January by vetreview

03 January 2021 ve t-review.com

VE T R E V I E W FROM VETERINARIANS TO VETERINARIANS

V E T REVIEW

Our mission is to provide togetherness and connection through open and authentic conversations!

Fol l ow us o n s o c i a l m e d i a

Foreign body penetrated spinal cord

Low birth weight leads to obesity in adulthood

Interview with Myra Tabet

Bone grafts

Interview with Nicole Allison

Ostheoarthritis consultations

24 Interview with Nuno Lobo

Mineralized thrombus

6 Gastric instability vs gastric dilatation

7 Vitamin D and gallblader mucocele

13 Veterinarian or an economist?

14 Chest ultrasonography

22 THC:CBD dosing

Cats and IV fluids

30 When surgery is an art

32 Interview with Jessica Hirsch

For advertising enquiries: info@vet-review.com Publishers accept no responsibility for the claims and opinions made by advertisers, manufacturers or contributors. All rights reserved. ISSN 2669-2376 Cover image courtesy: Elles Rijsdijk/stock.adobe.com

Ho w fo re ig n b o d y p e ne trate d s p ina l c o rd

Few cats have developed tetraparesis when wooden chopsticks penetrated the atlantooccipital space transoraly. In two cats foreign bodies were successfully removed via cranio-cervical ventral midline incision. (A) A small hole was found in the soft palate. (B) A linear radiolucent area (arrowhead) was found in soft tissues dorsal to the atlantooccipital joint. (C) A hypodense linear object penetrated the spinal cord. (D) CT imaging with the soft-tissue setting. (E) CT imaging with the bone window setting. A linear low-attenuation area penetrated the vertebral canal. (F) The fragment of the chopstick removed from the oral cavity.

Y,REVIEW Nozue Y, Nakata K, Fujioka T, Sakai Y and Kamishina H (2020) Case Report: Transoral 4 Nakano VET Penetrating Medullocervical Injury by a Chopstick in Three Cats. Front. Vet. Sci. 7:609869.

L o w b ir th w e ig ht le a d s to o b e s it y at a d ultho o d It is true for humans1, pigs2, mice3, guinea pigs4 and Labradors5. It was found that 70% dogs with low birth weight became overweight later in life. It is believed that when the energy supply is restricted, the offspring develop metabolic changes that increase nutritional efficiency and predispose to overweight in later life. Such adaptations promote survival. Early management of these predisposed puppies could help to reduce the prevalence of overweight in dogs.

1 - Fowden AL, Giussani DA, Forhead AJ. Intrauterine programming of physiological systems: causes and consequences. Physiology. 2006;21(1):29–37. pmid:16443820 2 - Gondret F, Lefaucheur L, Juin H, Louveau I, Lebret B. Low birth weight is associated with enlarged muscle fiber area and impaired meat tenderness of the longissimus muscle in pigs. J Anim Sci. 2006;84(1):93–103. pmid:16361495 3 - Beauchamp B, Ghosh S, Dysart MW, Kanaan GN, Chu A, Blais A, et al. Low birth weight is associated with adiposity, impaired skeletal muscle energetics and weight loss resistance in mice. Int J Obes. 2015;39(4):702–711. pmid:25091727 4 - Sarr O, Thompson JA, Zhao L, Lee T-Y, Regnault TRH. Low birth weight male guinea pig offspring display increased visceral adiposity in early adulthood. PLoS ONE. 2014;9(6). 5 - Mugnier A, Morin A, Cellard F, Devaux L, Delmas M, Adib-Lesaux A, et al. (2020) Association between birth weight and risk of overweight at adulthood in Labrador dogs. PLoS ONE 15(12): e0243820.

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D o not m is ta k e g a s tric ins ta b ilit y w ith g a s tric d ilatatio n a nd v o lv ulus White, C., Dirrig, H. and Fitzgerald, E. (2020), CT findings in dogs with gastric malposition: 6 cases (2016-2019). J Small Anim Pract, 61: 766-771.

Gastric dilatation and volvulus is a

Gastric malposition may be detected as

life-threatening condition, whereas dogs

an incidental finding on CT and,

with chronic gastric instability often have

although, gastropexy may benefit these

less severe clinical signs. As a result, dogs

patients, the identification of gastric

with gastric dilatation and volvulus

malposition does not necessarily warrant

require emergency surgical management,

immediate surgical intervention.

and dogs with gastric instability typically

Awareness that a malpositioned stomach

do not1. Because most dogs with gastric

on CT may be an incidental finding may

instability have chronic gastrointestinal

also prevent deflection from the more

signs.

current issue of the patient.

For dogs with gastric instability the

CT findings for gastric instability are the

position of the stomach may change even

same: the pylorus is in the left cranial

during hospitalization. Dynamic gastric

abdomen and the dorsal aspect of the

position (when stomach intermittently

spleen occupies an atypical ventral

assumes an abnormal position) may

position.

explain the intermittent and chronic clinical signs.

1 - Paris, J. K., Yool, D. A., Reed, A. E., et al. (2011) Chronic gastric instability and presumed incomplete volvulus in dogs. Journal of Small Animal Practice 52, 651-655 V E T REVIEW

V ita m in D a nd g a llb la d d e r m uc o c e le Jaffey JA, Matheson J, Shumway K, Pacholec C, Ullal T, Van den Bossche L, et al. (2020) Serum 25-hydroxyvitamin D concentrations in dogs with gallbladder mucocele. PLoS ONE 15(12): e0244102.

Dogs with gallbladder mucocele have lower vitamin D concentrations. In addition, decreasing vitamin D concentrations, but not clinical status, was associated with a more advanced ultrasonographic gallbladder mucocele type. Decreased vitamin D concentrations might have a causal role in the gallbladder

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SasaStock/stock.adobe.com

formation.

DVM Dr. Myra Tabet from Lebanon

Please tell your path to veterinary

ones I save, mostly, and the ones I make

medicine.

a big impact on the quality of their life. It isn't always easy but you should always

My journey began at 8 years of age when

look at the bigger picture and the good

I got my first dog and we immediately

impact that you are making.

became best friends. It was my childhood

I get easily irritated by ungrateful, greedy

dream to become a vet and help furry

clients; those who get a puppy or a kit-

friends as much as I can. I earned a BS in

ten for their kids and then do not want to

veterinary sciences in American Univer-

take care of him, do not want to pay for

sity of Beirut and went on to earn a DVM

his health and, especially, do not want to

in Szent Istvan University in Budapest. I

make any effort for their pet. It frustrates

recently got my PhD in Holy Spirit Uni-

me, but, thankfully, lately there is now a

versity of Kaslik. I worked for 4 years in

law that protects pets!

a well-renowned hospital in Lebanon. I have opened my clinic Dr Paw 2 years ago

Once you wrote that you are “recovering

how

and have been doing my own practice

perfectionist”. Most veterinarians would

lot of

ever since.

relate. What helps you to get back on the

able

balance?

I acce

be pe

Where you get your inspiration? What keeps you going? And, on the contrary,

As a vet you can become obsessed with

of my

what irritates you the most?

saving pets and being available for them

invol

ALL THE TIME! Well, that didn't end well

allow

for me, since I had a burnout and learned

ing"

I get my inspiration from my patients; the

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”I accepted that I cannot be perfect all the time.”

to put healthy boundaries. Through a

f hard work and introspection, I was to have a balance and moderation.

epted that I am human and cannot

erfect all the time. I am highly critical

yself and overcoming perfectionism

lved practicing more self-talk. It also

wed me to get rid of the "all or nothand I learned to lower my standards.

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What biggest problems regarding pets you see in Lebanon? And what tendencies are changing or will change soon? Biggest problem that we are facing in Lebanon and abroad is the "puppy pandemic". Because of COVID-19 a lot of people are getting pets without being fully aware of the commitment it brings. So, we are faced with puppies and kittens being abandoned and left on the streets. We are currently trying to raise awareness on the subject; I even did a live on instagram to explain to people in details what it means to take on board a new pup.

Follow Myra Tabet on instagram

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Do n o t m i s s the n e x t is s u e by su b s c r i b i n g to o u r news l e t t e r a t vet-re v i e w . c o m

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Bone grafts P ro m is ing b io mate ria l fro m s ha rk te e ths The autograft is still considered the gold

dation time in dogs with fractures and ar-

standard for the treatment of bone defects.

throdesis. In addition, no adverse systemic

However, given the significant morbidity of

or local reactions have been observed.

the donor site with which it has been

This biomaterial is also environmentally

associated, alternative substitutes for bone

friendly; because it is a natural product,

grafts have been developed.

gives value to fish waste, and reduces the

In one study1, a bone substitute composed

risk of disease transmission, as it comes

of CaP biphasic bioceramics obtained from

from a species phylogenetically far from our

shark teeths was used (BIOFAST-VET).

domestic species.

The use of this biomaterial reduces consoli-

Biomaterial vial (A), biomaterial granules (B), preparation of the biomaterial mixture with autologous blood (C).

García-González M, Muñoz Guzón FM, González-Cantalapiedra A, González-Fernández PM, Otero Pérez R and Serra Rodríguez JA (2020) Application of Shark Teeth–Derived Bioapatites as a Bone Substitute V E T REVIEW in Veterinary Orthopedics. Preliminary Clinical Trial in Dogs and Cats. Front. Vet. Sci. 7:574017.

Veterinarian or an economist?

Christian Durnberger highlighted moral

Veterinary profession is not anymore

challenges and conflicts between different

triangular (animal, owner, veterinarian). C.

roles veterinarians maneuver. Animal

Durnberger defines it as a “triangle within a

patients, animal owners, professional obli-

square”. Politics and its legal requirements,

gations and society as a whole all comprise

society and its expectations, other individu-

high demands from veterinarians.

al veterinarians in different roles (like

Described dilemmas apply not only for farm

colleagues, supervisors, employees and

veterinarians but also for small animal

competitors) as well as veterinary offices

practitioners. Extremely limited financial

also shape veterinarians' scope of action.

scope of animal owners could be the key

It may be that being an economist in veteri-

burden to provoke a feeling of powerless-

nary profession leads to emotional exhaus-

ness.

tion, depression and burnout.

Christian Durnberger. Am I actually a veterinarian or an economist? Understanding the moral challenges for farm veterinarians in Germany on the basis of a qualitative online survey. Research in Veterinary Science. V133, p 246-250. 2020

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C he s t ultra s o no g ra p hy Ne o p la s ia o r p ne um o nia? One of the most difficult things in thorax ultrasonography is to tell pneumonia from neoplasia. Although we can not rely solely on the chest ultrasonography to make final diagnosis, some characteristics could help predict the etiology. Recent study brings some clarity. The presence of neoplasia is highly suggestive if “nodular or mass-like lesion” and “consolidated lesion with heteroechogenicity” are noted. Besides, the feature of margin rather than the echo texture of a lesion might be more distinguished for the diagnosis of malignancy. The presence of “consolidation” along with “a negative finding of nodular/mass-like lesion” after careful scanning helps predict a diagnosis of pneumonia. This study highlighted the importance of entire thoracic scanning for making clinical decision. If consolidation is present and pneumonia is clinically suspected, a thorough scanning for “a negative finding of nodular/mass-like lesion” can support the clinical diagnosis of pneumonia.

Lin C-H, Lo P-Y, Lam M-C and Wu H-D (2020) Usefulness of Chest Ultrasonography in Predicting Diagnosis in Non-emergency Small Animal Patients With Lung Parenchymal and Pleural Disease. Front. Vet. Sci. 7:616882.

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Sonographic images of (A) focal consolidation vs. (B) nodular-like lesion, (C) consolidation with homoechogenicity vs. (D) heteroechogenicity, and (E) normal pleura vs. (F) thickened/irregular pleura.

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DVM Nicole Allison from North Carolina, USA

Tell us more

I am 27 yea

North Carol

horse. My h

He has a job

Assistant. I g

na, the only

very lucky t

rich with na

foster my lo

My mother i

childhood w

both large a

me than wa

I was very a

at age 4. Da

especially fe

pre-professi

in the studio

life long car

dancing, I al

with animal

themselves.

“Ballet made me happy but being a veterinarian could make me happy and give me a sense of purpose.” 16

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erinarian co of purpose.

college, no y

how much I

You have gr

e about yourself.

ars young. I am currently living in Asheville,

lina, with three cats, one dog, and one

husband and I are high school sweethearts.

b in human medicine as a Physician

grew up in the mountains of North Caroli-

y girl in a family with three brothers. I feel

to have grown up in such a beautiful area,

ature and outdoor activities. It helped

ove for animals and the environment.

is a veterinarian and much of my

was watching her treat and heal animals,

and small. Nothing was more impressive to

atching her work.

active at a young age and started dancing

ancing became a passion of mine and I

fell in love with ballet. I trained

ionally, spending most all my free time

o. I strongly considered making ballet my

reer and passion but as much as I loved

lways felt a stronger pull towards working

ls and helping those who couldn’t help

. Ballet made me happy but being a vet-

ould make me happy and give me a sense When it was time to make decision about

years spent in the ballet studio could deny

I wanted to be a veterinarian.

raduated this year from North Carolina

State University (NSCU). What was the best and the worst thing about your studies? How you felt about graduation ceremony that was held online? The best part about my studies at NCSU was endless resources of information and advice and working with the clinicians, mentors and teachers. I felt like they truly wanted me to learn as much as possible in the time they had available. Vet school is a very stressful experience and having excellent teachers and clinicians to learn from makes all the difference. I was never belittled or made to feel dumb at NCSU. They made me feel very welcomed and I always felt supported by my teachers and clinicians, especially in hands-on learning situations.

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The hardest part about my studies was that no matter how hard you try there is simply not enough time in the day to learn and do everything you want. There is such a large amount of material to be constantly studying and endless extracurriculars to get involved in for hands on experience, but the reality is that there isn’t enough time to do it all and you have to prioritize what is most important to YOU. For the amount of years I had looked forward to vet school graduation, I would be lying if I didn’t say it made me tremendously sad that it didn’t happen. COVID-19 changed everything. My classmates and I were on one of our last rotations, starting to seriously feel the excitement of our upcoming graduation, when we got a 24-hours-notice that we would not be allowed back on campus again. Clinics were over and all in-person training was done. Nothing can take away how much my diploma means to me, but not getting to celebrate with friends and family, and not getting to say goodbye to vet school and my classmates in person was a difficult loss to accept.

decisions made. Since start

Considering challenges of 2020, you said that you are

animal vet, I have been enjo

at least grateful for 2020 being the year you got your

ments, surgery, and dentistr

dream job. So how it is going?

that every day is different.

Although, it has been a little

The job is going great! I love seeing patients every

times of COVID-19. We hav

day and finally getting to be the doctor. There is a

in the building, which has c

little bit of healthy fear that comes with being a new

ed challenges. It will be inte

vet and knowing that I am the one responsible for the

feels like when things go ba

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ting my first job as a small

What is the best way to recharge yourself after long week at work? Tell us more about your love for hiking and nature as you live in a very beautiful place. I have found that nature and exercise have always been my go-to when I need to destress and recharge. Living in Western North Carolina there are so many beautiful places to explore and outdoor activities to do. Since graduating and moving back to the mountains, my favorite thing to do is to hit the trails on the weekend for a long hike with my husband and dog. It is a way for me to escape into nature and enjoy the sunshine. Hiking along a trail is where I feel the most clear minded and carefree. It gives me the opportunity to mentally and physically challenge myself. Hiking, to me, feels a lot like life, in that you have to keep pushing yourself to get to reach your goal. It can be difficult and sometimes unexpected, but the view and sense of accomplishment is always worth it. And you don’t always know how far you can go until you try.

oying a mix of appoint-

ry procedures. It is exciting

e weird as a new grad in

ven’t been allowing owners

Follow Nicole Allison on instagram

come with many unexpect-

eresting to see what it

ack to somewhat normal.

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W hy w e d o not lik e o s te oa r thritis c o ns ultatio ns ?

Convincing some owners to treat their dogs

not view themselves as having an

for osteoarthritis appears challenging, frus-

educational role. That may lead to inaccu-

trating and unrewarding for veterinary sur-

rate and unrealistic expectations and may

geons. Because some owners do not accept

limit veterinarians’ ability to treat osteoar-

their recommendations to provide analgesia thritis. for affected dogs.

Canine osteoarthritis is widely studied

Study1 found that short consultation lengths disease. But veterinarians’ diagnostic workare one of the main challenges to success-

up for osteoarthritis rarely follow that advo-

ful consultations.

cated by experts. Most common reasons are

Another important factor is poor recogni-

lack of time and perceptions that it would

tion of owners’ prior knowledge, beliefs and

not change the outcome.

assumptions. Some veterinary surgeons do

1 - Zoe Belshaw, Rachel Dean, Lucy Asher. Could it be osteoarthritis? How dog owners and veterinary surgeons describe identifying canine osteoarthritis in a general practice setting. Preventive Veterinary Medicine. V 185. 2020.

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Mr Doomits/stock.adobe.com

Ho w to d o s e T H C :C

Recent study1 found that 2 to 5 mg CBD + 0.1–0.25 mg THC/kg are well

Satur

tolerated by dogs. But clinically meaningful neurological signs, such as

lead

hyperesthesia, ataxia or swaying, were observed at high doses (10 mg CBD +0.5 mg THC/kg).

Krakenimages.com/stock.adobe.com

1 - Chicoine A, Illing K, Vuong S, Pinto KR, Alcorn J and Cosford K (2020) Pharmacokinetic nabis Herbal Extract in Dogs. Front. Vet. Sci. 7:583404. 2 - Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics o bcp.13710

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C B D in d o g s ?

ration of P450 enzymes in the intestinal mucosa or hepatocytes could to increased oral bioavailability and adverse events at higher doses2.

c and Safety Evaluation of Various Oral Doses of a Novel 1:20 THC:CBD Can-

of cannabinoids. Br J Clin Pharmacol. (2018) 84:2477–82. doi: 10.1111/

Cats and IV fluids R a p id d is trib u tio n b u t s lo w e lim inatio n

Why cats are more susceptible to fluid overload? Because they have rapid distribution but slow elimination of IV fluids. Low fluid elimination increases plasma volume and risk of interstitial edema. Despite of the type of intravenous fluid used plasma volume expands by 27–30%. Therefore, infusion rates need to be substantially reduced following initial IV fluid bolus in order to prevent fluid overload and to maintain the desired plasma volume expansion. It only applies for healthy conscious euvolemic cats.

Yiew XT, Bateman SW, Hahn RG and Bersenas AME (2020) Evaluation of the Distribution and Elimination of Balanced Isotonic Crystalloid, 5% Hypertonic Saline, and 6% Tetrastarch 130/0.4 Using Volume Kinetic Modeling and Analysis in Healthy Conscious Cats. Front. Vet. Sci. 7:587564. VE T REVIEW 23

DVM Nuno Lobo from Portugal

Tell us about your path to veterina medicine? You also were an Army

Officer, can you tell more about it?

Being a Veterinarian is truly a drea

came true. But actually, when I was

years-old I wanted to be an engine

because I had any idea what an en

does for a living, but because my u

an engineer and he had like 10 dog definitely wanted that.

It was only later when I realized tha

wanted to be a Vet. Fortunately, my

thought I should be an economist o

business manager (because I was g

at math), so she asked her Veterina

Assistant if I could go to the clinic d

the weekend, hoping that maybe s

ing all the sick animals, blood, syrin

and needles would make me chang mind...

Clearly, that didn't work. I found ev

thing fascinating: all the procedure

different clinical cases, the follow-

"You can always be better than you were yesterday." 24

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was about 13 years old but that ex ence really made me commit even to be a Vet.

ary

Regarding the Army, I was an Army

Taekwondo is more than a hobby to me, last

Officer for one year, I enlisted right after

year I actually competed in an international

the fifth year, mainly because I wanted to

Tae Kwon Do Open and I am also an auxiliary

complete the Bootcamp.

coach. Martial arts go beyond physical super-

Both my father and my grandfather were

ation, achieving goals, personal evolution,

s 6 or 7

soldiers too, and I needed money to pay

and winning competitions.

eer; not

for my final internship, before the thesis.

To me, the best part is that no one will ever

ngineer

Actually, there are Veterinarian Officers in

be perfect, which means you will always have

uncle is

the Armed Forces, and I thought maybe I

reasons to train, you will always have to im-

gs, so I

could finish my degree in the Army.

prove yourself and you can always be better

am that

Unfortunately, my requests were denied

at I

and my only option was to do the intern-

y aunt

ship at the Military Laboratory, near my

or a

Unit, after work hours.

good

Although I respect and admire all the

arian

research done at the Military Laboratory,

during

small animal clinic and surgery are my

see-

passion, so I applied and got accepted at

nges,

one of the best Veterinary Hospitals in

ge my

Portugal and ended up leaving the Army.

very-

You are practicing Tae Kwon Do, Korean

es, the

martial art. It is more than a passtime.

-ups, I

What is the best part about Tae Kwon Do

xperi-

for you? Besides physical strength how

does it help you to be a better veterinarian?

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than you were yesterday. At the beginning

act, and act fast without hesitations; you just

maybe only 10 out of 1000 techniques will

need to trust your training and your

be good; then - maybe 100; as you progress,

knowledge.

maybe you will do 200 good ones and 300 that are not that bad. The key is to stay

What is the most irritating thing for you in

committed: a lot of sweat, dedication, and

veterinary medicine? And what do you like

persistence.

most in it?

This is also the way I look at my job. I will never know everything but I will never stop

The thing that irritates me the most is defi-

learning, and practicing, in order to provide

nitely dealing with animal neglect cases; it is

the best service I could possibly give to my

truly heartbreaking and revolting.

patients.

What I like the most about Veterinary Med-

Besides the resilient mindset, I guess Tae-

icine it's surgery. I specifically like surgery

kwondo really helps me to deal with stressful

itself but the recovery part never ceases to

situations because in both sparring and emer- amaze me, our pets healing capacity is truly gencies freezing is not an option, you have to

gratifying to witness.

Follow Nuno Lobo on instagram V E T REVIEW

You are veterinarian or veterinary student and have a story to tell?

Let's get in touch info@vet-review.com

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M ine ra liz e d thro m b us

Few dogs with meningoencephalitis of unknown origin

(MUO) live more than two years past diagnosis despite treatment. One study described long-term complications of treatment in two dogs with MUO who lived more than 4 years. These dogs were treated with long term corticosteroids and cytosine arabinoside. Both eventually succumbed to respiratory signs associated with mineralized thrombi in pulmonary arteries. In addition to pulmonary thrombus mineralization, one of the cases exhibited pulmonary parenchymal mineralization, which has been widely documented as a side effect of corticosteroid use in dogs. Therefore, it is important to perform thoracic radiographs to monitor dogs on long term corticosteroids and cytarabine for pulmonary thrombotic mineralization.

Rosen S, Benedicenti L, Petesch S, Reetz J and Galban EM (2020) Case Report: Mineralized Pulmonary Artery Thrombi in Two Dogs Treated for Meningoencephalitis of Unknown Origin. Front. Vet. Sci. 7:569597. V E T REVIEW

Thoracic radiographs (A) prior to treatment and (B) after 4 years of treatment for MUO. (B) Mineralization of pulmonary arteries (arrow) is seen.

Thoracic radiographs taken after 5 years of treatment for MUO. (A) A tubular mineral opacity in the pulmonary artery (black arrow). Mineral opacity and loss of volume is present in lung lobes (*) with an associated rightward mediastinal shift (long horizontal line). (B) The mineral opacity in the artery (black arrow). The mineralized alveolar pattern with loss of volume in the lung lobe (*).

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W he n s urg e r y is a n a r t

Another case repo

Vehicular acciden

Following surgeri Orbitozygomaticomaxillary complex (who knows the longer term?)

rectus muscle com

is the region of the skull where the zygomatic, maxilla bones,

Small intestinal su

lacrimal, frontal and palatine bones unite.

the first time whe

Recent study describes promising surgical tumor removal tech-

Read the whole c

niques in this region of the skull. The main challenge is to achieve histologically clean tumor margins in a cosmetically pleasing manner.

(A) Severe skin

Read the whole study here.

necrotic debri (A) Severe skin defe (B)(B) Dorsolater debris. Dorsolat before surgical mus beforecorr su correction.

Photograph of the dermal advancement flap and closure of a

The chang tions of th flap 21 da

commissurotomy (A) and 14 days post operatively (B)

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1 - Lewin GA testinal subm

ort describes the management of complex facial wounds.

nt caused severe facial wounds with skin defects and proptosis in a dog.

ies were performed: local subdermal plexus rotation flap and a partial transposition of the dorsal

mbined with commercial small intestinal submucosa patch instead of enucleation.

ubmucosa in veterinary ophthalmology has been used to manage severe corneal damage1. It is

en small intestinal submucosa patch was used as a support material for the extraocular muscle.

case report here.

n defect and

is. ect and necrotic ral strabisteral strabismus rection. urgical

ges of the flap after surgery. (A) Viability of the flap 1 day after surgery. (B) The condihe skin flap and globe 18 days after surgical correction. (C) The condition of the skin ays after surgery.

A. Repair of a full thickness corneoscleral defect in a German shepherd dog using porcineVE small in T REVIEW mucosa. J Small Anim Pract. (1999) 40:340–2.

Jessica Hirsch

You

Veterinary medicine student from Tufts University, Massachusetts

ope

time

Last

crea

few

gery

I wa

wha

sch vet

and

disa

I pe

will the

and

Sinc

I ha the

"Disability can be a very private issue, but it does not have to be a secret one." V E T REVIEW

wou

I ca

who

fere

med

u have told your story very bravely and

Medical leave of absence still has some kind

enly in your blog. Why you decided it is

of stigma. And very competitive veterinary

e to share your story and create a blog?

medicine studies add even more weight on it.

hat have it brought to you?

What can be done to normalize medical leave of absence in our field?

t summer I decided to make the jump and

ate a veterinary Instagram account just a

Normalizing medical leave of absences, in my

w weeks prior to my brain and spinal sur-

opinion, requires addressing numerous other

y. I wanted to do more than tell my story,

stigmas in veterinary medicine.

anted to show the vet med community

Veterinary medicine is extremely exclusive.

at it’s like to take a LOA during veterinary

There are still people in this field who believe

hool, come back from that LOA, go through

that people with disabilities and/or chronic

school with disabilities/chronic illness,

illness should not be able to receive a DVM

d eventually what it is like to work as a

degree.

abled DVM.

Some members of the veterinary community

ersonally have found that people are most

believe that people who depend on wheel-

ling to change when they understand why

chairs and other mobility devices should not

change is important, the more specific

d personal the better.

receive a DVM because they would not be able to execute the clinical skills required to

ce creating the Disabled.DVM platform,

be a large animal or equine practitioner.

ave met so many amazing members of

Other members believe that those who are

veterinary community that I probably

deaf or hard of hearing should not receive

uldn’t have connected with otherwise.

a DVM degree because they would not be

an now say I have friends around the globe

unable to auscultate the heart and lungs ac-

o have opened my eyes to so many dif-

curately. There is a view amongst some veter-

ent cultures and perspectives on both vet

inarians that this profession is for the elite of

d and life.

the elite, the ultimate exclusive club.

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accessible models is not good enough for

them because they view this as “cheapenin the degree rather than making the degree more accessible. If you cannot work a 12+ hour shift in the

clinic then be on-call overnight and show u

to rounds sharp-minded at 7am, then you d

not belong in veterinary medicine. It is this

mindset that needs to evolve before we ca

even dream of normalizing didactic and clin

cal accommodations, as well as medical lea of absences.

Once you have mentioned that microaggre sion towards people with disabilities is

especially prominent in veterinary hospital

setting. Because our profession has a gene

attitude of pushing through or overworking

ourselves; and that is not always realistic fo

people with disabilities. How can we increa understanding in this fast-paced clinical atmosphere? They believe you must be able to perform every aspect of veterinary medicine proficiently or you are not worthy of the degree at all. In their minds, if you cannot complete a rectal palpation on a live cow, you are not worthy of the degree. Completing these tasks on

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We need a mindset change; but how do yo

actually initiate that change? You talk abou it. The veterinary community needs to not

only listen to disabled perspectives but in-

clude them in policy changes. It is no secre

ng”

that veterinary medicine lacks diversity; however, many forget that disability is a part of diversity. Disability can be a very private issue, but it does not have to be a secret one. Many vet-

erinary professionals are scared to vocalize

their needs to their schools or employers for

fear of backlash and lack of understanding.

Especially with rising numbers of invisible

ni-

disabilities there is a certain amount of skep-

ave

ticism that one is almost guaranteed to be

es-

met with. People with invisible disabilities are immediately vetted with intrusive questions coated in a default assumption that we are

simply trying to cheat the system to make our

eral

lives easier. But imagine how their fear might

change if they knew their school or place of

work was actively looking for people with dis-

ase

abilities to join the veterinary medicine field rather than treating it like an exclusive club. Imagine if veterinary colleges actively advertised how they support their disabled

students (or if I really were to dream deeply),

if they actively sought out more disabled students to diversify their student body. What

if veterinary medicine had a supportive com-

plex instead of a superiority complex?

What gives you strength to pursue your dream? My newly found passion for the field is what gives me the strength to keep going. Due to the gravity and delicacy of my surgery this past summer, there was a time where I had to consider what I would do if I couldn’t return to pursuing my DVM degree. I think it was then that I realized how badly I wanted to be a veterinarian and how much I didn’t want to do anything else.

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ccording to recent study, medetomidine is superior to

acepromazine for premedication in dogs due to its better analgesic properties.

Veterinary magazine for small animal veterinary specialists LittlehalesR. (2020). In dogs undergoing elective procedures is medetomidine superior to acepromazine when used as a premedication?. Veterinary Evidence, 5(4).

t was found that forwarder end knots provided increased knot

holding capacity and relative knot security compared with Square and surgeon's knots. Forwarder end knots should be considered for closures when suture is placed under tension.

Gillen, A, Munsterman, A, Barrett, E, et al. In vitro evaluation of the modified forwarder knot used to end a continuous suture pattern in large-gauge suture. Veterinary Surgery. 2020; 49: 1555– 1562.

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