Foot in Mouth- a remake of "Firework"

As you approach your next semester of clinics or classes- let this serve as a laugh and an inspiration :)

Especially for the class of 2012- you can make it! Almost there!

To the tune of "Firework" by Katy Perry

By Julie Kornder

Do you ever feel

Like a fluid bag

Is dripping on your head;

Just hanging by a thread?

Do you ever feel,

Feel so very stressed?

How will you ever sleep,

Pass the boards, and rest?

Can you localize

Where that horse is lame?

Block the nerves and trot.

These x rays all look the same.

Do you know that there’s an ophtho case for you?

Cuz there’s a Vet in you.

You just gotta

Shine your pen light

In the patient’s eye

To localize.

PLR is fine!

I’m gonna wear my White Coat

And finally use my Stethoscope.

Clinics make me say Oh! Oh! Oh!

As I stay up writing SOAPS SOAPS SOAPS.

I’m gonna wear my White Coat

And do a Minimum Database.

Chem CBC UA-A-A

I sure hope that they can Pay Pay Pay.

You don’t have to feel

Like it will never end.

May 2012,

You’ll be a DVM!

If you only knew

How to pay back your debt,

Communication, and

Practice Management.

Maybe the reason why

You do 3 fecal floats

So you don’t miss worms

And then see them with your endoscope.

Cushing Yes or No?

Your head will spin.

Your first emergency!

I just hope that

The barn is quiet.

I’m on call tonight.

A colic arrives!

Adrenal over-drive!

I’m gonna wear my White Coat

And finally use my Stethoscope.

Clinics make me say Oh! Oh! Oh!

As I stay up writing SOAPS SOAPS SOAPS.

I’m gonna wear my White Coat

And do a Minimum Database

Chem CBC UA-A-A

I sure hope that they can Pay Pay Pay.

Boom! Boom! Boom!

Clients already in the room room room!

Pet needs a rectal where’s the lube lube lube?

And vaccines are over-due due due!

I’m gonna wear my White Coat

And finally use my Stethoscope.

Clinics make me say Oh! Oh! Oh!

As I stay up writing SOAPS SOAPS SOAPS.

I’m gonna wear my White Coat

And do a Minimum Database.

Chem CBC UA-A-A

I sure hope that they can Pay Pay Pay.

Boom! Boom! Boom!

Internal Med with Dr Sum Sum Sum.

Boom! Boom! Boom!

No more eating lunch at Noon Noon Noon!

Case Report

By Stephanie Silberstang                      

Cornell University

Signalment: Adult Short-eared owl, undetermined sex

            Case # 702287

Common reasons for presentation of Short-eared Owls include collisions with vehicles or flying into windows. SEO opportunistically inhabit areas with small mammals, they are ground nesting birds and are also vulnerable to attacks by predators. SEO have an endangered status by the Department of Environmental Conservation.

History and clinical presentation:

The owl presented to the Wildlife Health Center on 11/21/10 after it was found on the side of the road on 11/20/10. Physical examination revealed dehydration, a thin body condition (3/9), and an open fracture of the right humerus. A contaminated wound was also present. No other abnormalities were revealed.

Presenting problems:

Open transverse fracture of the right humerus

Dehydration

Thin body condition score (3/9)

Differential diagnoses for the thin body condition included inappetence due to a metabolic disturbance, inability to apprehend food, neoplasia in the gastrointestinal tract, pain, sepsis, weakness, parasites of the gastrointestinal tract, or an inability to find food due to adverse environmental conditions.

Triage plan

Subcutaneous fluids were administered to combat dehydration and promote cardiovascular stabiliy.

Enrofloxacin was administered to treat infections of gram positive and negative organisms. This antibiotic is concentration-dependent and does not treat for anaerobic organisms.

Clindamycin is a broad spectrum antibiotic administered to treat many anaerobes, gram positive aerobic cocci, Toxoplasma and other organisms.

Butorphanol is a partial opiate agonist/antagonist used as an analgesic in birds. The action of butorphanol is thought to occur primarily at kappa and sigma receptors, which is effective for birds because they have a majority of kappa receptors. This analgesic is more effective in birds than morphine which target mu receptors.

Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) administered to reduce inflammation and pain through its inhibition of cyclooxygenase, phospholipase A2, and inhibition of prostaglandin synthesis. Meloxicam is considered COX-2 preferential and should be used with care in a dehydrated animal due to the possibility of increased renal toxicity.

Diagnostic plan:

Complete blood count (CBC) and chemistry panel to determine overall health by observation of red and white blood cell morphology and relative counts, and the extent of inflammation.

Radiographs to determine the extent of the fracture and to reveal any other internal injuries the owl may have acquired.

Fecal evaluation to determine if certain internal parasites are present in the gastrointestinal tract.

The results of these tests provide initial evaluation of the owl’s status. In addition, they provide a data point for monitoring the animal over time. Blood work should be rechecked after treatment has had time to take effect to monitor for improvement or if no apparent improvement is observed. Radiographs should be repeated to check for bony callus formation that indicates proper healing of the fracture site. In birds, callus formation is expected after about 5 weeks, but a prolonged healing time is expected in open and contaminated fractures.

Results of the CBC showed a packed cell volume of 39% and a white blood cell count of 17,100/uL with 13,900/uL heterophils and no band heterophils. No toxic changes were observed. Results of the chemistry panel revealed an elevated uric acid of 16.1 mg/dL.

Results of the radiographs confirmed a mid-diaphyseal fracture of the right humerus.  

Isospora and Capillaria revealed on routine fecal examination

These results revealed a parasitic infection that was likely the primary cause of the Short-eared Owl’s thin body condition. Open mid-diaphyseal transverse fracture of the right humerus was confirmed.

Iatrogenic/Nosocomial problems:

Increased body condition score (~100 grams over average weight for female SEO)

Early signs of bumblefoot

Surgery:

This mid-diaphyseal humeral fracture was surgically repaired in an attempt to restore the owl’s ability to fly. An alternative way to manage this case would have been partial amputation of the right wing distal to the shoulder joint. This would have avoided the risks encountered in placing an IM pin including spreading infection throughout the medullary cavity and having open wounds that communicated with the medullary cavity where the ESF pins were placed. Disadvantages of this procedure would be that the owl would no longer be able to fly, although this may also be true with a repaired fracture. Prognoses for fracture repair can range from poor to excellent based on many factors. Factors such as open, comminuted, infected and fractures involving a joint decrease the prognosis. Factors such as closed, simple, aseptic fractures and fractures not involving the joint increase the prognosis. Humeral fractures in birds have a lower prognosis than in mammals because the humerus in birds is pneumatic and is in direct contact with the air sacs. If a fracture becomes infected which is common in open fractures the infection can spread into the air sacs causing air sacculitis, significantly decreasing the life expectancy of the bird. This airsacculitis can appear as a diffuse whitening of the coelomic cavity in the regions of the air sacs

Monitoring:

This owl was monitored by checking the bandage for discharge and inspecting the incision and fractures sites for any signs of infection or deterioration as should be performed with all surgical incisions . Because the humerus was repaired with an external skeletal fixation device and an intramedullary pin, inspection of the device for bending, breaking or displacement of the pins was done during routine bandage changes. The skin around the wound healed after about two weeks as was expected. This owl had an intramedullary pin that needed to be cut and removed which was performed about three weeks post-op. Radiographs are used to monitor bone healing. A bony callus is expected to be seen approximately three weeks post-op, however, this owl took longer to have a callus observed on radiographs. In addition, the radiographs also revealed poor coelomic detail with air sacculitis being the main concern. Antibiotics can be discontinued after the wound appears to be closed and healing well with no signs of infection.

References:

Plumb, Donald C. Plumb’s Veterinary Drug Handbook, 6^th Edition.  PharmaVet Inc. Stockholm, Wisconsin. 2008.

Cascades Raptor Center. “Resident Raptor- Short-eared Owl.” http://www.eraptors.org/rr_shortEaredOwl.htm. Eugene, Orgeon. 2011.

New York State Department of Environmental Conservation. http://www.dec.ny.gov/animals/7080.html.

Life as a Vet Student- Advice to the Class of 2015

By Jamie Zhen

Cornell University  

            Living at home my entire life and having the luxury of my parents preparing delicious meals for me every day, I had to face the biggest challenge going away to school and living on my own: the kitchen. The most I’ve done in the kitchen was boiling water, scrambling some eggs, and microwaving leftovers. As I transitioned to living on my own, I feared I would be living off of ramen and microwavable meals. However, I was fortunate to have two amazing roommates who were culinary experts and were willing to guide me and share some of their expertise. Without their help, my transition to living independently wouldn’t have gone as smoothly as it did.
            Half-way through into my first year of vet school, I received an early Christmas gift. After a calf handling lab, I contracted cryptosporidiosis, a few days before my final exam. Cryptosporidiosis is a disease transmitted via fecal-oral routes and causes diarrhea that lasts anywhere from a few days to 4 or more weeks. As a vet student, I was destined to contract this illness sooner or later. Rumors were that once you get it, you will become “immune” to it upon future exposures. I crossed my fingers and hope that this is true so that I can look on the bright side of this situation of having this illness at the worst time possible. Although it was a fairly effective weight-loss strategy, I highly don’t recommend it. Despite the nausea and frequent visits to the restroom, I was still able to make it to school to take my final exam. The first thing I did as I entered the exam room and found a seat, I took out my bottle of Gatorade and container of saltine crackers. I made it through that day without much trouble. This experience certainly made it to the number one spot on my most memorable parts of my first year of vet school.

            In spite of contracting a zoonotic disease and being forced to cook for myself, I really enjoyed my first year of vet school. I learned so much without even realizing it. When I pursued a summer externship at an animal hospital, I actually understood the veterinary medical jargon being used. All of the countless hours of drawing diagrams of canine and feline anatomy as well as diagrams of physiological processes popped back into my head as I watched the vets diagnose and treat their patients. My first year of professional school was an extremely rewarding educational experience in which I was given an opportunity for personal growth. Although I miss being a first year student, I am excited to see what my second year of veterinary school has in store for me.

Life as a Vet Student- your Vet School "family"

By Erica Burkland

 Cornell University

On May 9, 2011, with only one week and a rigorous two-day final exam remaining in my first year of vet school, I watched my beloved gelding sustain a catastrophic femoral fracture. One minute Calypso was cantering from one end of the paddock to the other as the sun began to set on the crisp spring evening, and the next he was laterally recumbent in the grass. The moment I saw his left hind leg crumble from beneath him midstride, before his 1450-pound body had even finished hitting the ground, I knew he would never get up again. I knew I would have to say goodbye to my best friend before the sun finished setting.        

The hour between that gut-wrenching moment and Calypso drawing his last breath is a blur. After my veterinarian, the first person I called after Calypso went down was Kaylan, a friend and classmate of mine. I knew I wasn’t going to be able to do this alone. She left her post in the library and rushed to the barn to be with me during Calypso’s final moments. By the time the veterinarian arrived, Calypso and I were surrounded by a small army of people, most of whom I knew barely or not at all. It didn’t take long for my veterinarian to determine that Calypso’s left femur was fractured beyond repair. Kaylan knelt beside me in the dirt at Calypso’s head as he was euthanized; just as quickly as he had collapsed less than an hour earlier, he was gone for good. Distraught, I said my final goodbyes and left with Kaylan, clutching Calypso’s muddy halter to my chest. By then the sun was long gone behind the horizon. 

In the wake of such an unexpected and profound loss, I could hardly begin to imagine how I would make it through final exams. Fortunately by that time in the school year, my circle of close friends had been firmly established, and it was this makeshift family that pulled me through the unbearably painful weeks that followed. The night Calypso was euthanized, they flocked to my apartment and sat with me as I sobbed through phone calls to all the people who knew and loved Calypso as I did – my parents, the girls back at home that I grew up riding with, and my trainer of fifteen years. Despite having 8am class the next day, my friends stayed until the early hours of the morning, until there was nothing left for me to do but attempt to sleep. Although most of them had only met Calypso once or twice, they knew how much I loved him and what a huge part of my life he had been. They knew that I had made time to see him every single day during my first year of vet school, even on days when there was a foot of snow on the ground and nights when I didn’t leave campus until 11pm. They knew that I had been juggling two part-time jobs on top of vet school so that I could afford to keep him on a student’s budget. They knew that I had often missed out on extracurricular and social activities during our first year because Calypso was always my first priority. They knew, perhaps better than I did initially, that losing him would be harder than anything I had experienced before.

During the first week after losing Calypso, my vet school family surrounded me with love and support, making themselves available at all hours of the day and night despite being in the throes of finals week. When all I wanted to do was lay in bed, they took me out to lunch to drink margaritas and celebrate my once-in-a-lifetime horse. When all the “studying” I could manage on my own consisted of staring blankly at my computer screen scrolling through seven years’ worth of photos of my life with Calypso, they helped me prepare for our final by laboriously reviewing material out loud as a group. When I couldn’t sleep, they took me on late night drives to the banks of Cayuga Lake, where we sat on swings beneath the moonlight and they held me as I cried. When I repeatedly second-guessed my decision to put Calypso down, they assured me that I had made the kindest, most selfless choice I could have. When I wanted to give up, they promised me that it would get better with time and that they would be there with me every step of the way. 

Now I’m beginning my second year of vet school, and Calypso has been gone for almost four months. Although life without him has gotten easier, I still miss him every day. My friends recently surprised me with a bracelet that they had custom made from a lock of Calypso’s tail; I’ve worn it every day since. Not only do I find peace in always having a part of him with me, but it also serves as a reminder of how fortunate I am to have found an incredible new family that will always be there for me.    

Summer Experiences

In the spirit of the holiday season- enjoy a wonderful piece about the importance of taking time for the non veterinary related things in life!

By Chelsea Mason

Virginia Maryland Regional College of Veterinary Medicine

This summer was one of the most exciting and memorable of my life.  I spent most of it travelling with my boyfriend and expanding my cultural horizons.  He is leaving for a seven month deployment in September, and it was our goal to do as many fun and interesting things as possible before he leaves.  We went to countless vineyards, farmers markets, fairs, and festivals.  We went blueberry and blackberry picking, tried some new restaurants, and even made up a few interesting recipes of our own.  Though we had a blast doing everything we could in our area, the most memorable experiences were the road-trips that we took.  In June, we drove to New York to fulfill my lifelong dream of seeing “Phantom of the Opera” on Broadway.  It was incredible! Before the show, we toured the whole city. We went to Times Square, Central Park, and even had lunch on the roof of the Met.  At the show, we felt almost like celebrities; dressed to impress and sitting in the front row.  Afterward, we went to a swank rooftop bar, and someone actually asked me “who are you wearing?”  It was an amazing experience that I will always remember.

Our next adventure took us to Asheville, North Carolina.  Asheville is high on my list of places to move after graduation, so I wanted to go get a feel for the area.  We got to experience Asheville’s culture by taking a walking food tour of the downtown area. What better way is there to learn about a city than walking around and eating?  The main purpose of the visit, however, was to visit a successful veterinary hospital in the area.  The doctors and staff that I visited with were very welcoming and accommodating.  I toured the clinic, went in an exam room, and observed an ultrasound.  They are a teaching hospital, so the doctor performing the ultrasound quizzed me on anatomy the entire time. Thankfully, I remembered a lot more than I thought I would.  I was very impressed with the hospital as a whole, and definitely found a place that I would like to do a clerkship my fourth year.

Our last road-trip took us to Washington, D.C. to see “Wicked” at the Kennedy Center.  That was quite the trip, to say the least.  What should have been a three hour drive took five because we were in bumper-to-bumper traffic the whole way.  We planned to have a picnic dinner by the reflecting pool once we arrived. Unfortunately, no one told us that the reflecting pool was under construction and was nothing but a large stretch of dirt.  We survived the 100 degree temperature long enough to see the Lincoln Memorial, then had to go to the theater drenched in sweat.  To most people, that probably sounds like a terrible day, but when we finally parked at the theater we just looked at each other and laughed hysterically.  The show was incredible, the best of any that we have seen so far. And luckily, the trip home was completely uneventful.

Though some might argue that I should have spent this summer doing more veterinary-related things, I wouldn’t trade the wonderful experiences that I had for anything.  I have the rest of my life to be a veterinarian and experience all there is to experience in that field.   So I chose to spend my summer exploring with my best friend, opening my eyes to the world around me, and making memories that will last a lifetime.  I have no regrets, and I would encourage all of my peers to do the same.