Y2 S1 Week 3: Antech KeyScreen GI PCR, Granite Bay Swim Session, and Urinary Catheters!
We are rounding out week three and closing in on the last week of our renal block! This week started off with an awesome hot yoga session followed by a lecture on ultrasonographic imaging of the urinary tract. This was an interesting lecture and much more enjoyable than the first few ultrasound lectures since things are finally starting to look more like organs instead of just gray smears. We closed out the morning with a lecture on some additional acid-base physiology which is a fun way to learn about some clinical issues that can occur due to poor renal function.
During lunch we had an awesome talk from International Veterinary Outreach (IVO). This program began as a student club at UC Davis in 2011 and quickly became a nonprofit organization in 2012. IVO focuses on creating healthy communities free of animal suffering by taking a One Health approach to develop and implement sustainable veterinary services and training programs in economically disadvantaged communities worldwide. They have a plethora of opportunities for veterinarians and vet students to get involved and help teach underserved communities and their veterinarians how to improve the health of animals and the people surrounding them. During the lunch talk the team spoke about their trips to Tanzania and their efforts to help lower the population’s rabies deaths. In Tanzania there are about 2 million stray dogs, and an estimated 1,500 people die annually from rabies. This number is almost unfathomable and is a good reminder of just how fortunate we are to live where we live. In Tanzania dogs accounted for about 99% of all rabies transmission and the victims were primarily children. In attempt to protect the citizens of Tanzania, depopulation of wild dogs is common and often inhumane depopulation methods are used such as shooting/poisoning. Fortunately, with the help of IVO, Tanzania is beginning to have increased access to veterinary care and their local veterinarians are learning the skills necessary to better assist their communities. They are able to practice higher quality medicine and are able to teach their newly learned skills to their local veterinary students.
It was amazing to hear from the IVO team and it is exciting to learn about the impact that they are having around the world. It was also a nice reminder of how much of an impact we can have as veterinarians and veterinary students. Understanding medicine is truly a gift and it opens up countless pathways in life! If you are interested in hearing more about IVO and the opportunities that they offer you can click here.
After lunch we had the first part of our case-based discussion followed by a urinalysis lab. This discussion went over all of the clinical exam findings for our case which involved a dog with renal issues (obviously). We concluded that our dog potentially had nephrotic syndrome. Nephrotic syndrome is classified by significant proteinuria, hypoalbuminemia, hyperlipidemia, and edema, all of which were seen in our patient's laboratory work. We have another discussion session next week to analyze the kidney biopsy results. The urinalysis lab was a fun way to put the past week’s lecture material to the test and actually run through the whole procedure. The rest of the day involved some quality time with Churro and some studying.
Tuesday kicked off with a nice run with Churro followed by a discussion on upper urinary pathophysiology. This discussion was a great way to bring all of the prior lectures together and tie in the clinical correlations. It is always interesting to see the gross pathology images and understand how it ties in to the clinical signs that we may see in our patients! The rest of the afternoon was blocked off so that we could all prepare for the upcoming midterm exam. Tuesday evening I was able to escape the study grind and had the opportunity to attend a fun CE dinner with Dr. Yamate! This talk was sponsored by Antech and was focused on GI parasite screening utilizing the KeyScreen GI Parasite PCR Panel. Dr. Craig Prior presented a lot of nifty business tips and the importance on staying on top of parasite screening and preventatives. After a nice little chat on the absolute foulness of dog parks and other highly trafficked environmental areas, he discussed the advances in GI PCR and how it can help with the diagnosis of benzimidazole-resistant hookworms, and potentially zoonotic assemblages of Giardia duodenalis. This PCR test also screens for 20 intestinal parasites and has been seen to detect 2x more infections when compared to in-clinic fecal flotation. Once these parasites are detected, Antech can help provide information on how treatment should be approached. It was interesting to learn about the advances in GI PCR testing and the impact that it can have on the health of animals and the people who love them.
Wednesday morning started with a quick run around the block with Churro followed by the second exam of the renal block. This exam was a nice way to check in and see where we were at with the material. There is roughly one week left in the block and exams are always a good way to see how the information has settled in. The rest of the afternoon was free so Morgan Katelyn, Lily and I went to Granite Bay and got some quality time on the water. I was able to get an awesome 2.5-mile swim in while they paddle boarded around the bay. Being in the water is one of my absolute favorite things and having the ability to do this in the middle of the week is awesome! This mini day-trip was a wonderful way to relax after the exam and get refreshed for the rest of the block!
Thursday was a day full of lectures on clinical signs of urinary tract infections, their causes, and how they should be treated. It was interesting to see how treatment has changed and was refreshing to hear about shorted antibiotic courses and even the turn towards holding off on antibiotic administration. It is now suggested that sporadic urinary tract infections (bacterial cystitis with clinical signs) should be treated for 3-5 days with antibiotics while recurrent urinary tract infections should be treated for 7-14 days, and the therapy should be based on susceptibility testing. Short-term therapy is likely to have better owner compliance while still achieving the goal of a clinical cure (loss of clinical signs). If there are no signs present, it is recommended to hold off on antibiotic treatment. The second lecture of the morning was on uroliths which are stones in the bladder. This was an awesome lecture and helped tie together a lot of my clinical experience. We learned about the different composition of these stones and how they can be removed and prevented. We also learned about certain breed dispositions and genetic markers that predispose animals to developing these stones.
Below is a radiograph of a dog with large uroliths and what they looked like outside of the dog. If you are not used to looking at radiographs, try looking at the stones and then trying to find where you think they are in the image on the left. As you can probably imagine these do not feel great and cause a lot of trauma to the bladder wall!
Fun Fact: Many Dalmatians have a mutation in the SLC2A9 gene which causes a defect in uric acid transport. The SLC2A9 gene encodes a urate transporter protein which is responsible for the reabsorption of uric acid from the renal tubules back to the bloodstream and since Dalmatians have a defect in this gene, the function of this transporter is greatly impaired. This leads to a higher amount of uric acid secretion in the urine which predisposes them to the formation of urate uroliths. These dogs can be managed with dietary modifications and medications like allopurinol which reduces the production of uric acid in the body by inhibiting the enzyme xanthine oxidase. Thursday afternoon included a lecture on lower urinary tract disease pathology followed by some time in Dr. Yamate’s clinic. Spending time in the clinic with her and her team is always a blast!
Friday began with a hot yoga session followed by a histology lab focused on the lower urinary tract. We then transitioned into an anatomy lab which was an awesome way to put together the past lectures. We had the opportunity to place urinary catheters as well as practice performing a cystocentesis on a cadaver. This lab also had some awesome comparative anatomy demonstrations. It’s super interesting to see the ways that different species have developed over time and how they all still have a fairly similar anatomic basis.
The rest of the afternoon involved a nice discussion section with a plethora of cases that helped solidify the information from the past few weeks. The rest of the evening included some nice field-time with Churro and some lecture review.
Saturday started off with a quick three miler followed by Steve’s inferno hot pilates class. The class was once again a humbling way to start the day especially with the bonus burpees at the end of class. The rest of the morning consisted of some lecture review followed by some pre-vet mentoring. This time of the year is always super exciting because everyone is getting ready to submit their applications! I also love connecting with old friends and helping them work through their essays/applications and achieve their goals! Saturday afternoon involved a lot of frisbee time with Churro.
Sunday started off with and 8 mile run with Churro followed by some lecture review, more pre-vet mentoring, and preparation for the renal final exam!
Quote of the week: “Oh that is ripe!” – Dr. Viall after wafting the urine sample during the urinalysis demonstration
*As a side note, all of the renal notes have now been updated and are on the notes page. Enjoy learning the nitty gritty of renal anatomy and physiology!
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