Week 7: Imaging, Telemedicine, and ONC Care
Another week in the books! This week was very lecture heavy. We started off by going over the fundamentals of different imaging techniques such as ultrasound, x-ray, magnetic resonance imaging, and computed tomography. It was really interesting to learn the basic principles behind each modality in addition to gaining a better understanding of what all those shades of gray mean. Here is a quick and dirty overview of the two more common imaging modalities; X-ray and ultrasound.
X-Ray
Radiopacity: Unexposed areas of the radiograph. These structures are typically bony in origin and absorb or stop the penetration of the X-rays. This means that those beams do not reach the receptor and thus we see these structures as white on a radiograph.
Radiolucency: Exposed areas of the radiograph. These structures are typically cavities with depressions or openings such as a bone sinus, fossa, canal, or foramen and appear black on a radiograph. Other common examples of radiolucent tissues include the lungs, urinary bladder, stomach, and intestines.
Thorax Radiograph Tips:
Radiographs should be taken at the END of inspiration
Short exposure times are needed to freeze motion
kVp should be high (80-100kVp) *except in very small patients
Abdominal Radiograph Tips:
Exposure can be made between expiration and the next inspiration
Longer exposure times up to 0.1 sec are better tolerated than in the thorax
kVp should be kept as low as possible
Ultrasound
Anechoic: Black
Hyperechoic: Bright
Hypoechoic: Dark
Common organs on ultrasound:
Urine: Black-hypoechoic
Renal medulla and cortex: Medium Gray
Liver and Spleen: Light gray-echogenic
Prostate and renal sinus/pelvis: Hyperechoic
Bone and Gas: Very hyperechoic / shadowing
The rest of the week’s lectures consisted of neurotransmission and neoplasia!
We have some interesting case-study labs this upcoming week so stay tuned for those recaps!
On Wednesday I attended a lunch talk on telemedicine. It was interesting to hear how telemedicine has evolved in the veterinary world and what it could mean for our future as practitioners. Dr. Christie Long, the Chief Medical Officer of Modern Animal, spoke about when and where telemedicine should be used. The main takeaway from this talk was that virtual appointments may be beneficial for owners that have a difficult time physically bringing their pet into a clinic, or if the pet has a minor ailment that may not require direct medical attention. She emphasized the importance of establishing a veterinary client patient relationship in-person and making sure that the owners understand the limitations that a virtual consult present. A veterinarian cannot physically touch the animal during a virtual appointment so if the condition or ailment is perceived to be too severe and a telehealth visit will not appropriately serve the patient, they will be asked to come into the clinic for a follow-up visit. There are regulations on what can be prescribed with a telehealth appointment. At this point in time antibiotics can be prescribed for up to two weeks and no controlled substances may be prescribed. Another use for a virtual consult was to discuss quality of life. Dr. Long found that these conversations are often more comfortable for all parties involved when done at home especially since transporting geriatric patients may be difficult depending on their level of mobility. There is currently legislation being reviewed regarding veterinary telemedicine so it will be interesting to see what this will look like in the future!
Thursday was the first mentor day of the semester! Each small group (the same group that we do all our projects and discussions with) gets a mentor and that mentor sticks with them throughout vet school and is a resource and valuable point of contact. Our mentor is Dr. Krista Keller and she is a diplomat of the American College of Zoological Medicine. She attended Ross University for her DVM and completed her residency in Zoological Companion Animal medicine at UC Davis. During our mentor meeting she told us about her background and then gave us a tour of the companion animal and exotic portion of the veterinary teaching hospital. We were also fortunate enough to be able to observe an imping procedure. This procedure is basically hair extensions but with feathers. The patient had sustained damage to its tail feathers and due to the approaching winter season, it needed to migrate down to Argentina. This feat would not be possible given its current condition, so the surgeon implanted donor feathers into the damaged tail! As a result of this procedure the bird will be able to fly normally and migrate as planned! We were also able to listen in on one of her earlier cases from the morning regarding a rabbit. It was really awesome to get paired with such a cool mentor with interests different than myself and I am stoked to continue to learn from her!
Thursday night I was able to attend the Sacramento Valley Veterinary Medical Association (SSVMA) talk with Dr. Lindsay Huie on “Nutritional Support for Pets with Cancer”. This talk emphasized the importance of quality nutrition for pets especially those battling cancer. A majority of pets with cancer will lose interest in food or not be able to put on weight. Hills formulated a specific diet called ONC Care which is targeted at combatting this problem. The food is high in caloric value and has a softer texture than other kibble. While the intended audience is cancer patients, this food can also be used for pets battling anorexia, cachexia, malnutrition, hypermetabolic states, and pre/post surgery! For more information on this food you can click here.
It was a awesome opportunity to learn about the advances in pet food and how companies are working to combat symptoms of common diseases. This night provided a great opportunity to connect and share a meal with veterinarians in the local area and hear about their experiences!
Friday, after a morning of lectures, we had our second PBL session and got the pathology report back from our sick Singapura cat (read last week’s blog for the backstory). There was one caveat, the only part of the pathology report we got were the images of the biopsy slides and one normal reference slide. Our job was to take on the role of the pathologist, compare the samples, and determine if this cat has IBD or cancer. Throughout the meeting our group had some good discussion as to what we think the diagnosis is but we have one final session in about a week to come back with evidence to support why we have come to a certain conclusion. Additionally we will address how we would tell the client and proceed with the patient’s treatment plan.
The weekend kicked off with a movie night with my housemates! We watched Enola Holmes, and I am typically not someone who can sit through a movie or stay awake through a movie but this movie was engaging and there were a lot of unexpected events. Saturday consisted of a 10 mile run to whoop my running legs back into action followed by a lunch at Crapeville with my housemates and a good friend from SLO. We then walked around the arboretum and spent some quality time together back at the house. Sunday was spent doing some studying and prepping for the upcoming week!
Quote of the week: “If you were to drop a vet student into a law school lecture they would become a neoplastic lesion and I don’t blame them.” Dr. Woolard
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