UC Davis Rx One Health Summer Institute

Jerrisa Ching, Washington State University

As a representative of Washington State University, I participated in the 2019 University of California at Davis (UC Davis) Rx One Health Summer Institute in Dar Es Salaam, Tanzania from June 23-July 19, 2019. One Health is an initiative that involves the collaboration of multiple disciplines to promote the health and well-being of humans, animals, and environment. This program provided an immersive One Health curriculum and hands-on experience for veterinary students, veterinarians, and other health professionals interested in One Health, public health, international medicine, and global health careers. This year, the 2019 Rx One Health cohort was made up of 22 individuals from 9 different countries (USA, Tanzania, Malawi, Senegal, Somalia, Vietnam, Mongolia, Japan, and India). My Rx One Health cohort and I participated in diverse activities in Tanzania, which ranged from livestock farm visits and zoonotic disease surveillance activities, Ruaha National Park wildlife disease surveillance and sampling, health institute/research facility tours, agriculture visits, Mafia Island ocean conservation/ecology/water and waste management activities, Masaai community and culture engagement, and government policy discussion. 

The UC Davis Rx One Health program was valuable for my veterinary education and professional development as it guided me towards my career pathway in veterinary public health. After I participated in this program, I affirmed my passion for veterinary public health while providing myself open doors into One Health careers in veterinary medicine. In addition, I learned the importance of veterinarians' role in community and government engagement since this skill permits you to build a relationship with all species to implement One Health interventions in a population. From the Rx One Health program, I intend to incorporate my knowledge and skills to improve the public health infrastructure systems in the state of Washington and Hawaii, USA. 

For any veterinary students interested or want to learn more about One Health, public health, or global health, I would highly recommend applying and participating in UC Davis Rx One Health Summer Institute Program! 

Sugar Coated

Thank you, Chance Boyer from Iowa State, for these incredibe photos!

Shunt Case Report

Kristin Reichert, University of Wisconsin 

1. Signalment: Xxxx (not revealing name for patient confidentiality), 4-month-old intact female Golden Retriever

2. Presenting complaint: Intrahepatic Portosystemic Shunt 

3. History: Back in July, Xxxx reportedly presented to the emergency service with unspecified neurological signs. She underwent investigations that revealed elevated total bilirubin and ammonia, and she was transferred to the internal medicine service with a suspicion for a congenital hepatic portosystemic shunt. Upon abdominal ultrasound, internal medicine suspected that Xxxx had an intrahepatic shunt and recommended a soft tissue surgical consult. This would likely be for computed tomography with contrast to confirm the location of the shunt, followed by surgical management. To help mitigate her neurological signs from the accumulation of ammonia within her system and ultimate crossing of the blood brain barrier, Xxxx was prescribed levetiracetam, lactulose, and metronidazole. She was reported to have improved significantly with regards to her clinical signs as a consequence of these medications.

4. Physical examination findings: Xxxx presented BAR. Eyes and ears were noted to be unremarkable. Oral examination identified multiple fractured deciduous teeth. Mucous membranes were moist and pink with a capillary refill time of under 2 seconds. Heart rate and rhythm were normal with no murmur auscultated. Lung fields in all four quadrant were normal. Abdominal palpation was soft and comfortable. Peripheral lymph nodes palpated within normal limits. Integument had no abnormalities. Temperature remained within normal limits throughout hospitalization. Her presenting weight was 11.3kg.

5. Differential diagnoses: Upon presenting to the soft tissue service, the top differential was intrahepatic portosystemic shunt, due to the previous diagnostics that had been performed. However, upon initial presentation, differential list included ingestion of toxins, an episode of hypoglycemia causing seizures (potentially secondary to other disease processes), intracranial congenital defects causing seizures, idiopathic seizure activity, peripheral vestibular disease (including secondary to otitis media or otitis interna), neoplasia of the central or peripheral nervous system, infectious disease processes (including bacterial, viral, fungal) and a vascular event in the central nervous system.

6. Diagnostic tests/procedures and associated results: Whilst with the soft tissue service; a pre-operative complete blood count and serum biochemistry were performed in conjunction with an abdominal computed tomography scan with contrast, to confirm the location of the shunt and to appropriately prepare for our intraoperative approach.

7. Working diagnosis: Total bilirubin had returned to the normal range, which was slightly anomalous, however her ammonia had increased since her previous bloodwork, which remained consistent with the shunt persisting. The CT scan confirmed the presence of an intrahepatic shunt and provided visualization for surgical approach. This was determined most appropriate between the left medial and quadrate lobes of the liver.

8. Treatments administered/procedures performed: A 9mm Amyloid ring and key was placed around the shunt once surgically accessed and freed from surrounding connective tissue to the liver. A concurrent liver biopsy was performed and is pending histopathology. Intraoperatively, a temporary total ligation was performed to determine the necessity of the amyloid ring. It was determined that the portal pressures were too high with total ligation. This was determined by assessing the increase in motility of the intestines and force of vessel pulsation with the ligation in place.

9. Outcome/progress (if applicable): The amyloid ring is slow-closing and will progressively close over the next month or so. Xxxx will be monitored closely during this time, as there are concerns over portal hypertension or formation of acquired shunts. While generally positive in the long-term, if these complications do not occur over the next few months, there is always a concern that acquired shunts may form over time. In the meantime, Xxxx will remain on levetiracetam for two weeks, and lactulose and metronidazole for two months following the procedure, in hopes of helping her transition back to life as a puppy and decrease the accumulation of ammonia within her system.

Waiting on the Weekend

It is almost Friday! Check out these funny memes creates by Taylor Williams from Ohio State University that will help you make it through the end of the week. 

Smithcors Veterinary History Essay Contest

Are YOU interested in veterinary history? If so, check out the link to the Smithcors Veterinary History Essay Contest! This contest is sponsored by the American Veterinary Medical History Society, and it gives students the opportunity to thoroughly research a topic related to veterinary history, write an essay about it, and possibly win scholarships and publication. There are scholarships available for those essayists placing 1st through 4th.  Students wishing to enter can find everything they need (guidelines, entry forms, etc) on the website listed below. Submissions are due April 15th, 2020. 

 https://www.avmhs.org/essay-contest