S2W8: Heart Murmurs in Kittens, Josh Project, and "Endoscobee"
This week dove right back into the brain with a lecture discussing cerebral ventricles, cerebrospinal fluid, and the blood brain barrier. This was followed by a lecture on the cerebrum and one on the cerebellum. These lectures focused on understanding the different aspects of the brain and what can happen if there is an issue or lesion in one of those structures. It’s always interesting to learn about the clinical relevance of what we are learning especially while trying to understand neurology which can be obscure at times.
The day continued with a lunch talk by cardiologist, Dr. Ames, on heart murmurs in kittens. The lunch talk was case-based and centered around an 8-month-old kitten with a IV/VI right systolic parasternal murmur without any pulse deficits. The owner wanted to know if that cat was healthy enough to undergo a spay.
Systolic heart murmurs are graded on a scale of 1-6 so a four is fairly high up there. After describing the heart murmur Dr. Ames explained the difference between innocent and clinically relevant heart murmurs in cats/kittens. In short, innocent murmurs are “soft” murmurs meaning they are usually less than a grade III. They are not associated with other findings, are heard on the left side, and are gone by six months of age. They may also change or disappear when the animal is placed in different positions. Contrary to innocent murmurs, clinically relevant murmurs in kittens are usually going to be higher than a grade III, heard on the right side of the heart, persist after six months of age, and the patient may or may not have other clinical symptoms. As you now know, the kitten described in this case had a clinically relevant heart murmur.
When clinically relevant murmurs are auscultated, it is recommended that the patient gets an echocardiogram to assess risk before undergoing general anesthesia. While echocardiograms are the “gold standard” they are expensive, and many people may not be able to afford them. The next best option is thoracic radiographs and Pro BNP blood test which basically looks for signs of cardiac damage.
Dr. Ames explained the two most common reasons for a kitten to have a clinically relevant murmur are patent ductus arteriosus (PDA) and ventricular septal defects (VSD). Typically, PDA is characterized by a continuous left-sided murmur while VSD is a right parasternal murmur.
After these concepts were discussed, Dr. Ames then gave us some additional information about the case and an echocardiogram with color. With that additional information and pattern recognition we concluded that our kitten had a VSD. VSDs can be classified as large or small. Smaller VSD have a higher velocity of flow going across, so it is a louder murmur. To
understand this better, you can think of it like a hose. In this analogy the water flowing through the hose is the blood in the heart and the opening of the hose is the defect. If you have a hose and cover the tip so that only a small amount of water can come out, the pressure will be much higher than if the hose was uncovered, or even if the hole was just bigger. When the blood is
passing through a smaller hole, it will sound louder than if it was passing through a large
hole (defect). The other good thing about a small VSD is that they usually do stay small and do not get bigger. Additionally, it does not typically result in a shortened lifespan. If it is on
the borderline (found with specific measurements) it is recommended to repeat an
echocardiogram yearly or if there is a clinical change. On the other hand, a large VSD will
be less loud due to the larger defect resulting in a lower velocity. Left VSDs are more serious and can be helped with some surgical intervention that can allow those cats to live into early adulthood.
This talk was super interesting and a great introduction to some clinically relevant cardiology knowledge!
Monday finished up with another sheep brain dissection lab. This lab gave us the opportunity to go over the brain anatomy again and then after deconstructing the brain, we made a clay model and rebuilt the brain. By the time this lab was over we definitely had a better understanding of the brain’s complex anatomy.
Tuesday started off with a run with Churro and then a lecture on the anatomy of the hyoid, pharynx, larynx and skull followed by a lecture on the diagnostic imaging of those same structures. That afternoon we hammered those points even more during our prosection lab.
Wednesday started off with a discussion on how to “promote wellbeing during veterinary school”. Being a vet student is a part of our identity but should definitely not be our whole identity. This discussion started off by going over some statistics about mental health in the veterinary profession. Here are five startling facts that you may or may not be aware of.
1. A study done in the UK showed that DVMs were 4x more likely to die by suicide than the general population and twice as likely as other health-care professionals.
2. The incidence of depressive episodes among DVMs is approximately 1.5 times the national average (CDC).
3. Nearly one in five vets regret becoming a veterinarian. (Merck)
4. Vet students are more likely to suffer from depression than human medical school students, undergrads, or the general population (Kansas State).
5. 32% of first-year vet students had signs of depression, including during the first semester of study (Kansas State).
While these facts may be a little overwhelming, it is important to note that veterinary schools (including UC Davis) are working hard to provide support and resources for their students during challenging times and help them prepare for life after school as a veterinarian.
The remaining time in this discussion was spent assessing our relationship with stress, cognitive distortions, and promoting happiness.
This talk was a good way to put things into perspective and make sure that we are all still taking time for ourselves during school. For many students including myself, having a seat in this school has been a life-long dream and yet during the stress of exams and additional life obligations, it is easy to have that perspective slip through the door. It is also easy to say that “I’ll be happy when…. (I am done with this block, graduate, get an internship, finish residency, buy my own practice….). The list goes on and on, but true happiness will never be achieved if it is dependent on an external circumstance. Getting into vet school is a prime example of that. So many people think or say they will be happy after they get into vet school and then once they get there, the end goal changes and so does the pursuit of happiness. Learning how to appreciate where you are in this moment while still looking forward to the future is key to being able to be genuinely happy. It’s definitely much harder than it sounds but something that helps me is remembering that this is exactly where I have wanted to be my whole life and I need to take time to enjoy it and appreciate being here because so many qualified people did not get this opportunity.
The rest of the morning consisted of lectures on the sensory systems and the afternoon finished up with some quality time with our cadavers. During this dissection we explored the muscles of facial expression and also were able to see cranial nerve VII which has a lot of interesting responsibilities but is primarily responsible for facial expression.
Thursday started out with a nice 6 mile run with Churro. I then met up with some UC Davis vet students and we made our way to the Children’s Hospital in Sacramento for a volunteer session. UC Davis has a program called, “Josh Project”. This is a program was developed when Tennessee veterinarian, Dr. Randy Lang’s daughter was in the hospital undergoing surgery. Dr. Lang was frustrated with the lack of materials explaining surgery and offering comfort at a child’s level during their hospital stay. He understood the power of the human-animal bond and set a goal to help young patients get more comfortable with the medical world by using the engaging format of animals. During our stay most of the patients were too unstable to come to the joint playroom so we split up and went bedside. I was paired with an incredibly sweet little girl, and I was able to explain some parts of her treatment in a way that she understood. We used a stuffed rhino as a demo patient and went over IV lines, catheters, bandaging, as well as MRI and x-ray. I found out that she has an overall love of all animals and insects (except spiders) and especially loves orcas! We then worked through some puzzle games and talked about her hobbies and her awesome friends back at school. Our time together flew by! This was such a fun way to connect veterinary medicine to human medicine. I am so glad that UC Davis has opportunities like this because it is a great way to step back and realize that we have a much bigger purpose than just being vet students or veterinarians. Yes, that time could have been spent studying for the upcoming neurology exam but at the end of the day having the ability to connect with people and make a difference in their day is far more important that a grade on an exam. It is also another one of those things that puts life into perspective. All of these kids would happily trade places with me, yet I’m the one that gets to walk out of the hospital after a few hours and continue to pursue my goals, my health is not something that I have to constantly fight for.
That afternoon we had our last mentor meeting with our incredible mentor Dr. Keller! This mentor meeting was focused on endoscopy and finished up with some information on rabbit intubation. Dr. Keller went above and “beeyond” (you will get this in a second) and made multiple models for us to practice using the endoscope on. The first simulation involved eight balloons filled with random items and the goal was to use the endoscope to go inside the balloon and fill it up with air (insufflation) so that we could see what was inside. Let me just tell you it was wild in there, we found zombie hands, wine corks and tires. The next simulation was “Endoscobee” which was a cleverly crafted bee model that had 6 bee jokes, glued around the edges. Our objective was to learn how to manipulate the endoscope so that we could read the jokes in the bottle. These activities were great ways to practice scope handling techniques and I am grateful for the time that Dr. Keller took to make these demos. She even had to borrow some of her kid’s balloons and little toys which was a risky endeavor and should definitely not be taken lightly.
After the endoscope practice, we learned about rabbit intubation. This is an important skill to understand since rabbits are the third most common companion animal species in North America! While intubation may not seem as routine as it is in our canine and feline patients, it is HIGHLY recommended and is the best standard of practice. There are a few options that practitioners can draw from in order to improve the level of care that they can provide while these animals are under general anesthesia. The first one we learned about was a tool called a v-gel. In certain circumstances this tool can be a good alternative to using an endotracheal tube and is easier to place. A v-gel is a supra-glottic apparatus meaning that it sits in the pharynx and the gel-like material and design contour that mimics the anatomical airway structure of the rabbit creates an airway seal. The second option is regular intubation with an endotracheal tube. Both of these options have pros and cons and when done properly either are a much better choice than forgoing intubation all together.
Overall, this was a super interactive and exciting mentor meeting, and I am super grateful that we had Dr. Keller as out mentor this year. She really went above and beyond to make sure we got the most out of our limited meeting times!
Friday started off with a hot yoga session and then we slammed through four lectures. These lectures were focused on the hearing, smell, pain, the limbic system, and vestibular system. After that I had a break from 12:00 to 1:30 so I was able to get a nice swim in at the rec pool. The afternoon finished up with a palpation lab where we got to test out some of the cranial nerves in dogs and practice our neurology examinations! This was a fun way to combine all of the information that we have learned over the past two weeks!
Saturday started off with a nice run with Churro and a hot yoga session! The rest of the day was spent studying and getting things done around the house. Sunday followed a similar schedule with studying and preparing for our first neurology exam on Monday!
Quote of the week: “That dog is doxycycline deficient” -Dr. Vernau
Comments