Help with math.

I find myself teaching people pharmacology math a lot.  It's a subject a lot of people approach with fear, but if you can let go of the fear and bear with me, I can definitely teach you:

It all comes down to this:

Divide what you WANT by what you HAVE:

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If you WANT 300mg and you HAVE 150mg tablets:
Divide 300mg by 150mg (300 / 150) = 2 tabs

To double-check yourself, reason it out:
The tablets are 150mg each.  So, if you give 1 tablet, that's 150mg.  If you give a second (150mg + 150mg) that's 300mg and that's what you want.  So, you need 2 tabs.
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If you WANT 800mg and you HAVE 100mg/ml solution:
Divide 800mg by 100mg/ml (800 / 100) = 8ml

Again, use reason to double-check:
The solution is 100mg/ml.  That's 100mg in each ml.  So, the first ml is 100mg, add another ml and get 200mg, add a third, you get 300mg, etc until 800mg at 8ml.
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Now, let's try less easy numbers:

You need to give 144mg.  You have 16mg tablets.  How many do you need?

Want = 144mg.  Have = 16mg.  144 / 16 = 9 tabs.
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You need to give 42mg.  You have 14mg/ml solution.  How many ml do you need?

Want = 42mg.  Have = 14mg/ml.  42 /14 = 3ml.

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How many 75mg Rimadyl tablets does Fluffy need if he was prescribed 225mg per dose?

Want/Have.  225 / 75 = 3 tabs.

Be careful not to switch your WANTS and HAVES!

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Kitty needs 0.06mg of Bupernorphine per dose.  You have 0.3mg/ml Bupernorphine.  How many ml does Kitty get per dose?

Want/Have.  0.06 / 0.3 = 0.2ml

Reasoning this one out is a bit harder, but is still possible if you move the decimal 2 places to avoid dealing with such small numbers.  If you do this you end up needng 6mg of Bupernorphine and you have 30mg/ml.  The first ml is 30mg.  Whoa!  Too much!  We only need 6mg!  So, a half of a ml (0.5ml) is 15mg.  Half of that is a quarter ml (0.25ml), 7.5mg -close, but too much.  Half of that is an 8th of a ml (0.12ml) and 3.8mg -too little.  So, the answer is somewhere between 0.25ml and 0.12ml and closer to 0.25ml.  This matches up with what we got!

If you are a little better with math you may have noticed in the above reasoning that at the first step 1ml, 30mg is 5 times what we need.  This means you need a 5th of a ml which is 20% or 0.2ml.  If you don't see that right away, that's ok.  The long way still works and math comes back the more you practice!

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The last one was a hard one.  Did you get it?  Contact me in the comments or on Facebook with any questions!

2.5 years later...

I forgot about this blog until someone Facebook messaged me recently because they were nervous before starting the program this fall.  So, I figured I'd give the blog a little update on what's going on with me post-graduation and post-certification.

First, this is a story about the fact that you never know where this career can take you.  I went into the program married and living in a house in Aurora, IL.  I was happily volunteering in a shelter that did spays and neuters and thought my interests were shelter medicine, surgery specialty, or general practice.  In my second year Eileen (our Exotics and Clinical Pathology II teacher) reminded my class that there were a lot of opportunities available for our second externship:  zoos, research labs, wildlife rehab, marine mammal rescue, exotics practices...  I just froze.  Marine mammals?  I had been fascinated by them since I was a little kid!  Could I really work with them?  I worked hard and ended up getting an externship approved at the Marine Mammal Center in Sausalito, California.  They offered no housing, but my husband happened to get a job offer to work at Twitter in San Francisco at around the same time.  We flew out for his interview and to check out the area; he took the job, and moved out there right away while I finished school.  That gave me a place to stay for the externship and so, I took it! The rest is history.  At the end of my externship I was absolutely in love with the idea of helping to not only rehabilitate seals and sea lions, but also help Marine Mammal Center work with many other organizations to do all sorts of research to benefit marine mammals, humans, other animals, and the environment.  Even though my husband and I divorced shortly after graduation I got my own place, continued volunteering at Marine Mammal Center, and got a job at a very busy small animal clinic.  I love the Bay Area and am really excited that I've been working at Marine Mammal Center (paid!) as a Fill-In Vet Tech pretty regularly for about 8 months now!

I have to say JJC gave me an amazing foundation to build upon once I graduated.  Large animal class was a lot of fun, but I never thought I'd really use the skills I learned like herding cattle.  But, being in a pen with sea lions and getting them to move is a lot like herding cattle!  Also, all that work at the microscope in Clinical Pathology class really paid off.  With lots of practice (because I like microscope work) the doctors at the small animal clinic I work at now as ME to give them second opinions on their slides!  I've also caught incorrect dosing, drug interactions, and am trusted at my small animal clinic to premed, induce, intubate, prep, and monitor for anesthesia with little to no help from a doctor.  I get complements on my x-rays, understand the views the doctors require based on the animals' presenting complaint, and am comfortable doing exams on my own and writing in medical records (in SOAP format).  All these things I learned at JJC and perfected on the job!  I've met lots of students from other schools and I'm certain JJC students are some of the best.  Dr Keller is really hard on his students, but it pays off once you're on the job so keep that in mind when you're upset that you studied so hard and got a C on one of his killer Keller exams!

All in all life is good.  If you have any questions or comments feel free to add them here or find me on Facebook.  I'm happy to help ease jitters, listen to rants from current students, tutor via email/FB, or whatever!

Compounding Math

Pharmacy math is often intimidating, but it is really important that we get it right, so here's a little post aimed at making you more comfortable doing compounding math.

1.  Make 10ml of Methimazole with 5mg tablets at 5mg/ml.

We need 10ml at 5mg/ml.  That's 5mg for every ml. 
So, if we want 10ml, we multiply top and bottom by 10. 
That's 5mg X 10 = 50mg in 1ml X 10 =10ml.

We need 50mg of Methimazole and our Methimazole is in 5mg tablets.
So we divide 50mg by 5mg to get the number of tablets we need:
50 / 5 = 10.  We need 10 tablets.

And our total volume is 10ml, so we need 10 tablets in 10ml of solution.











2.  Make 30ml of Doxy from 50mg capsules at 25mg/ml.

We need 30ml at 25mg/ml.  So, multiply the top and bottom by 30:
25mg X 30 = 750mg.  1ml X 30 =30ml 
So we need750mg of Doxy in 30ml of solution.

Since our Doxy is 50mg we need to know how many capsules to use to gt 750mg:
750mg/50mg capsules = 15 capsules
So, we need to use 15 capsules and 30ml of solution.


3.  Make 20ml of 15mg/ml Meloxicam from 7.5mg tablets.

We need 20ml at 15mg/ml.  So, multiply the top and bottom by 20:
15mg X 20 = 300mg.  1ml X 20 = 20ml
We need 300mg and we have 7.5mg tablets, so:
300mg/7.5mg tablets = 40 tablets in 20ml of solution.


4.  Make 12ml of 25mg/ml Baytril from 100mg/ml (injectable) Baytril.

This is a little different since our medication is liquid.  In the above problems our total volume and amount of solution needed were always the same, but for liquid medications the medication's volume has to be taken into account as part of the final solution, so we need to use the formula: 
(C1) X (V1) = (C2) X (V2)

Original concentration (C1) = 100mg/ml Baytril
Original volume (V1) = unknown amount of Baytril
Final concentration (C2) = 25mg/ml Baytril
Final volume (V2) = 12ml of solution

So:  100 X (x) = 25 X 12
Multiply each side to get:  100x = 300
Solve for x:  300/100 = x, so x = 3

So, we need 3ml of Baytril.
And we need 12ml total.
So, 3ml Baytril and the rest of the volume will be solution.
Find the amount of solution by subtracting the amount of Baytril from the total volume:
12ml total - 3m Baytril = 9ml of solution


5.  Make 4ml of 10mg/ml Baytril from 100mg/ml (injectable) Baytril.

4 X 10mg = 40mg
4 X 1ml = 4ml

C1 = 100mg/ml Baytril
V2 = unknown amount of Baytril
C2 = 10mg/ml Baytril
V2 = 4ml

100 X ? = 10 X 4
100X = 40
X = 40/100
X = 0.4

0.4ml Baytril

Total solution = 4ml
4ml total = 0.4ml Baytril means 3.6ml of solution will be used.

Old Ray

At my externship at Marine Mammal Center back in March-May we had a California Sea Lion "restand" (meaning he'd been picked up, rehabilitated, and released before) named "Old Ray".

The backstory is that when Old Ray was picked up the first time the vet suspected leptospirosis, a parasite that attacks the kidneys.  But, when he was sedated for an exam, they noticed some hard lumps on his neck and decided to take some x-rays.  The radiographs showed that Old Ray had shot gun pellets and a bullet (probably a .22 caliber) lodged near his jaw.  But, because he had no wounds the vet decided that the bullet and shot were just incidental findings.  Old Ray was fattened up and when at a decent weight and acting well, they released him.

Shortly before I started at Marine Mammal Center in mid-March, Old Ray was picked up again.  He was reported by a concerned citizen that said they saw blood coming from his eye.  So, once again, Marine Mammal Center's Rescue team went out, caught him, and brought him back to the medical center in Sausalito, Ca.

This time Old Ray's left eye was severely damaged or missing and the right eye appeared to have a cataract. It was clear that if he could see at all his vision was not very good.  So, Old Ray was sedated and more x-rays were taken in order to determine if he had been shot again.  Unfortunately, because there were so many pellets on the previous radiograph, it was difficult to tell if he had been shot again.  Either way, Old Ray's prospects of being were not good if he couldn't see, so they started the paperwork required to try to place him in a zoo.

Once the paperwork was filed and it was clear that Old Ray was going to be staying with TMMC for awhile, the vetstaff decided to move him to a larger pen with a bigger and deeper pool and I was lucky enough to be one of the people who got to move him to the new pen.  I can't tell you how great it was to watch him feel the pool, then dive in and go straight to the bottom before jumping out on the other side and seeming to look (or more likely smell) at the beautiful rocky beach viewable from his new home.

I left to go back to Chicago with a quick goodbye.  After the move I was careful not to spend too much time with Old Ray because it was clear I had some affection for him even though there was no guarantee that a happy ending was in store for him.  So, when I moved to the Bay area in June and went back to volunteer at Marine Mammal Center, it was with some caution that I inquired about Old Ray.

It turned out he was still there, but he had undergone cataract surgery.  While Old Ray was pretty laid back and calm before the surgery, after it he became much more active and more aggressive.  Immediately the vet staff stopped any training he was undergoing and they are now evaluating him once again for release!

Due to space constraints, however, since I've been back Old Ray has been back in a smaller pen.  Today he got a new penmate, though!  A small sea lion pup named Whirlybird.  Whirlybird was rescued because he is blind.  It appears he had some trauma to both eyes and the penmate he was with was bullying him and not allowing him to eat.  So, the vet staff decided to try putting him in with Old Ray.  They were an unlikely couple since Old Ray is a very large adult, but again I was lucky enough to be on the team of people that moved Whirlybird.

So, we opened Whirlybird's pen and "boarded" him out of his old pen and into the new one (basically pushed him with large wooden shield-like boards).  When Whirlybird entered the pen, Old Ray came out of the water barking.  But quickly his barks grew softer.  And he moved closer, sniffed Whirlybird, and then backed up.  He continued a repetitive, soft bark while backing up the ramp that lead into the pool.  And eventually Whirlybird caught on and followed the sound of Old Ray's barks and entered the water.  Old Ray followed and they swam together for awhile before Old Ray allowed Whirlybird to have the pool to himself.

We let them be at that point, but when it came time for the afternoon feed I quickly grabbed the fish bucket for Old Ray and Whirlybird's pen to see how they'd do eating together.  When I arrived at the door, Whirlybird was sitting right in front of the door and Old Ray was in the pool.  I entered the pen to try to board Whirlybird into the pool (they can only be fed in the water to simulate the hunting in the water that they need to do in the wild).  But Whirlybird would not move.  I threw a couple fish in the pool and Old Ray began barking once again.  When I tried again to push Whirlybird up toward the ramp to the pool, Old Ray came out of the pool and toward me and Whirlybird.  Since he's an adult sea lion I quickly retreated from the pen and called in a more experienced person to help.

A fellow volunteer, Stan, entered the pen and Old Ray was at the top of the ramp barking at Whirlybird.  When Stan pushed Whirlybird toward the ramp Old Ray just watched silently for a moment and then began barking again.  Whirlybird then started moving forward and Old Ray backed up and continued barking until Whirlybird made it into the water and then Old Ray jumped in.  We were then able to dump the fish in the water and leave them to eating.

It was so heartwarming to see the interaction between those two and I'm happy to say that Indianapolis zoo is currently thinking about taking Old Ray if he starts doing better in confinement and if he's  not deemed well enough to release!  It's a good thing too because if I wasn't attached to this poor dude before I certainly am now!

Board Review Session 5-21-12

Resources:
VetMedTeam -review course
www.capcvet.org -parasite review and iphone app
zukureview
www.vettechprep.com
itunes.apple.com/us/app/vtne-exam-prep-veterinary
www.vtstudy.com

Job Sites:
www.vetquest.com/classifieds
www.wheretechsconnect.com
navta.net
vettechplus.com (Canada)
vettechrelief.com (temporary/relief work)
veterinaryteamjobs.com
our "official" Facebook page (will be out in the next week or 2)

Recommended books:
Practice Questions: http://www.amazon.com/Review-Questions-Answers-Veterinary-Technicians/dp/0323068014/ref=sr_1_2?ie=UTF8&qid=1337635934&sr=8-2
Review/overview: http://www.amazon.com/Mosbys-Comprehensive-Review-Veterinary-Technicians/dp/0323052142/ref=pd_bxgy_b_img_b
Review and Practice: http://www.amazon.com/Veterinary-Technician-Exam-Editors-LearningExpress/dp/1576857387/ref=pd_sim_b_3

Surgery:

• A ventilator would connect where the reservoir bag goes because it does exactly what you'd do manually ventilating the patient.
• In the circle: manometer, CO2 absorbent, reservoir bag, valves to keep everything circulating in one direction, the patient
• Out of the circle: vaporizer (precision), flow meter, etc.
• Rebreather: circle, changes take 2-5min to take effect
• Non-rebreather: no absorbent, changes take effect in about 30sec, usually for smaller patients (under 15kg)
• Reservoir bag sizing: ~10ml/kg minimum X 5-6.  If 10kg = 100ml X 5 = 500ml.  Always use the next size up, so 1L.
• If a reservoir bag is too big there's more dead space which means it takes longer for changes to take effect and you can't see the bag moving making monitoring respiration harder.
• Manometers measure in 1 of 2 units: cm of H2O or mmHg.  Normal breathing should not excede 4cmH2O or 2-3mmHg and when bagging you should not excede 20cmH2O or 14mmHg.
• Atelectasis = the collapse of alveoli (they stick together), we sigh patients periodically during surgery to prevent this.
• Rebreathing types: 
• Closed: doesn't necessarily mean the pop-off is off, just that you are only meeting and not exceeding the oxygen needs of the patient.  No waste.
• Semi-closed: oxygen requirements are exceeded, excess is vented, what we usually use, wasteful, but easier to manage/safer
• Open: face mask, cat box, etc causes increased stage II excitement, most wasteful
• Barbiturates: long acting, short acting, ultra short acting.
• Hepatic enzyme inducer = metabolized faster once activated, like alcohol tolerance, it builds up over time and continued use (mostly an issue with phenobarbitol use in epileptic patients). 
• lowers RR and HR, apnea expected after bolus is given
• Protein-bound: blood proteins are albumin and globulins, both made by the liver.  
• When bound to protein it is inactive, but this is accounted for in the dosing.  A patient with a lower TP has less inactive drug and can OD.  
• Lipid soluble: ultra short acting is the most lipid soluble.  Blood is water, the lipid soluble drugs pass the blood brain barrier.
• Water soluble gas anesthetics act slower and clear the system slower, they last a long time because they don't want to leave the blood (water).
• Fat soluble gas anesthetics act quicker and clear quicker because they readily leave the blood and are blown off by the lungs.
• MAC: Minimum Alveolar Concentration, the percentage of gas that causes movement to stop in 50% of patients.
• Maintenance is estimated to be MAC X 1.5, so a gas anesthetic with a MAC of 2 will have a maintenance around 2 X 1.5 = 3%.  (This is without premed.)
• Avoid barbiturates in sighthounds and very thin animals.
• Obese patients require a lower dose and wake quicker.
• Thin patients can OD because there's no fat for the drug to attach to.
• Slough when given perivascularly.  If this happens, infuse with fluid, heat, and massage.Non-reversable
• Not analgesic, so more is required for painful surgeries.  Also don't prevent wind-up
• The following potentiate bartiturates: low TP, acidosis, hypovolemia, atropine, hypothyroid (lower metabolism)
• Ace is contraindicated in boxers, stallions (penile prolapse)
• Atropine is contraindicated in ruminants (decreases gut motility)
• MAC vs MIC, MIC is Minimum Inhibitory Concentration, used to find the antibiotic dosage that'll be effective against a problem bacteria
• Culture & Sensitivity: the size of the zone of inhibition does not determine the efficacy of a drug by itself.  The size of the zone is effected by the size of the molecule as well as by it's efficacy, so a table is referred to to decide which drug is more effective.
• Narcotics are potent respiratory inhibitors.
• Math: There are many C1 C2 = V1 V2 problems on the exam.  Dr Keller suggests changing all concentrations to mg/ml and all volumes to ml.  Also be VERY careful not to answer with the final volume if what they are asking for is the amount of water that needs to be added!!!
• 1 grain = 60-68mg.  Use 60mg and choose the closest answer from the multiple choice.  Atropine comes in 1/120gr which is 60mg/120 = 0.5mg.
• Vaccines:
• Dogs:
• Blue eye is associated with Adenovirus 1, Adenovirus 2 does not cause symptoms and is used in current vaccines.
• Borellia burgdorferi = Lyme
• Paralyzes cillia = Bordatella
• Effects the tips of villi = Corona
• Kills crypt cells (which create villi) = Parvo
• Causes hard pad = Distemper
• Causes enamel hypoplasia = any illness that causes extreme hyperthermia (Distemper is one)
• CS include URI: Distemper, Hepatitis, Parainfluenza, Bordetella
• Cats:
• Pneumonitis = Rhinotrachetits 
• Non-enveloped virus = Distemper (feline parvo-like virus)
• Panleukopenia = Distemper 
• Rhinotracheitis = a herpes virus, URI symptoms, canker sores especially on cornea, goes vanerial and causes abortion if cat is pregnant
• Retroviruses: FIV, FVLV
• Bacterial = Chlamydia
• Spread through aerosol: Rhino, Calici
• Spread through vomit and diarrhea = Distemper
• Spread through close contact / body secretions:  FIV (Feline Immunodeficiency Virus)
• FIP cannot be caught, it's FECV (Feline Enteric Corona Virus) that mutates within the body to become FIP
• FVLV exposure results in:
• fought off, complete recovery
• dormancy, hides in bone marrow
• CS
• FVLV can be tested via ELISA and IFA.
• ELISA: usually in-house, only tells you an animal was exposed, not if viremic or not.  If positive, an IFA should be done 6 weeks later.
• IFA: will be negative if the virus is completely latent, done 6 weeks after an ELISA to try to catch it before it'd be completely dormant
• Heart:
• S1 = 1st sound, A/V closure, systole, highest BP, louder, longer, lower pitch, "lub"
• S2 = 2nd sound, SL closure, diastole, lowest BP, softer, shorter, higher pitch, "dub"
• mitral valve = bicuspid
• oscillometer measures blood pressure and gives a digital readout
• doppler measures blood pressure and requires you to listen
• MAP = Mean Arterial Pressure (most accurate BP measurement)
• Murmors are graded I-VI, 6 is worst, 5 & 6 have a "thrill". Can also be described as systolic/diastolic, crescendo/decrescendo, holosystolic, PDA, etc
• Left side: PAM (pulmonic = most cranial, aortic = middle, mitral = most caudal)
• Right side: Tricuspid
• EKG's
• P = atrium depolarization
• QRS = ventricle depolarization
• T = ventricle repolarization
• Insufficient means not fully closed, Stenotic is not fully opened (actually the vessel is narrowed not a valve problem)
• Drugs:
• Alpha 2 Agonists: xylazine, Domitor, detomidine
• Benzo's: valium, medazolam
• Organophosphate toxicity: SLUDDE (salivation, lacrimation, urination, deficiation, diarrhea, emesis)
• Treated with atropine
• Phenothiazine derivatives: Chlorpromazine, Ace
• Alpha 1, 2 and Beta 1 and 2 stimulents = epinephrine, norepinephrine (sympathomimetic)
• Cappa and Mu receptors are effected by Narcotics
• Anticholenergic drugs are anti-rest eg Atropine
• Ceiling effect = butorphanol (has an agonist/antagonist effect, used for anti-cough, analgesic, but blocks other narcotics)
• Horses:
• Lipazzan origin: Spain
• Horse found in the Bedouin desert: Arabian
• Draft breed in england = Shire
• Racing horse in US: Quarter horse
• Long distance horse: thoroughbred
• Walk/run horse: Tennesee Walking horse
• Bred for speed: Apaloosa
• Strength: Arabian
• Original horse breed = Morgan
• Nez Pierce horse = Apaloosa
• Belgium = Belgian
• Before WWI only 3 sires existed = Friesian
• Knights used = Shire
• Pink skin, amber eyes = Cream Draft
• 14.2 hands to the wither
• Polyestrus: cow/sow
• Seasonal polyestrus: 
• horses (late winter to spring/summer, when light increases)
• goats/sheep (as light decreases)
• TDN: total digestive nutrition = the amount of energy in a food, corn is high in TDN, beans are lower, but higher in protein.
• Ketosis: happens because colostrum is high in sugar, Tx is IV Dextrose fast with Dexamethasone (which makes the liver squeeze out sugar)
• All animals are born immunocompetant (able to make antibodies), colostrum is needed to get over being exposed to so many new antigens after being born.
• Milk Fever is caused by low calcium -all of it is put into the milk.  Tx is IV 23% calcium gluconate SLOWLY!!! 
• Causes "wry neck", animal can't move neck because calcium is needed for nerve function
• Fat has 2.25 X the energy of carbs.
• Calcium is made from vitamin D3 and sunlight (UV)
• FAD: Foreign Animal Disease
• Anthrax: anaerobic, spore forming, DON'T OPEN CARCASS!, prevents clotting, if spores are inhaled it's 99% fatal
• Foot and Mouth Disease: effects cloven hoofed animals (horses are immune as are carnivores)
• Hog Cholera 
• Trichanosis (uncooked pork)
• Toxoplasma gondii: definitive host = cat
• PRRS (Porcine Respiratory & Reproductive Syndrome), causes pneumonia and abortion, an concern at zoos
• Roughage vs Concentrate: 
• Concentrate has more protein (corn, beans) but cause obesity.
• Roughage =  hay
• Hind gut fermenters: horses, 
• Pre-gut fermenters: bovine, end product of ammonia is used by bugs for protein
• Ammonia converted by hepatocytes into urea and diluted and excreted by the kidneys as urine
• High BUN with normal kidneys can be caused by a blocked cat, cachexia, malnutrition, starvation
• #1 nutrient = water!
• 8-21% is the minimum protein needed by domestic animals in their diet. Younger animals need more protein than older ones.
• Selenium is deficient in the midwest and over abundant in the west
• Feed additives:
• males are given female hormones to make their muscle soft
• females are given male hormones to make more muscle
• CMT = California Mastitis Test, tests for DNA (the cow's somatic cells or bugs')
• Bulk tank, SCC (Somatic Cell Count)
• Withdrawl time must be kept in mind when antibiotics and other drugs are given.
• Iron shots given to piglets because there isn't enough in pig colostrum
• IgG is found in colostrum
• A colt turns 1 year old on January 1st
• Anatomy names: pastern, fetlock, canon, splints, knee, stifle
• Left paralumbar fossa = auscultation of rumen
• Right paralumbar fossa = auscultation of horse cecum
• Paralumbar fossa landmarks: last rib, lateral process of the lumbar vertebrae, external abdominal oblique
• Esophagus is on the left side
• Iron shots should not be given in the ham muscle because it turns the meat black
• In carnivores the colon is dorsal to the cecum and the cervix is dorsal to the bladder
• Horse Diseases
• EIA (Equine Infectious Anemia) aka Swamp Fever, Coggins test
• EEE/WEE/VEE: transmitted through arthropods, hard to isolate once an animal is positive
• EME
• Rhino -40% of respiratory disease in shows, a virus
• Shipping fever
• Strangles caused by Strep equi, LN swell and "strangle"
• Flu
• most viruses cause abortion
• When visiting a farm with sick or dead animals the order of examination should be: babies, old animals, pregnant animals, and sick/dead animals LAST to prevent spread of infectious disease.
• Tetnis -the bacterial toxin causes death, paralyzes muscles, saw horse stance, lock jaw, nictitating membrane prolapse, hyperesthesia, can be transmitted through open castration.
• Naval/Joint Ill: caused by umbilical infection -DIP IT!!!
• FPT: Failure of Passive Transfer.  
• Colostrum needs to be received in 12-24hrs.  
• After that IV GGT can be given, but not orally because the intestines can no longer absorb the large molecules.
• Colostrum banking: freeze 1 pint of colosturm, lasts 1-2years.
• Can use cow colostrum in horses if nothing else is available
• Founder: ventral rotation of the 3rd phalanx.
• Insensitive lamina grows on the hoof inward
• Sensitive lamina grows on the bone outward and interdigitates with insensitive lamina
• Paravertebral nerve block
• proximal paravertebral nerve block, dorsal roots and ventral roots
• Bovine Diseases
• BRD: Bovine Respiratory Disease
• Red Nose
• Ruminations occur at 2x/minute
• Esophageal/Reticular groove: allows milk to bypass rumen and go to abomasum for absorbtion
• Foot & Mouth Disease, deer can be carriers
• Neosporum caninum -dogs and canids are the host, cause abortion in bovine
• Displaced abomasum
• Rumination: regurgitation, remastication, reinsalivation, redeglutition
• Milk is weighed in pounds
• Disinfection of teats is done far to near
• Milking is done near to far
• Reproduction
• Baby pigs prone to hypothermia
• Piloerector muscle causes hair to stand (goosebumps), aids to preserve warmth, but doesn't work when hair is wet, or covered with mud/feces
• Anterior Pituitary makes ?
• Posterior Pituitary secretes oxytocin
• Hypothalamus makes oxytocin
• FSH: Follicle Stimulating Hormone
• Estrogen: made by follicles
• Estrogen produces signs of heat
• LH (Luteinizing Hormone) causes ovulation and makes the CL (Corpus Luteum)
• Egg is released into peritoneum, estrogen causes fimbria to direct egg into oviduct
• Oxytocin causes milk letdown and uterine contractions
• In mares 1 CL is not enough to maintain pregnancy so she cycles again to produce another CL for the progesterone
• PGF2a brings animals into heat, used to synchronize their cycles
• Dystocia: Presentation (head/tail 1st), Position (hips/back to dam's pelvis), Posture (legs or head back)
• During parturition don't work against the dam, reposition fetus when she's relaxed.
• Calf Jack:  During parturition don't pull when the dam is relaxed, pull when she's pushing and pull slightly upward
• Rest after neonate's head is out, give them a chance to breathe before pulling the rest of the way out.
• The higher the SG of colostrum the better.
• Castration equipment and open (emasculator -nut to nut) vs closed (emasculatome, banding)
• Parasitology:
• Nematodes are round worms, they have L1, L2, L3 stages (no others do).  
• L3 is always the infective stage except in lungworms
• In carnivores lungworms are spread from dams to pups via licking
• Heartworm:  Dirofilaria immitus
• the male and female worms produce microfilaria which are pre-larval stage and not infective
• L1, L2, and L3 stages take place in the mosquito
• L3 stages come out with mosquito saliva and enter the animal through the skin
• L4 stage migrates to muscle and stays there awhile
• then the larva enter a vein, become L5 and travel to the heart where they become adults
• Adult worms live 7 years, microfilaria can remain for 2-3 years
• Fecal float solutions have a higher SG than water so the ova will float.  One example os Sheather's solution (sucrose)
• Tracheal Migration: intestine > liver > lung > trachea > pharynx > swallowed
• Whip worms don't undergo tracheal migration.
• Whips live in cecum/colon.
• Trichostrongylids (hooks)
• Ostertagia ostertagia, hypobiosis/overwintering
• Cestodes, tapes: require intermediat host (indirect lifecycle)
• onchosphere with hexacanth embryo
• infective stage = cystacircus
• orbatid mite is the IH for ruminants
• rabbits for taenia
• flea for dog/cat tapes
• proglotid, scolex, rostellum
• Trematodes -snails, water required
• Protozoa: infective stage = sporozoite
• Isospora = small animal
• Eimeria = large animal
• Neosporum caninum: cow ingests sporozoite, goes to brain, infects calf when cow gets pregnant, calf can be born alive as a carrier, born alive free of infection, or aborted.
• Dewormers (know).  Ivermectin kills just about everything.
• Equine pinworms are NOT zoonotic!
• Hydatid cysts = ecchinococcus
• Flukes target organ is the liver, gallbladder, bile duct
• Transmission: transdermal, transmammary, transplacental
• Insects have 3 body parts, eyes, antenna, 6 legs
• Arachnids have 2 body parts, no eyes, no antenna, 8 legs
• Insects and arachnids are both arthropods 
• Egg, Larva (Instar), Pupa, Adult
• It takes a minimum of 3 weeks for the cat flea lifecycle to complete
• Heartworm can be diagnosed in the following ways: direct blood smear, buffy coat, modified knotts (blood is lysed and spun), Difil (filter), ELISA
• What is above the buffy coat in a microhematocrit?  Plasma
• EDTA works by binding calcium
• Wigglers and tumblers = mosquito
• Fly lays eggs which can become maggots in as little as 18 hours
• Fly strike = stable fly = Stomoxys calcitrans
• Flies that won't go in barns?  Horse and Face 
• Cause pinkeye: face flies
• Thyamin deficiency in cattle = polio (not related to human polio)
• Permanent feeders = horn flies
• Screw worm: eradicated in the US, still have them in Mexico, have been found in Texas.  Maggots live in and eat live tissue.
• Stable Fly requires vegetation 
• Ixodid = hard tick (have scuttum and festoons)
• Miasis = infestation with maggots
• Facultative = maggots live on surface, eat dead skin
• Obligatory = burrow, breathing hole (Bot flies)
• Acariasis = infestation with mites = mange
• Pediculosis = infestation with lice
• Nits = eggs of lice found on hair
• Mallophaga = large head mite
• Anoplura = small head mite
• Keds = only fly that doesn't have wings
• Rocky Mountain Spotted Fever is spread by ticks
• Corioptes = Night Crazies
• Otodectes = ear mites
• Hemostasis
• Intrinsic/blood pathway is activated by rough blood flow eg artery w/ hole
• faster
• XII > X > II > I
• Extrinsic/tissue pathway is activated by injury
• slower
• III (thromboplastin) > VII (hagemen factor) > X > II (prothrombin to thrombin) > I (fibrin)
• No one test tests both pathways.
• APTT (and any other test that starts with "A") tests intrinsic and common pathways.
• OSPT, PT (and tests that start with letters other than "A") test extrinsic and common pathway.
• Endothelial injury results in a hole, vessel becomes sticky because of VonWillebran's factor, platelets adhere and secrete seratonin which lowers blood pressure, platelets become viscous and metamorphasize becoming larger and more sticky, thrombin adheres to the platelets and they form a platelet plug
• Platelet plug is water soluble
• Scratches on the inside of a red top tube activate hageman's factor (VII) and the blood clots
• Cetaceans, reptiles, and birds do not have hageman's factor (VII)
• Prothrombin > Thrombin > XII (excess thrombin activates XII)
• Factor XIII strengthens the clot and is self-limiting so that the clot doesn't just keep growing and growing
• Clot = thrombus
• When a clot breaks loose it's called an embolism, usually lodges in lungs because the vessels there are the smallest
• Blood cells
• 3 types: Leukocytes, Erythrocytes, Thrombocytes
• Leukocyte types: granulocytes, agranulocytes
• Granulocytes: neutrophils, eosinophils, basophils
• Agranulocytes: Monos (pleomorphic), Lymphs (very little cytoplasm)
• Stain: Blue, Red, Purple (burp).  Blue = methyl alcohol, makes cells stick to slide
• Basophilic granules in granulocyte = Dohle bodies = only in neutrophils
• Non-refractile inclusion in erythrocyte = Howell Jolly Body
• Leukocytopoesis, granulopoesis, etc
• Neutropenia, fewer than normal neutrophils
• Immature neutrophil = band = stab
• Opsonization = rendering antigen weak so humoral immunity can phagocytize it
• Only cell that leaves circulation and returns = lymphocytes
• how lymphs exit blood vessel = diapedesis
• Margination = chemotaxic factors cause cells to adhere to margins of blood vessels
• Normally 50% of blood cells are marginal in dogs
• Normally 70% of blood cells are marginal in cats
• Stress, excitement, etc cause epinephrine to be released, BP rises, and marginal cells release and go into circulation causing what appears to be a high WBC even though there is no real increase in cells.  This is NOT associated with a left shift since production is not increased.
• When blood sits before being viewed cells become hypersegmented and bands become segs
• T-cells are from thymus
• B-cells are from bone marrow
• IgG, IgA, IgM, IgE, IgD all made by plasma cells
• MPS = Mononuclear Phagocyte System
• Eosinophils increase with worms, wheezes, and weird diseases
• Only blood cell not made in bone marrow = lymphocytes
• Immunocyte = activated cell, basophilic cytoplasm
• Erythrocytes made in bone marrow
• Platelets are made by megakaryocytes
• IMHA: blood cells are coated with antibodies, spleen can't eat them all, half-eaten cells remain in circulation as spherocytes.
• IMHA also causes hemaglobinuria and hemaglobinemia
• Equine have no polychromatophils/reticulocytes
• The difference between polychromatophils and reticulocytes is just the stain that's used.  Reticulocytes are stained with NMB (New Methylene Blue)
• Pancreatitis causes injury to the common bile duct, the inflammation causes the common bile duct to become blocked, this backs up the bile that's released into it as well, as the bile backs up more cellular damage occurs releasing liver enzymes
• AST - leakage enzyme, liver specific
• GGT - injury to bile duct, bile duct specific
• ALK Phos/ALP - not specific, in every organ, but only bone and bile duct show on test
• increased ALP in pups likely due to fast growing bone
• increased ALP in older dogs can be osteosarcoma
• increased ALP with vomiting is common in bile duct blockage/pancreatitis
• Creatinine - made by normal muscle metabolism, no function, a waste product,  filtered by kidneys.  Increase can indicate kidney not filtering properly.  Also increased with overexercise or blocked cats.
• BUN -can be caused by kidney issues

About the test:

• 225 questions, only 200 count.  25 questions are being tested for next year's test and don't count, but they don't tell you which ones those are.
• 7 domains
• You are patted down before entering the room for the test.
• You get paper/pencil or a white board and marker
• Calculator is on the screen
• Test allows you to mark questions unknown, review, cross out answers, and enter notes.  Also a summary page that'll tally questions you marked "unknown", etc.
• Tell you pass/fail after a survey, but actual pass/fail based on how others did during your test period, so a "pass" doesn't guarantee you passed -you have to wait for the official letter.
• Study Jan's math cheat sheet
• Parasympathetic/Sympathetic
• Inflammatory, Stress, Excitement responses
• Old tests

First week at Marine Mammal Center (2nd externship)

Monday and Tuesday were comprised mostly of getting tours of areas of the facility and doing some small stocking tasks to get to know where things are at the facility.  On Wednesday I was scheduled to work "crew", which I wasn't expecting to like much.  "Crew" are the volunteers who clean the pens, prepare the food, and feed the seals and sea lions.  But they are given some advanced tasks such as tube/force-feeding the animals, giving fluids, and injections, etc.  The other downside to working "crew" was that they start at 7am rather than 8am which, with over an hour commute, makes a really tough morning.

So, Wednesday I showed up and was introduced to the crew.  Doug, Scott, Jeff, and another volunteer who's name I can't remember (I've me SO many people in the last week!) who made me instantly feel like part of the team and did a great job of training me.  First was "board school" where I was taught to use boards that are available at each pen for protection and to herd the elephant seal pups so that procedures like tube feeding can be done.  After an animal is in position, the "boarder's" job is to keep the people restraining, feeding, or cleaning safe from the rest of the animals in the pen.  So, that was my job in the morning -learning to keep myself and others safe!  And it's not easy, the ones that are feeling good challenge you, push on the board, bite at it, and try to get around it to get at you, so you have to stay on top of things, especially when two come at you or you have one and another in the pool that you have to watch!

(Example photo from a release, this is not my photo.)

Next was lunch.  On Monday and Tuesday lunch wasn't much fun, but Wednesday our team all ate together on these picnic tables overlooking the beach and it was as much fun as it was beautiful!  I really, really, love my Wednesday crew!

(Example photo, I did not take this.)

After lunch Scott grabbed a big, stuffed seal to be a model as he showed me how to restrain an elephant seal pup.  You have to sneak up on them and when they raise their head to threaten you, you wrap a towel around it's head to cover its eyes and then quickly put your hands on the back of the head to force it down to the ground (with the towel under it for protection) while you put a knee on either side of their body so you end up looking like you are sitting on them (although no weight is applied). You tuck their front flippers behind your calves and then just try to keep them there.  I practiced a couple times on the stuffed seal, then Scott and Doug picked out a more lethargic elephant seal pup for me to restrain for tube feeding.  I did a pretty good job on that one, so I was given a second slightly more energetic one to restrain and I did pretty well on that one too.  I left for the day with a promise of more challenging ones next week.

(Example photo, I did not take this.)

On Thursday, because I had some experience restraining elephant seal pups, I got to go out with the vet interns to restrain the elephant seal pups for their admit exams (their length is measured, blood is drawn, they are examined physically, and then tagged).  This time no regard was given for my newbie status and I had to restrain some pretty feisty pups!  It was hard work, and my arms and groin muscles are sore as a result!

On Friday there were no vet techs on duty and one of the vet interns had left, which left me, an RVT volunteer, Dr VanBonn, and another vet to do everything.  We started with exams of sea lions which are much harder to board, capture, and restrain because they are more mobile than the elephant seals, so I just assisted and recorded for the vets.  Afterwards I helped anesthetize and monitor a female Adult California sea lion who had a spontaneous abortion on a beach then reportedly wasn't using her hind flippers. Her exam went well, she was using her hind flipper normally before she was sedated and she'll be released soon. Next we anesthetized a male elephant seal pup for radiographs in the x-ray room. He had trauma to his rear flipper. He was bitten by something and bones were exposed on both sides as well as a bone that was only hanging on by the skin. Surgery for amputation of exposed bones is scheduled for Monday but the bones are like the ones in your fingertips, so he should be releasable after he recovers.

 (Example photo, I did not take this.)

Next we took the portable x-ray machine to radiograph the head of a juvenile male California sea lion who was a re-admit. He had previously been shot, rehabilitated, then released. A few weeks later he was found on the beach bleeding from his eye. We wanted to see if he had been shot again, but he's so full of shotgun pellets (and a .22 bullet lodged near his mandible) we can't be sure if that's the case until someone does a really close comparison of today's rads and the original ones from his first admit. Poor thing. After lunch and rounds we anesthetized a juvenile male California sea lion who came in with a massive hematoma on his right shoulder. They took liters of fluid out of it about a week ago and put a drain in. We removed the drain, flushed the wound, and ultrasounded the area. It looks like it's healing well although some of the skin is necrotic and will end up sloughing off causing a large wound, but his prognosis is good as well.

(Example photo, I did not take this, but see that traffic cone? 

It is used as a loose mask for the first stage of masking the animal down

before we switch to a tighter fitting mask.)

So, it was a full week and I'm happy to say that the getting to know you phase is mostly over.  Hopefully over the next 7 weeks I'll get more hands-on experience doing injections, blood draws, etc but I learned a lot this week and was able to monitor anesthesia and chart it as well.  At the start I didn't even know the difference between a sea lion and a seal, so learning the anatomy, behavior, restraint, and just being safe around wild animals was important too before I just jump in there and treat them like a dog or cat.

A philosophical post about our terminal rat lab.

There's this magical thing that we call "life".  We can all recognize when it exists and when it goes away whether we're talking about a plant, an animal, humans, or even bacteria.  It's very basic, but it's also very fragile.  As kids we learn about this frailty and about how final death is.  And so, since I was a child, I've held a high respect for life no matter what form it takes.

For this reason I do not squash spiders I find in my house.  They get a free ride over winter (except wolf spiders who get to tough it out in the garage), and they get moved outside if it's warm enough for them to survive.  I also feel bad pulling weeds.  And after it rains and the worms come out I do my best not to step on any and have even driven my car around them when they are big enough to be seen.  I don't take this respect for life lightly!

So, Tuesday night I lay in bed, unable to sleep, thinking about the upcoming lab where we have to euthanize mice and rats.  And, I'll confess, I almost took one home to save it from its fate (but I didn't feel it'd be fair to put it in a truck and move it to California in a few months).  But, knowing that they were being sold as feeders for snakes, and knowing that with us they'd be euthanized peacefully under anesthesia, I came to terms with it.  Where the night before I swore I'd talk my way out of having to euthanize one myself, I ended up volunteering to do it in lab. 

All-in-all I understand the need to do this lab and I'm happy that the teacher and class were respectful for the most part and we all did everything we could to make their journey to the "big cheesus" as stress-free, quick, and painless as possible.  And the necropsy lab that followed was important and valuable as well.

So, it wasn't fun, but it wasn't as bad as I feared either.  It's sad for sure, but I think it's important to come to terms with the fact that what makes life so precious is its ability to be extinguished at any time.  Wild animals face this all the time from predators, the elements, difficulty finding food/water, disease, humans, cars, and so on.  Blah, I can't fully justify it.  But I can come pretty close.  :-\  RIP our little rodent friends.  You taught us a lot and we thank you.  :(