Mast Cell Tumors

I found a mass on my dog Zella. She is 4 years old, a border collie lab mix, and I feel like she is way too young to be developing masses. When I felt it, it was very mobile but a little hard and was located just above the shoulder. In my heart I was wishing that it was just a lipoma which is a fat deposit but I knew that it felt a little too hard to be fat so I took her to the vet. One fine needle aspirate later and we discovered mast cells. It was a tumor, mast cell tumor to be exact. Usually they are found growing in the skin but she had it in her subcutis which is why it was so mobile (I also found out from a vet at work that there is a much better prognosis with SQ mast cell tumors in comparison to skin tumors which tend to have a lot of systematic effects). So it had to go, I can’t leave cancer in her just waiting to spread. Her mass was about the size of a bouncy ball but we had to take out the cancerous tissue and healthy tissue on all sides to make sure we got all of the tumor out. In the end, she had a pretty decent chunk of her tissue removed. They also used a CO2 laser in the surgery which simultaneously cuts and cauterizes any blood vessels. It is less traumatic to the tissue that is left behind so it allows the body to heal faster. The images below show pictures of her mass that we removed, the surgery in progress, and post-surgery. Some of them may be a little gross so feel free to just scroll past and not look too closely.

A week later we had it out and sent to the veterinary school for a histopathology report. It was a grade 2 mast cell tumor (1 is very benign and 3 is very malignant), 0-1 on the mitotic scale meaning it is slow growing, and it had good margins so it appeared we got it all out. The vet wants me to get an abdominal ultrasound done to make sure that it hasn’t spread to the liver or the spleen but it keeps getting pushed off due to financial burdens. The same day that I got her back from the vet she scratched out 3 sutures. We went back and got the wound debrided (freshens up each edge of the incision to allow for it to heal together easier) and sutured back up. That was about $200 on top of her $600 surgery. 3 days later she pulled out another suture but the vet said we could heal it by secondary intention (leaving it open to heal) which was such a relief as this is eating into my savings. Of course, 2 days later she pulls out 2 more and it is oozing everywhere. So now we are at today and she is currently at the vet. Turns out she has a pretty bad infection that formed that created dead space in her subcutaneous region causing the SQ suture layer to pop and is why her incision was having so much trouble closing. We thought the inch on each edge of the incision was healing well but when they went to replace those sutures, the wound popped open meaning it wasn’t healing at all. Long story short, mast cell tumors like to secrete histamine which prevents blood clotting/flow to the area making it really hard for the body to heal and prevent infection. The vet assured me that both Zella and I were doing everything right (other than her scratching but she doesn’t think that caused the infection) and that it wasn’t our fault that the incision wasn’t healing as we hoped. She ended up having to pull the remaining sutures, debride the incision, flush out the incision really well, and re-suture it closed. Now we are at another $200 for re-suturing, $95 to send in a swab of the incision to culture the bacteria in order to find out what it is to treat, and about $100 for antibiotics. Now she is  on pain meds, two types of antibiotics, benadryl, and a twice a day dilute Nolvasan flush. Her post-surgical care is about to cost just as much as her surgery and we are still going with it.

You are probably wondering why I didn’t just put a cone on her to stop her from removing her sutures. God I wish I could just put a cone on her. Unfortunately her incision is just above her shoulder and below her neck so a cone would sit too high. She is also scratching it with her back leg and not chewing on it (she can’t reach that part of her shoulder wit her mouth) so a cone wouldn’t help anyways. After she pulled them out the first time, I started putting t-shirts on her to hide them and a sock on her foot to pad her nails.

She is really good at getting the sock off and becoming a ninja to scratch at her incision. She lulls me into a sense of security by not bothering it for 36 hours and then, the one time I turn my back, takes a swipe at it and pulls them out. The picture above shows her modeling her new t-shirt, which I honestly think she loves wearing, and her passed out on the couch arm-rest due to her pain meds.

Needless to say, her ultrasound might not be happening for awhile….

 

Summer, Finally.

Sorry I haven’t posted anything in a LONG time. It has been a roller coaster of a semester for me. Good news is that I got engaged to the man I love and I passed my first year of vet school! Bad news, I ended up having a very difficult conversation with my fiance in which he had to explain why he was ending our relationship. It was pretty tough. I hold no animosity towards him though as I couldn’t possibly blame someone for not loving me as much as I love them. That just wouldn’t make sense.

But, now it is summer time and I have definitely been kept busy with my jobs. A lot of my co-workers left for the summer so I have been on multiple on-call shifts for my emergency surgical assistant job and it has been busy. I have already seen multiple foreign bodies, hemilaminectomies, septic abdomens, Achilles tendon repair, lacerations due to one dog attacking another dog, and pyometras. My boss also has me training new workers which is crazy because I feel like I don’t even know what I am doing. I also picked up a part time job working as the student worker for the Shelter Medicine program at my school. Basically all I do is clean, pack, and sterilize the instruments used for spays/neuters. Another plus for it being summer is that  I actually have time to clean everything. It is surprising how dirty the house can get during exams when you spend only a few hours at home each day.

That is pretty much all I have to say for now, until next time!

Year 1.3

So far this quarter has proven to be very challenging. We have been learning cardiovascular, respiratory, and GI physiology. The midterm had twice as many lectures for physio than our normal exams usually would have and I can definitely say the physiology is my most challenging course. But, in a week and a half is my final and then I will be done with this quarter and on to the new stuff.

I can positively say that I know almost nothing about horses. I am taking a equine husbandry and medicine elective this quarter, affectionately dubbed ‘horse course’, and I am beginning to realize how little I know about these guys. It’s hard to believe that, by the end of my four years, I will need to know everything about every animal. I’ll definitely be taking more equine courses in the future.

Currently, I am struggling to find something to do over the summer. I have my job as a surgical assistant but that is only, at most, twice a week. I keep telling myself that I will be fine if I don’t have another job over the summer but it will be nice to make some spending money and possibly make enough so I don’t have to take out as much in loans for the next year. So far I have applied for a Banfield hospital vet assistant job/mentorship, a job on a local petting farm, an internship with the Wildlife Medical Clinic, and the summer research program with my college. I am really hoping I get the summer research as it pays pretty well and will really help me in the long run. I am considering apply to some more jobs just in case none of these pan out, but I might wait a little bit longer before I do that as a lot of businesses and such wait until last minute to put out job postings.

On an unrelated note, I have been noticing a lot of bullying between all four classes. On a day to day basis it really is rare, but when I think back from to it from day one, it feels like it is way more than it should be. I am trying my best to be as nice as I can be with my peers but I don’t feel like it is enough. I feel like I should be speaking out when I see it but I am just not very confrontational and I don’t want to put a target on my back. I’m also positive that they will just say that they are only having some fun and that so-and-so doesn’t care. And they probably really believe that because on the surface they aren’t saying anything that bad, but I know the person on the receiving end isn’t comfortable.

Also… I am going to Colorado over Spring Break! I am so friggin’ excited! Colorado is my dream state. The plan is to stay in multiple cities over the break to go snowboarding, hiking, and visit the Denver Zoo. I cannot wait.

Sloths & Manatees, Vertebral Outcasts

Fun fact time!

It is a rule of thumb that nearly all mammals have the same number of cervical vertebrae (7) regardless if it is a giraffe, mouse, or human. However, sloths and manatees are the exception to this rule.

Two-toed sloths have 5-7

Three-toed sloths have 8-9

Manatees have 6

Alright, back to studying!

Year 1 Part 2

Tomorrow marks the first day of the spring semester. Last semester was one quarter in classes and the other quarter in clinical rotations. This semester however, is two straight quarters in classes until summer break. 4 quizzes, 2 midterms, and 2 finals left until my first year is officially complete and I will be 1/4 of a doctor. It is all still very exciting to be honest. My classes for this quarter are histology and the lab, gross anatomy and the lab, physiology, neurobiology, clinical correlations, intro to food supply medicine, and equine medicine and husbandry.

So, updates on everything. I STILL can’t say anything about the bobcat that is in our care right now as it is still with us for recovery form it’s surgery. I can tell you that it is healing well and we are hoping to send her to a rehab soon. I also ended up getting a job. Yup. I told myself that I wasn’t going to get a job during the school year while I was in vet school but my workaholic-side kicked in sooner than expected and I caved. BUT, I got a job as an emergency on-call surgical assistant. Basically, I am on-call one evening during the week and one shift during the weekend (Each shift is 12 hours). So it really isn’t that big of a commitment and it will help me network with the small animal surgery people, my technical skills, and my general anatomy/surgery skills. I applied for the summer student job program with Banfield and was offered an interview that is happening tomorrow. I am on the fence about doing this program because I’ve heard good and bad things about it depending on the location, so we’ll see.

Farms Rotation

Last week I had my farms rotation, which is my second to last rotation of this year. It has been such a great break from sitting in lecture halls for hours on end and slaving over cadavers in the anatomy lab.

So here are a couple things that I have learned in this rotation:

1. Drawing blood from jugular veins in sheep
2. Drawing blood from tail vein in cattle
3. Auscultations (listening with stethoscope), percussion (pinging certain structures), and succussion (palpating an area while listening with a stethoscope)
4. Stages of parturition
   1. Restless nesting behavior, cervical dilation, myometrial contractions (can last anywhere from 1hr-12hrs)
   2. Ferguson’s reflex (contractions initiated by fetus in the birthing canal), myometrial AND abdominal contractions, straining reflux (if not in stage 2, vaginal palpation shouldn’t cause any straining) (can least 30min small ruminants, up to an hour in cows)
   3. Expulsion of all fetal membranes (time varies, if it takes more than an hour in a horse then it is an emergency but is considered normal if it happens in a cow).
5. I was able to observe a pig blood transfusion
   1. I also learned that pigs are ulcer machines if they get stressed or are off feed.
6. There were many cattle that came in with a displaced abomasum (DA) which is when there is torsion to the left or right of the abomasum disrupting normal gastrointestinal function
7. Any surgery that enters the gastrointestinal tract is considered automatically a ‘dirty’ surgery, meaning not sterile.
   1. There was a bull that presented as ‘aint doing right’ and off-feed. Physical exam showed a ping on both the left and right abdomen indicating gas
   2. A blood pH was taken showing alkalemic blood (basic), low in Cl-.
      1. This indicates that the abomasum ( the true stomach of bovines) was not producing hydrochloric acid as it should be or that it was getting diluted due to fluid build-up. If it was an intestinal problem, we would see the blood pH as acidic as there would be a loss in bicarbonate in the gut (a basic chemical that neutralizes the hydrochloric acid leaving the abomasum)
   3. The vets elected to go straight to surgery and found a compacted feed blockage in the pyloric sphincter exiting the abomasum. They went in, removed the feed, and closed him up.
   4. The bull was given fluids and was eating normally again that night.
8. Bulls usually present lameness in the front feet (due to increased muscle/mass in the cranial half of their body) and cows usually present lameness in their hind feet.
   1. Lameness could be due to an abscess/ulcer, overgrowth, corkscrew claw were the hoof wall grows into a spiral, and really pretty much anything else that can damage the feet.

Sorry that this post was kind of all over the place and didn’t have much purpose. I just wanted to get something posted. If you have any questions about anything in my posts that you want me to expand on feel free to ask, it’ll honestly help me study. Also, I know I promised to tell you all about the bobcat that my wildlife team is treating but I am still wanting to hold out until it is released to a rehab center before I post anything

Imaging Fun

I am on imaging this week and so far it has been fantastic (granted it is only Monday but it gives me high hopes for the days to come). Today we discussed a case that happened a few years ago concerning a Boston terrier. Boston terriers are predisposed to peritoneal-pericardial diaphragmatic hernia (PPDH). I know that is a huge scary word but it is really quite simple. Most people think of hernias in the abdomen (result of a weakening if the abdominal walls/muscles that allows a loop of intestines to slip out) and diaphragmatic hernias are very similar to that but it is when there is some sort of penetration of the diaphragm allowing the guts to slip through into the chest cavity. Now, PPDH is when the contents slip through the diaphragm and into the pericardial sac (the tissue covering the heart). This was actually an incidental finding, she came in due to concerns of dribbling urine. You would think that this would be a major problem, but it is actually a congenital issue found in some Boston terriers and they can live full lives with it. The main cause for surgical intervention is if something that expands were in the sac (i.e. stomach). The symptom for this would not be from the heart but from difficulty breathing due to pressure on lungs.

Now time for pictures, yay! All names and information has been removed for confidentiality.

This image below shows a chest radiograph of what would be normal to see. The line separating the lungs and the liver/stomach would be the diaphragm. Since the patient is a Boston terrier, all of the organs will be slightly closer together but this gives you a good idea of what you should be seeing.

Now the images below are of the PPDH patient. You don’t have to be a radiograph-reading wiz to tell that something just isn’t right about this. The lung fields are small or missing (most of the lobes were actually collapsed), the heart is practically indiscernible, there are what appears to be loops where the heart is (shown by the darkened spaces which could be gas in the intestinal tract), and it is impossible to tell the entire length of where the diaphragm is.

So now you are probably wondering, or have forgotten more likely, about what happened with the urine dribbling issues. She was found to have bilateral ectopic ureters. The ureters are the tubes that bring the urine from the kidneys to the bladder and ectopic means that they are traveling to somewhere other than the bladder. This can be a not-too-uncommon cause of urinary incontinence in young dogs.

This pooch did have surgical intervention to restore all gut contents to their proper place and the ureters were placed back to their rightful place to the bladder.

 

That is all I have for you today but keep an eye out for future post where I discuss the bobcat my wildlife team is taking care of. I don’t want to make a post on it yet until we have a better idea of the prognosis and treatment timeline. We were also instructed to not post anything about it on the internet until future notice as it is a great PR opportunity that will garner a lot of attention and the managers wish to be the only ones currently putting out information so that it can be the most correct information. Hopefully we can get some funding in to help pay for the relatively expensive surgery it will need to be released into the wild.

Also, I am getting another dog. A ~4yr old great dane. This puts my pet count to 3 ferrets, 2 guinea pigs, and 3 dogs (I have issues haha). Here are some pictures of Buddy ft. Zella my border collie/lab mutt.

Rotation Vacation

The past 2 weeks have been pretty great. My rotations were shelter medicine and small animal internal medicine. For shelter med, I basically acted as a surgical assistant for sterilization clinics. Our school has a mobile surgical unit that allows us to go to surrounding shelters and offer low cost spay and neuters. I was actually allowed to perform a few kitten neuters. It was amazing.

Last week I was on internal medicine where I was paired with a 4th year and got to see ultrasounds, radiographs, slide staining, barium series tests, fine needle aspirates of masses and livers, and a whole lot more. It was a very busy week and I learned a lot more than I could have hoped. We had a patient with an unexplained fever (still not sure what it was but it spontaneously resolved), a patient with non-regenerative anemia in which we performed a bone marrow biopsy and cytology, a patient with diabetes complicated by diabetic ketoacidosis, and so much more.

This week I am on my dentistry rotation and it is only day one but I have already practiced simple extractions and surgical extractions on a canine tooth and the 1st and 2nd premolar.

In the wildlife clinic I have been helping take care of our red-tailed hawk (yes the same one as before that we have had all school year but it is in the works to be transferred to a zoo) and a turkey vulture. Let me tell you a thing or two about turkey vultures, they are messy and smell god-awful. The turkey vulture was transferred to the IRC today to finish rehabilitating with the ultimate goal of release back into the wild.

In non-school related news, I had an interview today for a job as an on-call emergency surgical assistant. Which is at the veterinary teaching hospital so I suppose technically it is school related except it’s a job and not a class. I feel like it went well but we shall see. 4 people interviewed and 3 positions are open so my chances are good. If I could get this job I will be a happy camper. It is only 2 on-call shifts from 6pm-6am so it would not interfere with my classes or my studying but still provides me with some sort of income.

Long story short, vet school is the hardest thing I have ever done but I am loving it.

Post Finals

Last Friday we finally received our scores from both final exams and the palpation quiz and I must say I am extremely happy with both of the grades. I put many hours into studying for it and I am glad it has actually paid off (who’da thunk). After my day 1 final, I felt pretty confident in how I did but I definitely felt like I was lacking in the histology/imaging section (spoiler alert: I only missed 2 out of 50!). Let’s just say that I did not feel confident after my Day 2 final. All together there was only about 50 questions and the first person finished about an hour in and nearly everyone else at the 2 hour mark. I probably left 5 minutes before time was up. I walked out of the testing room and felt thoroughly wrecked by the exam. However, I apparently used my critical thinking skills very well (or I over-estimated what they wanted on the exam and was too hard on myself) because I got a pretty decent grade! Overall I did much better on my final than my midterm. Long story short, I am in good standing with the school after my first quarter!

Now I am in the second quarter of the semester which consists of our clinical rotations and is so much more relaxed than the first quarter. I have actually had time to go workout and actually make a balanced meal *gasp*. My first rotation was surgical skills in which we learned suture patterns, types of suture material, commonly used surgical instruments, dehorning/castrating methods and instruments, surgical prep, and sterile techniques (i.e how to scrub in and gown for a surgery). I’m pretty glad that I had this rotation first because it provides me with a good base knowledge that I can apply to my 7 other rotations. This past week I just finished my equine medicine and surgery rotation. I’m pretty pleased with how this rotation turned out since I didn’t know what to expect as my horse experience is pretty limited. I got to observe enucleation (removal of the eye) surgeries, arthroscopy (visualization of the joint spaces) surgery, and a debulking/exploratory surgery on a horse with a large mass on it’s head. I also got to see radiographs taken, ultrasounds on an eye and thorax, and countless of other general medicine practices. Unfortunately I cannot tell you much or show you any pictures to keep client confidentiality but you can just believe me when I say it was cool. I honestly cannot stress enough how beneficial it is to have clinical rotations starting your first year in vet school. Other vet schools don’t have any sort of real clinical experiences until the fourth year which is a year of clinical rotations. I could honestly say that this will allow me to be much more comfortable and confident during my fourth year.

On an unrelated topic, I have been extremely spoiled in how much I get to see my man. I had plans to see him last weekend which fell through but he was able to finagle it so that he could visit for a night while he was passing through. Plus I got to see him this weekend as a reschedule from last weekend and I will get to see him next weekend also since he has a job interview on Friday (I’m so proud of him!). Then it i just the wait until Thanksgiving break where I will get to see him for a week. I never would have imagined that I would get to be with him this much during our long-distance semester. Of course the visits always seem to pass too quickly but I really can’t complain as some of my peers in long-distance will only get to see their significant others over breaks for the next four years. I really am a lucky gal.

Exams, Palpations, and Great Horned Owls, Oh My..

I am so tired. It’s insane how tired I am. I have been having extremely long days of studying pretty much since the midterm. Oh, good news about that, I actually did very well! I’m pretty proud of myself. I also got a good grade on my palpation quiz of the forelimb of the horse (I had to palpate things like muscle bodies, specific parts of bones, nerves, vessels etc). So a little bit more of post-midterm information about my life. My man (and his dog Zella!) was able to come visit for a weekend. It was such a nice break from vet school. We went out to eat a lot, probably more than we could afford, and we picked apples at the local apple orchard as well as went to the movies with some of my vet friends. We also relaxed a lot and I, being the tired vet student I am, kept falling asleep on the couch. Oh! Last weekend I went paint-balling for the first time! It really hurts getting shot, I got some pretty neat bruises and welts from that. I could hardly handle the fear of getting hit by a paintball, I couldn’t even begin to fathom how soldiers must feel in war. Definitely makes you appreciate everything they do for you so that you don’t have to worry about that. Since then, I have done pretty much nothing but study. It’s pretty rare for me to be out of the vet school before 10 pm and I have been trying to work on not feeling guilty anytime I am doing anything other than studying. It’s not healthy to be constantly studying and I have to pretty much force myself to take time everyday just for me. Which is probably why I am still up at 2 am doing this… Anyways, Monday I will be having my second palpation quiz, this time on the equine hind-limb and this coming Thursday and Friday will be my final exams. It will be a bit different than the midterm, which was only one day of exams. The Thursday exam will be just like the midterm (3 hour exam over core classes, 1 hour anatomy practical) and the Friday exam will be integrated. This means that the professors will come up with questions that will incorporate information from other subjects. I.e. if there is nerve damage in this limb, how do you test if it is motor damage or sensory damage, what is physiologically happening to the muscles, and how do you determine what spinal cord segment is affected? That sort of question would test my knowledge of both anatomy (know what muscles are innervated by what nerves and what spinal cord segment contains those nerves) as well as neurobiology (using reflex, superficial pain, deep pain, and other neuronal tests). Or it could be a question such as an animal has these endocrinological symptoms, how would this effect neuronal development and what could it physiologically do to the body (testing my endocrinology, physiology, anatomy, and neurobiology knowledge). It will definitely be interesting to see how well I can connect the subjects we are learning.

In the Wildlife Clinic I have tube fed my first baby bunny, syringe fed baby squirrels, and we have been working on a Great Horned Owl that we got about 2 weeks ago. He came in sternally recumbent (laying on his sternum), anisoscoria (different size pupils), dyscoria (abnormally shaped pupil), leukocytosis (indicative of infection), and a proprioception deficit in his right wing (doesn’t quick have a grasp on where his wing is in time and space). When we took radiographs (where we observed no soft-tissue or skeletal abnormalities) we actually found a microchip! That was a surprise. We called all of the microchip companies but it isn’t registered anywhere so we will just have to wait and see what happens with that. We got an optho consult for his eyes and it was determined that he had a retinal detachment in his anisoscoria/dyscoria eye which he will never be able to see out of and minor inflammation in his left eye. We have been giving him eye drops for the past week and his eyes look a lot better. I will post a picture at the end of this of how his eyes look, unfortunately I don’t have a before picture and only a picture of about a week in of eye drops but you can still appreciate the odd shape of his pupil. Owls will have no problem surviving in the wild with one eye, so pretty much as long as we can figure out what is up with his wing we will be able to release him.

Below is the picture of the owl, you can see his left pupil has a slight indentation to it on the lateral side. He is such an amazing creature. (I am using the pronoun ‘he’ but we don’t actually know the sex).

Oh, and the red tailed hawk that my team has is still with us but is doing perfectly fine. We moved her to a flight cage so that she is more comfortable and we are currently trying to find her a permanent home with human caretakers as we have determined her un-releasable as she is glove trained (meaning she has been taken care of by humans previously). We have a falconer interested in her but she isn’t the greatest at finding her food, so I am not sure if she will pass their hunting test. But we will just have to wait and see.

I think I am going to end this post here. If you have anything specific you would like me to talk about, regardless if it is about vet school or not, go ahead and send me a message! I think it could be fun to post about specific questions you guys have.

I will go ahead and leave you with one piece of information that I have learned today: Glucocorticoids (stress hormones) can increase the sensitivity of catecholamine (fight or flight) receptors in the vessels, increase sodium uptake, inhibit aldosterone (which is a hormone that maintains water balance), and increase the output of neutrophils into the peripheral vessels but decreases their ability to migrate to the tissues to provide their action.