This month I attended an ultrasound conference held by Canon which focused on mitral regurgitation. I have learnt a lot of things in the conference such as the speed of regurgitation cannot be used to determine the severity of regurgitation. It can be misunderstood very easily thinking that the faster the regurgitation speed is, the severer the case is, but in reality it is often the opposite since the speed partly depends on how big the gap of the mitral valve is, so if the gap is bigger (i.e. more serious case), the speed of regurgitation will be slower since the pressure difference between the ventricle and the atrium is smaller. So in more serious cases, the regurgitation speed is often slower. Also, septum movement should also be taken note of, because if a lot of blood rush back to the ventricle, it will expand and causing the septum to fibrillate, which is an evidence of more serious mitral regurgitation. Moreover, I learnt about measuring proBNP to determine the heart condition in cats during my summer internship, and in this conference, I learnt that ANP is a better measurement than proBNP. BNP is secreted by the ventricle and has a high species specificity, so the test kits is species specific. But if you want to measure the atrium condition to determine the risk of mitral regurgitation, ANP is a better choice because it is secreted by the atrium, and its species specificity is very low so that you can use human laboratory kits to test dog/cat ANP.
As for my hospital internship, I observed a tympanic bulla surgery which took 4 hours to complete. It was a cat having signs of fluid in the tympanic bulla after CT scanning, so the doctor need to approach the bulla ventrally and drill a hole to drain the fluid/pus. The doctor thought the surgery would be completed quickly because there were only a few steps and was relatively simple in the videos he watched beforehand regarding this surgery. However it was a strenuous task because there are a lot of muscle layers ventral to the tympanic bulla and also a lot of important structures are present such as the jugular vein and artery, the salivary glands and different nerves. In the end it took 3 hours in order to reach the tympanic bulla and after that the surgery was completed quickly. Being a surgeon is even more difficult than being an internist because even if you were well prepared for a surgery, you can never predict what would happen during the course and you can only improvise base on your knowledge and experience, while being an internist you have more time to think and make plans and most cases the complications can be controlled and reduced by reducing the drug dose.
I have been learning from my tutor at the wildlife clinic in December period. As I have worked alongside my tutor over the semester, he decided to let me try out some consultation. Had to record client’s information then passed on the data to my tutor. I had a rabbit patient for my first consultation, apart from some clinical symptoms, feeding habit, environment are some of the most important thing to note down. However, I missed out on its sterilisation history as it is an essential part during canine and feline consultation, because this process is related to risks of some diseases.
My second patient was a duck and there is a great difference compared to consultation with cats. For instance, we should take note of their duration on water as well as their enclosures. That day gave me some valuable experiences as I will never forget the sterilisation part and some of the essential details during water bird consultation.
During my large animal surgical class, the lecturer used the skull of a horse to demonstrate equine dental surgery. In addition, he demonstrated procedures on bovine tumour and fistula-in-ano. This process requires a cut into the stomach tumour, and install a tube into it, allowing the vet to check the stomach content directly in future checkups, or extraction of gastric fluid secretion in urgent cases.
Then the second half of December is all exam preps for the upcoming January exams.