns and the rest do not that they will beat up on the hornless animals.

3/7/12 New Bolton Center Purpose of visit: Today many cases were followed up. Many required radiographs and a few needed surgery. There were many patients that needed care and half of the students were at a UPENN conference. Due to the shortage of people I got to do a lot of hands on activities. Outcome: At 8:15 we arrived to attend a meeting on pathology. Just as we got there they were finishing up a caesarean section on a lamb with twins. The babies were healthy and we were trying to train them to nurse throughout the day. The pathology meeting was very hands on with many deceased organs. We looked at many tissues and tried to find abnormalities that would explain the cause of death. I was please with myself that I was able to recognize many of the organs but I still have a lot of learning to do to be able to recognize abnormalities and connect them to disease. At 9:00 as usual rounds were done where everyone gave updates and plans for the day. The first case I followed was three baby (1 day-2 day old) brown swiss calves. They all came in with injuries having to do with their right front leg, most likely a management issue. All three at some point were brought in for radiographs, one ended up in surgery, one with a hard cast, and one with just a splint and soft wrap. The one in surgery needed repair of its radius, which was accomplished with a bone plate. The ulna was broken also but they said it would heal with the support on the radius. The meta carpus of the calf receiving the hard cast was broken. I got to participate in prepping the calves and putting in catheters. Also I was able to restrain the calves when taking radiographs. A goat came in that was attacked by a pit bull. His ear was almost completely torn off and its jaw was broken pretty badly. The doctors arent even sure if they can repair his jaw but will be trying first thing tomorrow morning. I also helped the students with their heavy load of patients by cleaning up the brown swiss calves from their dehorning yesterday. A red angus came in with pneumonia and while they were performing a physical exam did a test by placing a bag over the cows nose. This lead to the build up of CO2 and made it harder for the cow to get oxygen, which made it easier for the students to detect any wheezing or coughing. Then once the bag was removed they noticed she could not get her breath back easily and coughed which were signs something was wrong. There were still no calves from the two heifers induced Monday morning but expected to calve soon. What was learned from this experience: The sheep that had the c-section had difficulty understanding the babies were hers and wasnt sure how to let them nurse. I learned that since she was a young mother, it was her first time, and had a csection that it was common for these mothers to have trouble understanding she has babies and to let them nurse. While prepping the calves I learned how to make a quick scrub with gauze, water, and betaseptic. This was something simple but still

new to me. From day one I learned about the bovine kidney and how it was lobular and today got to recognize one in pathology, which was great. 3/8/12 New Bolton Center Purpose of visit: First thing this morning the baby goat was in surgery in an attempt to fix his mandible. The rest of the day normal procedures took place such as ultrasound, PCV, and other blood tests and treatments. Outcome: The day started off at 8:30 with surgery on the goat that was attacked by a pit bull and brought in yesterday. The surgery was interesting and different since we were trying to place the shattered mandible back together. Four screws, two on either side, and a pin straight through were used in attempt to fix the jaw. Then foam tubing and cement were used on the outside of the bolts to keep them in place for proper healing. The ear of the goat was also repaired as best as possible. Next we ran a PCV (packed cell volume) on a baby Holstein that came in for bloat last night but the bloat was gone by the time it got to NBC and now is believed to have pneumonia. The normal PCV for bovine is +/- 30 and the calf was 32. In young calves it is believed that there is a connection between bloat and pneumonia. A large Holstein that was housed on a sandy/gravel farm was in since it had eaten the gravel. We treated it with ten gallons of pepto bismol and mineral oil to help the debris get out of her intestine track. This patient was held in isolation since it was thought she had a contagious intestinal disease. Majestic Girly Girl the red Angus from yesterday was brought to ultrasound where they looked into the liver for further signs of diagnosis. They ended up finding a mass on the right atrial wall blocking the tricuspid valve. This mass lead them to believe the cow had bacterial endocarditis or lymphoma. Due to the location of the mass and other blood tests Dr. Sweeney and the students are leaning more towards lymphoma. One of the brown swiss calves from yesterday was put in a sling (aka goat-mo-bile) in attempt to help her walk. This physical therapy hopefully will teach her how to stand and walk since she has not been able to stand on her own since she was born. Finally a catheter was put into the red Angus so she could receive antibiotics as well as easy blood collection. The two Holsteins x Angus that got pregnant on accident did calve last night. The fetal membrane had been expelled by one of them but they are still waiting on the second. What was learned from this experience: Today I learned how to do a PCV and what information is gathered from doing one. I also learned the normal percent of red blood cells in ruminants, which helped read the PCV. Also the plasma of a ruminate will be an off white while the plasma of a horse will be yellow. The connection between pneumonia and bloat in young calves was also brought to my attention from one of the students. He said this occurrence of events was common and at times expected since the Vegus nerve runs through the thoracic cavity and to the rumen.

3/9/12 New Bolton Center Purpose of Visit: the purpose of today was to wrap up cases from the week and go over the treatment plans for the remaining patients. The main case of the day was to determine the diagnosis of the baby calf and to decide on the best treatment possible. Further analysis of what may have lead to the severe damage of the abomasums will be performed in pathology. Outcome: To start off this last morning there was grand rounds. This entailed presentations from three groups of students about a specific interesting case they have seen in the past two weeks. Three equine cases were given: uterine torsion, EMPF (equine mulitnodular pulmonary fibrosis), and arthritis. We then met again in D barn to do quick rounds and updates. The calf that came in as a bloat was on its way to ultrasound. There it was discovered he had mass amounts of fluid in his abdomen. It was thought the abomasums was perforated and this was confirmed in surgery. The owners agreed to do an exploratory on the calf and then decide if it could be treated. Before opening the abdomen they legated the umbilical cord to prevent bacterial from entering once it was opened. In surgery a large hole was found in the abomasum, which was the cause for all of the fluid in the abdomen. All of the intestines and other organs in the abdomen were clumped together with fibrin and there was diffuse peritonitis. Since the damage was so severe the owner gave permission to humanly euthanize him while under anesthesia. He was then closed and to be further analyzed in pathology. As of now it is believed that the colostrum used by the facility did not have adequate antibodies and protection of the calf from bacteria such as clostridium. To try and confirm the reason for the severe infection bacteriology, histology, other tests were run to check for aerobes and anaerobes such as clostridium. In pathology the severity of the infection and damaged tissues was apparent. A blocked goat that has been in the hospital since we arrived on Monday was getting surgery in an attempt to remove a stone lodged in the sigmoid flexure. A scope was used to try and basket the stone but this was unsuccessful since the stone was too large to pass through the remaining urethra. I questioned if it was reasonable to cut through the skin into the urethra to retrieve the stone but a student explained that the tissue is so sensitive that once the incision tried to heal it may actually close the urethra. This was a frustrating case for the clinicians and students since the goat was otherwise healthy. I do not know the outcome of this case but I believe the goat was put down after given the owners consent. What was learned from this experience: early when physically analyzing the calf we learned that clostridium is often treated with penicillin. It was also confirmed that substitute colostrum might not be as protective for the calf compared to colostrum from the mother. While in pathology I learned that to get the most accurate

necropsy it should be performed within five minutes of death. In ruminants the gut is likely to change after five minutes postmortem.