Beyond the Vet School Walls – Week 1 of Mentor Rotation

The last weeks have been busy on the general practice rotation. Having spent the last 3 months within the vet school walls, I seriously started counting down the days until I could break away. Exhaustion was starting to take its cumulative effects on me. Even though I had no ICU patients, or extremely demanding cases, fatigue just crept up on me slowly. But after getting everything packed up and ready for the next four weeks, I got a second wind. The veterinarian I am shadowing is located 5 hours away from the veterinary school, and that feels like plenty of breathing room. This has been a rotation I’ve been looking forward to for months, mostly because I want to load up on mobile practice experience. The experience here will be most relevant to my career goals as a mobile equine vet, as opposed to the veterinary teaching hospital’s case load as a tertiary referral center.


4 WEEKS in the FIELD TRUCK

Two credits spent shadowing a veterinarian are mandatory within our curriculum. There is also the option of doing an additional two credits, making the experience out of the veterinary teaching hospital a total of four weeks. Not to be used for working interviews, this professional experience is more like a preceptorship or mini-internship. Unlike the preceptor, the veterinarian/hospital chosen for the rotation can be any location or individual of our choosing. I picked a reputable mobile equine practitioner that works in my hometown, an experience most likely to resemble the position I am seeking. With an emphasis on sports medicine, his spectrum of clients are much wider than I anticipated. With a robust clientele, he also doesn’t currently see new clients. English disciplines make up the majority of the equestrian work he does, specifically dressage and hunter/jumper. While familiar with these disciplines (I used to ride hunter/jumper in the days before college), I am fairly unfamiliar with the racetrack world. Fortunately, I picked an enthusiastic mentor to follow around and look forward to spending more time around the track.

My first week in the truck, we mostly saw wellness appointments such as exams, dentals and preformed vaccinations. We also did lameness exams and joint injections. Most joint injections were straightforward, hocks for jumpers and the occasional coffin joint. Depomedrol and Hylartin were the most frequently used injectable agents.


AND THEY’RE OFF!

Our visits to the track were in preparation for opening day at the races, so we checked about 20 horses for one particular client. Most of the emphasis was on the thoracic limbs, where significant amounts of wear and tear occurs. Signs indicating possible areas of concern included joint swelling, joint pain upon palpation, sensitivity to flexion of the distal limb, pain elicited by palpation of the flexor tendons and suspensory ligament, degree of movement of the sesamoids and any other palpable abnormalities in the distal limb.

The fast pace of the track left me feeling lost at times, not to mention the fact that my unfamiliarity with racetrack culture meant I was left high and dry when it came to interpreting track lingo and jargon. I usually try to make a mental note or better yet, a physical one, so that I can look up the phrases later. I didn’t dare reach for the notebook this week, for fear that I might look up and find everyone gone. Instead, I just focused on keeping up with the exams, radiographs, treatment plans and made sure I didn’t do something that might slow everyone down.

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Being surrounded by a conversation spoken in a language you don’t understand can be uncomfortable and intimidating. I was definitely feeling the pangs of ostracism while trying to decipher and deduce what was being said. Unfortunately, I was met with little success and the speed at which we worked did not allocate time for translations. I decided to focus on the tasks at hand for the time being. My evenings would then be spent on race-savvy sites, trying to familiarize myself with this foreign jargon.

Aside from the language barrier, I also tried to keep mental track of the medications we were administering, discontinuing or considering implementing. I managed to scribble about 10 of the most common medications at the end of the day, and eventually got around to looking up some racetrack medication references. On one such site, I found this concise list of frequently used drugs. It is pasted below, and I although prices vary, I like the fact that there a rough estimate on the costs of these medications. Establishing and calculating prices, fees and overall billing is something our rotations don’t address in fourth year. And as a veterinary school, the overall charges tend to be cheaper than in practice. I have pasted the information I found, along with the source to be credited.


COMMON MEDICATIONS AND INJECTIONS

RACETRACK MEDICINE

ADEQUAN: a common ANTI-ARTHRITIC medication used to stabilize articular CARTILAGE. It is also used prophylactically to PREVENT day-to-day loss of cartilage components. Cost: $65 per injection.
Anabolic steroids: an anabolic steroid such as Equipoise is used to improve appetite, repair tissue, promote weight gain and accelerate recovery from disease or injury. Anabolic steroids may cause aggressive behavior in mares or geldings and have adverse effects on the reproductive function of mares and stallions. Cost: $50-$60 per injection.
Banamine (flunixin meglumine): Like aspirin and bute, a nonsteroidal anti-inflammatory drug that is available in injectable and tablet form. It is commonly used to treat colic. Cost: $20 per injection.
Clenbuterol: A bronchodilator used to treat respiratory disease. Its trade name is Ventipulmin. It works by relaxing smooth muscle tissue in the airways, returning constricted air passages to normal size.
Cortisone: a common corticosteroid used to treat joint inflammation. It is injected into the joint and has shown effectiveness and safety in some joint disorders. However, research has shown that using corticosteroids in equine joints sets in motion a destructive cycle. Prolonged use of corticosteriods is considered one of the primary causes of degenerative joint disease or osteoarthritis. Cost: $50-$150 per injection.
De-worming: given at least four times per year. If an oral paste is used, trainers may administer it themselves. Cost: $25-$30 per treatment if administered by a vet.
Furosemide (trade name Lasix): a diuretic used for the prophylactic treatment of exercise-induced pulmonary hemorrhage (EIPH or bleeding), which is believed to work by lowering pulmonary-arterial pressure. Cost: $30-$40 per injection for racing.
Gastrogard (omeprazole): an oral paste used to treat equine ulcers. Cost: up to $50 per day.
Gentamycin: a broad-spectrum antibiotic. Cost: $30-$50 per injection.
Hyalronic Acid: also known as hyalronate or hyalronan, is the natural lubricant in the joints. It is injected into the joint, sometimes with cortisone, to reduce inflammation. Cost: $50-$150 per injection.
Penicillin: an antibiotic. Cost: $15-$20 per injection.
Phenylbutazone (bute): a nonsteroidal anti-inflammatory drug that is available in injectable and tablet form. Cost: $17 per injection or $30 for 100 1-gram pills.
Premarin: an old-style remedy for bleeding which is thought to work by strengthening capillaries. Cost: $70 per injection.
Vitamin “jug”: usually a mixture of vitamins and electrolytes in ½ to 1 liter of fluids administered after strenuous exercise. Cost: $30-$40.

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All in all, this first week has been going great. I have been enjoying the various barns and facilities that we visit, and 95% of the clients have been friendly, agreeable and interesting. The traffic has been horrendous, taking a nasty toll on our commute times to farm calls (90% are farm calls). My mentor has been patient and understanding, especially since I have not worked with him before. He has a similar theory to me, that there is more than one way to skin a cat…and although he may have different techniques, the ultimate outcome has been the same. I am eager to learn a variety of different techniques as this only adds to my repertoire of skills.

I am excited for the next 3 weeks, and the cases that are on the horizon. I already feel like I’ve learned more in a couple days than I learned on 4 weeks of rotations. There are several specific things I would like to see more of, and hopefully some opportunities will present (not that I am hoping for sick animals in a sadistic way, of course!!)

What I WOULD LIKE to see more of

– Emergencies {lacerations, colics}

– Pre-purchase exams

– “Nerving”

– Standing castrations (we don’t do this technique at the vet school)

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