Death Is Coming

Red Hartebeest
Red Hartebeest

Elephant Adventures

The latest episode of Safari Vet School saw a new group of vet students arrive at the reserve, with most being more experienced than their predecessors yet just as keen to get stuck in to the fun. This week’s episode seemed to have much more of an edge to it, with the word ‘danger’ very much being the one that kept cropping up. Whether it was the ‘danger’ posed by getting too close to a protective female elephant and her calves, or the ‘danger’ posed to the Hartebeest that was very close to succumbing to the effects of hyperthermia, the new students had a lot to really keep their adrenaline levels at maximum.

The elephant experience reminded me of a story my late grandfather used to tell us, in which he came face to face with a rogue bull elephant whilst living in Kenya right out in the bush. The elephant in question had apparently been terrorising local people and it was suspected that it had something very wrong with it. My grandad was charged by it and had the terrifying and upsetting decision to make of having to kill it, in order to safeguard his own life and those of his family. As a result, we had it drilled into us from a very early age of the unpredictabilty and ‘danger’ posed by animals, even those we consider to be cute and generally harmless.

Overheating & Death as an unhappy fact of the job

The incident with the Hartebeest was a close one and it was clear that the group very nearly lost the animal to over-heating. This really drove home the fact that in spite of our best efforts, animals are ultimately complex biological systems with all of the inherent unpredictability that you’d perhaps expect but which can serve up real curve-balls on occasion. This is an important lesson to learn early on in a veterinary career as there are guaranteed to be a number of such situations throughout any vet’s working life. I had one such case on the weekend. We had a middle-aged Rottweiler transferred to us from it’s vet for ongoing fluid therapy and treatment for vomiting, weight loss and bloody diarrhoea (not the nicest of combinations). The dog was also very yellow and clearly had significant liver issues. Owners have a great way of really piling on the pressure and the owner’s parting words were that her dog “could not die.” As I say, no pressure. Further blood tests and an ultrasound scan later made it clear that the dog had serious liver problems and as such the prognosis was guarded to poor. She did, however, start to look better and more responsive after a few hours of fluid therapy, and as such we felt that we may have made a difference. Now this is where as a vet you have to be very careful as animals like this have a particularly nasty habit of perking up just before a major crisis, and that’s exactly what happened. The dog suddenly went downhill, turned pale and basically started dying in front of our eyes. Unfortunately, in spite of our very best efforts, the damage was too great and she was put to sleep. This really drove home the fact that cases can take an unexpected turn, sometimes for the better, sometimes for the worse, and that as vets one of our most important tasks is to sensibly manage owner expectations. It would have been easy at admit to reassure the owner by telling her that her dog was “going to be OK,” but that would have been misleading and caused even greater anguish to her compared to being realistic and cautious by advising a guarded prognosis. Although the dog’s owner was understandably very upset, she had been given a chance to come to terms with the fact that her pet was very ill and may well die rather than languising under false, or misguided, thoughts that everything was going to be OK. So, the thing I would say to the Safari Vet School students is that in spite of their best efforts, that particular Hartebeest on that particular day had obviously ‘decided’ that it was going to test the boundaries between life and death. Sometimes stuff just happens and you have to be prepared to accept the fallout, learn any lessons and then move on.

All change down on the range

Black rhinoWell, what can I say? Life has managed to get in the way and interrupt my normal Safari Vet School musings this week, hence the ridiculously late penning of this week’s rambling offering. For those of you who may have been waiting with baited breath for the next installment – that’ll be you then mum – I can only apologise and endeavour to do better this week. So, on with it…

It was our final week with the current group of students and it all ended rather nicely really – we couldn’t not see some lion action, afterall. I reiterate what I have said before but Will is a master shot with the old darts. Truly classic stuff. Good job too as well, as wanting to get in and have the job done swiftly must have definately have been the aim of the game when dealing with the lion cubs (although what I saw looked nothing like the cute bundles of fluff and claws that I think of when I hear the word ‘cub’), especially given the short work they were all making of the cow. A bite from a lion would certainly entitle the recipient to some serious man (or woman) points and usurp any tales of being ‘savaged’ by a bog standard domestic kitty, something which, to date, I have still managed to avoid and intend to continue to avoid.

I am just trying to recall what else happened (it is late as I write this)…. oh yes, rhinos. The main recollection I have of that part of the show was the fact that the rhino apparently ended up getting jabbed about fifteen times! Ouch. I am sure there was a good reason why they didn’t just opt to swap syringes whilst leaving the needle in place, rather than have to repeatedly make new needle stabs? Again, I am probably prompting shouts of derision and cries of ‘ignorance’ as I say that. I have not, after all, ever had to administer antibiotics to a wild rhino so I guess that’s the way it is done. Just a though though.

Its been great fun watching the students work together and grow as individuals over the course of the past few weeks and I am sure they all returned to their respective vet schools refreshed and full of new found enthusiasm and passion for the subject. Lets see what the next lot are like…

Did you hear the one about the haptic cow?

Haptic Cow, bovine simulator
The classic veterinary image

We’re all aware of the classic premise of virtual reality and the principle of experiencing a visual virtual world. But what about haptic technology? What does that mean to you? I had a unique opportunity to see this technology in action last week when I was fortunate enough to be invited to speak at Bristol Veterinary School and met with Professor Sarah Baillie, Chair in Veterinary Education at the University and inventor of the famed ‘Haptic Cow.’

I first became aware of the Haptic Cow when I was an undergraduate at Bristol myself, and found the idea simply incredible: using a computer programmed device to realistically simulate the tactile experience of pregnancy diagnosing cows, something that some vet students get immediately whilst others struggle with perpetually. I place myself in the latter category. No matter how many cows had the (dis)pleasure of me rummaging away fruitlessly in their general pelvic region, I simply could not make the link between the random ‘mush’ that I was feeling – or rather, gradually not feeling, as the blood in my arms was systematically squeezed out – and the textbook picture of ovaries, follicles and the various forms of the bovine uterus. The problem was that there was no way for the lecturer to help other than to tell you what you should be feeling and where. Most of us simply ended up nodding knowingly and feigned a sudden reversal in our ignorance. The truth was that it was easier to pretend that we could feel what we were supposed to, thus hastening our exit from said cow’s rectal area, than to battle on. After all, the cows don’t thank a trier!

Enter the Haptic Cow. The idea is that you, the user, reaches into a fake cow (a black and white fibreglass shell with a specially designed robotic arm inside) and attach the end of the aforementioned arm to the end of your middle finger – the one you would use as a ‘friendly’ greeting to someone you didn’t much care for – via a small thimble-like attachment that fits snugly on the end of your digit. The magic then happens when the computer program is launched and the ‘model’ of the cow is run. On the screen you are able to see some simplified representations of various structures, such as ovaries, and this is matched by what you are able to ‘feel’ in the simulator. It’s a very bizarre sensation but the truth is that using this technology, which relies on the computer program outputting to three motors controlling the robotic arm in three planes, it is possible to haptically simulate all manner of structures, textures and body systems. I was given the chance to ‘PD’ a cow, diagnose an ovarian follicular cyst, and even experience the sensation of rectally examining a horse, something that is an important part of a colic investigation, yet which is notoriously risky to the horse, and subsequently to the vet’s professional indemnity cover! Using the Haptic simulator removes all of the risk associated with learning these techniques and after just one short session I would feel confident going out tomorrow and diagnosing colic or telling a farmer if their cow was in calf. That’s incredible considering I didn’t manage to achieve that in an entire year at vet school.

The potential for such sophisticated technology in dramatically improving the standard and effectiveness of medical training is huge, with the technology already having been applied to modelling a cat’s abdomen for training in abdominal palpation, to teaching human doctors the fine intracacies of prostate examination – the model human a@*e was hilarious! I can easily see haptics being combined with augmented reality, or other such technological advancements, in forming sophisticated surgical training programmes, dramatically advancing career development and patient care, in all species.

Professor Baillie’s career is as equally incredible as her invention, having graduated from Bristol vet school with an additional intercalated degree, and then spending a number of years in clinical mixed practice. A forced break from the physical rigours of being a vet in practice led Professor Baillie to complete a Master’s degree in computing, in spite of no prior experience of the field, and led to the start of her work with haptic technology and a subsequent PhD and the Haptic Cow. After time teaching at London Vet School, Professor Baillie is now back at her Alma Mater, Bristol, providing students with the incredible opportunity to train with her amazing inventions.

Stress, Cheetahs & Loved Ones

cheetahDogs everywhere!

Watching Safari Vet School this week reminded me of those days in practice when you find yourself, for no apparent reason, completely behind with consults and as a result feeling the stress levels rise and the panic start to simmer beneath the cool, controlled exterior that one must always be seen to command whilst consulting. The students, led by mentor Steve Leonard, although by his own admission, in somewhat of a haphazard and seat-of-your-pants manner, had the task of administering first opinion veterinary healthcare to the area’s pet dogs, with apparently hundreds of animals being presented patiently by their owners, who could not really afford to provide the sort of basic veterinary care that we often take very much for granted in this country. The team conducted clinical exams, vaccinated the dogs against rabies and administered both preventative measures, such as worming, to treatments for specific problems, mostly skin issues such as mange. Many of the dogs were unused to veterinary attention and so the work was clearly hazardous, not only from the risk of being bitten, but also the risks of potentially contracting one of the plethora of conditions that the dogs were likely to have been carrying. Anyone who has ever had the misfortune of picking up mange – something I thankfully have not – will attest to how uncomfortable it is and how repeating the experience is not high on the wish list. Still, despite the challenges and eventually running low on supplies, the students all seemed to get on brilliantly and no one got bitten, which is always a bonus!

The work conducted by the team with the local community really helped drive home the importance of animals to communities, especially in impoverished parts of the world. Animals play many vital roles within society, from providing food, to powering agriculture, and, on a more social level, to providing companionship for people, and the importance to such communities of ensuring their animals remain fit and healthy is clear to see. I had the good fortune to become involved with the charity WVS (Worldwide Veterinary Service) a couple of years ago after competing in three triathlons over three months to raise money to help fund their amazing work. Their belief is in educating and thus empowering the local people to care for and safeguard their own animals’ health, rather than simply flying in, firefighting the problems and then flying out again, as is the case with a lot of charitable endeavours. They offer vets the chance to go out to various parts of the world and volunteer their expertise and time to help in much the same way that the Safari Vet School students do. Steve mentioned in the show that he was going to repeat the experience and I would suggest that he gets in touch with the WVS, who I am sure would be thrilled to benefit from his profile in supporting the work they do.

Give that man a medal

Can I say right now that vet Will should be on the South African shooting team at the Olympics because someone who is able to hit two Cheetahs running at full pelt with a dart, from a helicopter, first shot, deserves a gold medal!

Missed yet Proud

There was one part of the show this week that particularly struck me on a personal level, and that was when vet student Vicky was talking very honestly about the sadness felt due to her grandmother passing away before she was able to see her attend the course. I fully empathise with Vicky here as I longed for my grandfather, who had always been an encouraging and positive influence in my life and efforts to gain a place at vet school, to see me graduate as a vet. Unfortunately he passed away even before I had started university and was not even able to see me commence my training, something I find very sad, especially as I know how happy and proud he would have been. I am certain, Vicky, that your grandmother would have been as proud of your achievements with the Safari Vet School as I know my grandfather was of me ๐Ÿ™‚

Rediscovery

OryxQuite an adrenaline fueled episode of Safari Vet School this week with stress levels at an all time high as the students tackled the task of darting and then transporting a number of Oryx to be loaded on to a trailer and sent to another reserve. The main danger, as I could tell from the safety of my comfortable armchair, were the HUGE horns that these animals have, and which more closely resemble fencing foils than anything else, with the very clear potential to impale anyone unfortunate enough to be found on the end of one. I would say that the plastic tubing used by the team was probably one of the best inventions ever, in that particular moment!

I did wonder whether it would have been an idea for them to get intravenous catheters in place in the animals’ ear veins at the outset, given the fact that they needed to be transported what seemed to be a reasonable distance, and would have provided much swifter and safer venous access to allow the repeated top-ups of medication that the animals ended up requiring. Needless to say these would then be removed prior to the animals waking up. Perhaps that is my small animal logic and experience coming into play as I don’t have any direct experience of managing wild large animals. Feel free to shoot down my idea ๐Ÿ™‚ Or should that be dart down?

One very interesting part of the show for me was the segment at the end on Tom’s rediscovery, if you will, of his desire to continue in veterinary. He is certainly not the first vet student who nears the end of the course feeling disillusioned and doubtful about whether a life as a vet is the path for them after all, nor will he be the last. The facts are these: veterinary is a very demanding and intense course, often with little opportunity to really disconnect, step back and take in the wider picture of what it means to be a vet and of the opportunities, including globally, that being qualified offers graduates. Due to the huge body of knowledge that needs to be imparted to veterinary undergraduates it can at times feel as though we spend the course having to rote learn huge volumes of knowledge, with the result being that the theory and the practical ‘magic’ of the course and profession – the primary reason many of us choose veterinary as a career option – become disconnected.

Vets are by their very nature the type of academic high achievers that are always seeking mental stimulation and a challenge. This, again, is one of the reasons why veterinary, with its “hardest course to get onto” label, is so attractive to such students and why occasionally the trudgery of endless rote learning can grind us down and leave us feeling somewhat uninspired and seeking professional and academic gratification elsewhere. Its a very real shame and unfortunately something that needs to be addressed at the training level. After all, how is it that you can start five years training with a hundred or so super motivated and รผber enthusiastic individuals who have dream’t of nothing other than becoming vets, to find several of those same people seriously questioning their path and looking for an alternative one by the end? It’s not really as though they didn’t have some idea of what they were letting themselves in for, as the vet schools do expect applicants to to demonstrate work experience.

Aside from the fact that many vet students realise that they are smart enough and qualified enough to do anything they set their minds to, including in careers that pay considerably more than veterinary does, two of the main factors that I can personally identify as being important in the feelings of disillusionment felt near the end of the course are a) a sense of feeling like a trained chimp, having to plough relentlessly through swathes of endless course material and ‘lists’, with no real requirement to engage the brain and really think about a problem, and b) the fatigue, both physical and mental that sets in by the end of the course. The fact is that very little of a vet student’s time at university is truly their own, with term time a busy blur and “holidays” anything but, as you are expected to complete a lot of EMS placements. There is very little opportunity, in my opinion, to just take some time to explore yourself, try new things and connect with people and experiences truly outside of the confines of the vet school and profession as a whole. It is often the students who do “venture out” of this circle, for example by intercalating, that are the ones to start questioning their ongoing interest and desire to stay within the profession, often as a result of them being able to take a year out to “exercise their grey matter” in a completely different manner and to expose themselves to ideas beyond veterinary ones. There will, of course, be those students who intercalate and re-enter the vet course rejuvenated and full of fresh motivation and enthusiasm for their veterinary career, and this is excellent. I believe that this kind of motivational shot in the arm is just what’s needed during the latter stages of the course.

I personally wish Tom all the very best whatever he decides and it is especially important to remember that just because we happen to be doing one thing today, there is no reason why we have to be doing the same thing tomorrow – people change, careers change, lives change. Embrace change.

Affordable Genome Sequencing

Nanopore technology

Okay, so not the most exciting of blog post titles but hear me out because this is some pretty amazing technology that I am about to talk about here…

Imagine a day when it will be possible to pick up a small, handheld device and with it rapidly and reliably sequence your entire genetic code, or even that of your favourite pet. “To what end?” I hear you say. Well, the promise of personalised medicine is one that has been on the horizon for many years and the technology that one Oxford company and team of researchers is engaging in is casting some light on the very exciting future that we may be facing. The principle of personalised medicine, as I understand it, is to use the information that is unique to you, ie your DNA, or genetic code, in order to identify the risks of you developing certain conditions or diseases and either specifically intervening to halt or manage such eventualities or, in the case of a disease state developing, such as cancer, using both your own genetic blueprint and that of the disease causing entity in order to select, or even design, tailored, targeted and ultimately more effective and reliable treatments. The prospect of being able to take a cancer cell, sequencing it’s DNA and identifying which drugs are most likely to be highly effective at eradicating the tumour, whilst drastically reducing, or possibly even eliminating, side-effects is one that is simply too important to ignore. But how could this be possible?

One company based in Oxford, and borne out of the research efforts of Professor Hagan Bailey of Oxford University, is leading the field in the development and application of nanopore technology to sequence individual molecules, such as DNA, and determine their exact composition. This is achieved through the use of a specially engineered protein nanopore set into a layer, either of lipid (like our own cells), or a synthetic material, such as graphene, and through which a molecule such as DNA is passed. This is a little like a train passing through a mountain by way of a tunnel. The really clever part is the way this apparently simple process of passing the DNA through the pore can sequence the strand and tell us the exact order of bases.

Nanopore DNA sequencing
Nanopore in membrane

A current flows through the layer containing the nanopore and the passing of the DNA molecule causes disruptions in the current flow, with specific, characteristic disruptions attributable to each of the four bases making up the DNA sequence. By recording these unique current disruptions the technology is able to identify the bases and the exact order in which

Nanopore DNA sequencing
DNA strand passing through nanopore

they pass through the pore, and thus sit within the DNA strand. In other words, it is possible to sequence DNA in real-time. Very exciting!

What about veterinary applications? Of course the main uses of this promising new technology would be expected to be applied in human medicine initially but it is highly likely that veterinarians will be able to make use of it as well. Potential applications obviously include veterinary research, disease monitoring, therapeutic uses, such as treatment selections in cases of disease states such as cancer, and much more besides. Rapid and reliable ‘kennel-side’ analysis using a simple handheld device like the one alluded to in the opening paragraph may very well be a reality in the not too distant future. Exciting times indeed!

For more information on Oxford Nanopore Technology and their exciting work visit their website at www.nanoporetech.com.

This is a good blog by someone who really knows what they’re talking about – a real life geneticist. Click here to read.