Celine Experiences Clinic Life to the Full!

Last week we welcomed our first work experience student. Celine Berjot is currently studying biology in her preparatory year before begining a veterinary degree in Paris.
She was able to participate in several aspects of clinic life and took an active role in helping to monitor and treat the hospitalised patients.

We were able to look at normal anatomy, putting into perspective what Celine had been reading about in her text books. She spent some time taking and recording pulse and respitation rates for animals under anaesthesia and becoming used to what normal physiological parameters look and feel like.

It was a busy week as we were even able to cover the basics of preparing patients for surgery, clipping, sterile prep, intubation and pre op injections.

Celine spent some long hours in the clinic but the highlight of her camp must be a case she was heavily involved in. At the start of the week a preganant and paralysed stray cat was brought in. She was spayed because she had no hope of being able to give birth. Celine was responsible for physiotherapy and massage of the hindlegs to help with any recovery. The decision was made to operate on the spine to try and relieve some pressure on the spinal cord. Celine was invited to scrub into the surgery and was allowed to help by irrigating the surgery site with saline.

We hope we provided Celine with an idea of what to expect when she completes her veterinary studies and maybe we will see her in the future when she is qualified and ready to develop her surgical skills!

Izabela Returns to Small Animal Surgery with Style!

 
Our latest camp attendee was Polish vet Izabela Swierczynska. She graduated 7 years ago and has been working since then in the UK with large animals . We had the pleasure of reintroducing her to small animal surgery.

She started small with cat spays and worked her way up to large dogs. She coped well under pressure with some fairly delicate uteruses which were a haemostatic challenge.

Her surgical time improved over the course of the camp but more importantly her technique was consistently safe and of a high standard.




She was also able to perform two enucleations and the majority of a 3kg splenectomy during her stay as well as assisting in a few other surgeries.
In between surgeries she also participated in a few medical cases and whatever we threw at her she met with the same positive attitude. We are sure she would make an excellent small animal vet and look forward to hearing how she develops her skills in the future.

Carribean Camp!

February saw a change to the normal Veterinary Training Camp. The whole team were in the Dominican Republic for a neutering campaign on behalf of Animal Spay and NeuterInternational. In collaboration with Animal Balance and Pets Breeding Control. 

Drs Aurelian And Petrisor Stefan spent time with local vets performing and teaching surgical techniques which are particullarly applicable when working with stray dogs where a minimally invasine technique and quick complication free recovery is vital for survival on the street.

Ruth Osborne spent time with 1st year vet student Raul Morrilo And Nancy Ines Ramirez Castillo

They were learning about anaesthesia and preparation of the patient. In no time at all they were able to intubate any size dog with no assistance whether it was upside down or the correct way up. Rauls IV skills and injection technique score a 10 out of 10 and we are confident they are going to be central to future neutering campaigns in the Dominican Republic.

New Year, Old Friend

It’s the new year and the Veterinary Training Camp has already completed its first camp of 2014!

We started the year welcoming back an old friend. It was wonderful to see Elena Graebener from Germany again and this time she was able to spend a little time with both Dr Petrisor and Dr Aurelian to benefit from their slightly different teaching styles.

Her first visit was under the guidance of Dr Petrisor and she enjoyed her time here enough to come back for more! Since September she had started a new job and also done some work neutering in a shelter.

Elenas tissue handling skills have developed nicely in the last 4 months so we concentrated on building confidence as well as adding in a few other surgeries such as her first solo leg amputation and acting as assisting surgeon in some orthopaedic procedures.

We are confident she will continue to grow as she continues to perform more surgeries and we look forward to hearing how she develops with time.

Great Fun With Greek Vet Nektaria

Nektaria with one of her patients

The VTC finished the year with Greek Vet Nektaria-Lefkothea Tzourou. She is currently working in the UK and joined us to increase her surgical confidence particularly with bitch spays. As she had completed a fair amount of work spaying cats we focused on different types of dogs. Small, large, fat, skinny, deep chested, puppies, pregnant and in season all landed on her surgery table during her time with us and she was able to take everything we could throw at her! She mastered the techniques and knots that make up a safe, minimally traumatic surgery and her surgical time reduced as she became more familiar with the movements required. There were a few memorable moments during her stay including the power cut mid surgery. We concluded if Nektaria is able to operate on all of the different types of dogs found here in Romania then the relatively ‘normal’ dogs in the UK should hold no fear for her. We cannot wait to hear how she gets on putting into practice her improved skills after her experience with the VTC. We wish her all the best for the future and hope to stay in touch.

Even an unexpected powercut does not phase Nektaria

Cambridge Graduate Castrates with Ease

Deep Chested Bitch Spay Holds No Fear For Georgina

Our latest camp attendee was Georgina Hall from the UK. She graduated this year from Cambridge Vet school and wanted to perfect her surgical skills before beginning her first job.

The clinic here in Craiova has been very busy with surgeries as part of a free sterilisation campaign by Romania Animal Rescue.

Once Georgina had mastered the minimally invasive techniques under the guidance of Dr Petrisor Stefan she was able to help us work through some of the 200 surgeries for the local animals of Craiova.

Using her surgical skills on the cake she bought the team!

She was also was able to amputate a tail and perform two enucleations as well as assisting in surgeries such as intersusception repair and ulnar osteotomy.

Georginas confidence grew over her time with us and she over halved her surgical time whilst producing some very nice neat small incisions. She coped well when presented with an unexpected haemostatic problem and is going to develop into a very good surgeon.

We wish her all the best in her new job and look forward to hearing about her first post camp surgeries!

First Spay, First Spayathon for Dr Cristina!

Last week The Veterinary Training Camp was joined by Dr Cristina Petre from Ploiesti, Romania. She spent 5 intensive days learning and perfecting sterilisation skills that she will take back to her home town where she can continue her work with the local stray dogs. Her training was sponsored by Romania Animal Rescue. Her minimally invasive techniques, small incisions and rapid recoveries will make a huge difference to the animals of Ploiesti.

On her last day we were able to take her into the field! We took part in a spayathon organised by Swiss Group Einzatz Fur Tiere and Romania Animal Rescue. We have every confidence in time she will be able to organise such projects for her local community.

This is what Dr Christina had to say about her experiance with the VTC

The Veterinary Training Camp has provided an unique experience for me, made possible through Dr. Aurelian Stefan's guidance. Although I was a little nervous at first, Dr. A gave me confidence and helped me do my best. The air was peaceful and nice during the five days of training.

 

Ovariohysterectomy is a Piece of Cake!

Last week we were joined by Veterinary Surgeon Wenche Mokkelgard from Holmedal in Norway. It was a warm week with temperatures in the mid twenties, around 10 oC higher than in Norway at present. She received an equally warm welcome at the clinic in Bucharest where the course was held.

Our emphasis this week was canine ovariohysterectomy as this is the area Wenche felt she could improve her skills the most. Dr Aurelian Stefan found to his delight Wenche already had a sound basis in surgical skills and set to work developing and expanding her abilities. She got to grips with some new suture techniques that will help her sleep at night as she now can be confident her ligatures and sutures are safe and secure. She mastered the skill of handling stainless steel sutures, which is not easy. This is a strong, non reactive suture that will never fail if your technique is correct.

The week contained some tough surgeries from deep chested dogs to pregnant females but our attendee took it all in her stride and was a seasoned pro by the end of the week, able to remove any uterus put in front of her with skill and efficiency. The deep chested and lactating females were perfect candidates for Wenche to learn a flank approach to ovariohysterectomy in the dog. She learnt when to use this approach and why in some dogs it can be considered preferable to a midline incision.

The easiest incision of the week!

As life is always full of surprises it is important to know what to do with a bleeding patient as this is a serious complication and potentially fatal even if you are aware of the problem as soon as it happens. Most newly qualified (and some more experienced vets) if they are honest fear this situation which is why at the Veterinary Training Camp we prepare you for this emergency so you clearly know what to do if you encounter a haemorrhage in the future. We are confident if Wenche does come across a haemhorrage in her surgical career she will be having a stiff drink afterwards to celebrate a successful outcome not to get over the stress of the life or death situation!

 Overall it was an intensive week but very satisfying to see someone develop their surgical confidence. Wenche worked extremely hard and the results show. Everyone at the clinic found her a delight to work with and we wish her all the best as she pursues her veterinary career.

November 2011

Last week we ran a small specialised training camp with only one attendee. Dr. Florin-daniel Lucaciu travelled from Baia Mare in the Northwest of Romania. His training has been sponsored by Romania Animal Rescue (www.romaniaanimalrescue.com) and after his week with us we hope he will be able to work towards improving the welfare of stray dogs and participate in the Romania Animal Rescue Spay and neuter project integrated with the Think Stray Campaign.

It was an intensive week with several long days where Dr Lucaciu was operating between 9 o’clock in the morning and 9 o’clock at night. Even though the days were long, ending with aching muscles, time was still found to relax and enjoy a few alcoholic beverages.

The week started well even if the linear alba proved to be somewhat elusive to begin with. Attention to detail was important as Dr Lucaciu learnt about the properties of different sutures, where was best to use them and why. He tirelessly practiced his knots to ensure they were always secure and he also learnt the importance of haemostasis. Overall around 20 surgeries were performed.

Dr Aurelian was very pleased with how our trainee improved over the week and he certainly passed the test performing a bitch spay on a particularly large dog towards the end of his time with us.

Provided Dr Lucaciu continues to practice the techniques he has learnt with us he should be a valuable asset to many spay and neuter campaigns in the future as well as providing the best care to his patients. We wish him every success in this!

Day 5: Camp September 2011

The early start was not as difficult as I had expected after such a long day yesterday. The adrenaline fuelled excitement of making sure our last day counted probably helped, although I was sure the tiredness would catch up with me next week. The street dogs were in their usual locations as we arrived at the meeting place for the last time. When we arrived at Giurgiu we continued with our mission of spaying all of the pregnant females in the shelter and Katy also embarked on a special project.

Katy with Tar boy

A dog had been brought in which was covered in tar. We nicknamed him Tar boy. His skin was becoming sore especially around the mouth. He was anaesthetised and Katy spent most of the morning cutting the tar from his coat using only scissors and bathing him in detergent. She did an amazing job as he looked a different dog afterwards. We could say the same about Katy as she had tarry blotches all over herself!



Before dressing was removed



What was under the dressing

We were hard at work when the dog catchers arrived with a small male with a bandage around his elbow. They asked if we would have a look at him. You could smell him long before you could see the dressing clearly. The dirty dressing was saturated with infected wound discharge and bone was just visible at the top. One look and we reached for the anaesthetic, the quickest way to provide a good level of analgesia and allow us to have a proper look at what horrors lay beneath the bandage. The dog was amazingly well behaved despite having such a painful injury. Once he was asleep we removed the bandage to find an open fracture of both the radius and ulna. The surrounding tissue was hugely swollen and infected. We loaded him up with NSAID’s and antibiotics and set to work preparing the limb for amputation. Sandra began the surgery with Aurelian assisting and demonstrating techniques for achieving haemostasis. The dog was entire so he was castrated as well. We were just finishing the procedure when the Shelter owner came to tell us the owner had arrived. He was initially not happy that we had removed his dog’s leg but once the problem was explained he was extremely grateful. The dog had been hit by a car four days ago and the owner could not afford veterinary care for him. He was lucky to have been brought to us.


Our team of Surgeons!

Before the dematt

With all three vets involved with the amputation Katy was free to continue her welfare work and was able to shave a very badly matted dog. The dog must have been so uncomfortable with those tight mats and looked much better afterwards. Hopefully a haircut of that standard should really increase the chances of someone wanting to give him a home.

We were so caught up in our work we almost forgot about lunch. We made some time for this and went to eat overlooking the river Danube. It was beautiful. The camp attendees were presented with their diplomas for making it through a tough week and we returned to the shelter to fit in a couple of final surgeries before it was time to pack up and return to Bucharest. Before we left we inspected our patients for the last time. It really gave us a sense of achievement walking down a row of kennels seeing each dog with a pink ear tag signalling they had been neutered and by us! Our totals for today were 4 males and 7 females which gave us a grand total of 58 neutering operations over the 5 day period (not including the other dogs we treated). Maybe not a huge total in the scheme of things but we are happy each surgery was performed with the utmost care and attention with techniques that would minimise any chance of post operative complications.

We headed back to Bucharest, Sandra, Lidia and Katy talking about how they can put what they have learnt to good use. Me, I was thinking about our next camp, what we could see and the amazing people we could meet.

Day 4: Camp September 2011

Little did I know this would be a long but amazing day as I caught the metro to the meeting place. We were all tired but determined to make the most of our penultimate day of the Veterinary Training Camp. We were a well oiled team as we launched into our routine when we arrived at the shelter. Our previous patients were all looking good with the anaesthetic emergencies bright and happy, so all in all a good start to the day.



Dog with Glaucoma

We became very selective with the dogs we picked trying to make our choices count. As a result several of our surgeries were on pregnant females. The operations and anaesthetics went smoothly with Lidia and Sandra really demonstrating how routine surgery should be performed. We had also identified a dog with glaucoma and were able to perform an enucleation today, the second of the week.



The atmosphere was relaxed as we went about our work and we shared some interesting stories on topics ranging from small rodents to amazing inventions. It wasn’t just the camp attendees who were learning today.

Flank Spay

There was a great opportunity for Aurelian to teach a flank spay techniques. This is a technique which is adopted depending upon the patient and can be preferable in lactating bitches especially if feeding puppies. It is also sometimes chosen in deep chested dogs. Sandra quickly got to grips with the techniques and was able to see why this approach would be preferable in some cases.

Worming the puppies

If all of the surgeries did not keep us busy enough with an amazing 11 females and 6 males being neutered today plus the enucleation. Lidia, Sandra and Katy also set to work examining and worming a large group of puppies that arrived at the shelter. We made plans to bring vaccines for them tomorrow.



We were operating until after sunset using only lamps to work by in an effort to get as many dogs neutered as we could. As we were leaving the shelter, tired but satisfied, Aurelian got a call from Almavet a clinic in Bucharest. They had a complicated emergency case that they needed his expertise with.

Lidia Operating by Lamplight

We arrived back at Bucharest at about 9.30pm. Two cases were waiting at the clinic for us. The first was a 14 year old boxer with a pyometra, her bloods were fine so she was prepared for surgery which went without incident. The second case was a little more challenging and not just because it was happening at the end of a long day.

Penile trauma

The second case was major trauma to the penis, including a break to the os penis. The dog must have suffered extensive bleeding as he was pale and shocked. The decision was made to salvage as much of the healthy tissue as possible rather than opting for urethrostomy in the first instance. The physiological state of this dog meant his anaesthesia was just as challenging as the intricate surgery. Balancing fluid therapy, cardiac output and anaesthetic depth was a delicate minefield especially well after midnight following a long day. We are pleased to report the dog made it through his surgery as is doing very well. Further details and pictures of the surgery can be found on our facebook page.

We left the clinic in the early hours of the morning ready to grab a few hours sleep before our last day in Giurgiu. We had agreed to meet an hour earlier to make the most of the time we had left. As tired as I was I couldn’t wait to get started on the  work for the next day.

Day 3: Camp September 2011

Bucharest was decidedly chilly as we waited for Aurelian to collect us at our usual meeting point. It made a change after the heat of the last few days. We arrived at the shelter and settled into our routine of setting up the equipment, checking the patients and selecting the first dogs for the day. Our patients from yesterday were looking good, one male had been licking a little overnight but a repeat of NSAID helped to stop this.

Mesenteric tumour

Today was a day for surprises as a medium sized black female we were expecting to be spaying turned into an exploratory laparotomy when an abdominal mass was palpated after anaesthetic induction. The bitch had already been spayed and a mesenteric mass was located and successfully removed. The rest of her abdominal contents appeared normal and she recovered well. We would have liked to have been able to analyse the mass but this luxury was not available to us in this location. We were suspicious it may have been a foreign body reaction connected to her previous surgery and it reminded us of the purpose of the Veterinary Training Camp, highlighting the importance of good, careful preparation and sound surgical technique.



Close monitoring catches problems early 

We were also unlucky enough to have two anaesthetic emergencies. A little black female and a large old male. He had a pronounced heart murmur and was in fairly poor condition. We were suspicious he may have heartworms which is relatively common parasite in Romania. These cases highlighted the importance of close monitoring and the advantage of having IV and airway access via intubation. We were able to identify deteriorating peripheral pulses and progressive bradypnoea and bradycardia and act quickly with IV administration of an Alpha 2 antagonist, Atropine and doxapram. We did not have an oxygen source but was able to ventilate manually with an ambu bag. Both patients recovered successfully, a credit to the team who remained calm in a stressful situation.

The team hard at work!

Uterus with small Incision (Sandra Patzner)

We have passed the halfway point of our camp and have been working so hard that Lidias fingertips have become numb from breaking ovarian ligaments but we all agree there is nothing as satisfying as the sound when it snaps! Yet again the day had gone so quickly and it was time to drag ourselves away from our work and make the trip back to Bucharest, satisfied with the 3 males that were castrated today and 9 females spayed.

Day 2: Camp September 2011

Female with demodex

Another beautiful day dawned again in Bucharest. We met in our usual location and today were able to recognise the small group of dogs that lived near to Piata Unirii and identify their small territory. We were slightly quieter today as Monday had caught up with us. It is surprisingly tiring getting used to working with different drugs and in a new environment but all this was forgotten as we arrived at Giurgiu shelter. The group went to check our patients from yesterday as I prepared the theatre for today’s surgeries. 

We were pleased to be able to treat a little female who we noticed yesterday had demodectic mange. We are hoping her skin may have improved enough by the end of the week so she will able to be spayed but suspect this is not likely to happen.

The dog’s wounds all looked perfect with no redness or swelling. All except for the very first female who had somehow managed to remove her intradermal skin sutures. We were very disappointed but set to work debriding and resuturing the wound ensuring her pain relief and antibiotic cover was repeated.

One of the biggest surgeries of the day was a heavily pregnant bitch spay. It was emotionally as well as surgically challenging.  The bitch was already in poor condition which was likely to deteriorate if she had to feed and raise a large litter of puppies. That litter would then go on to produce more puppies so in a years time approximately 50 more dogs could be roaming the streets with more puppies on the way from that one female (assuming they were lucky enough to survive). Sandra operated efficiently to remove the distended uterus and was able to put to good use the Millers knot which she had perfected yesterday. This is ideal for surgeries which need good knot security. Within an hour the bitch was recovering well and we were confident she would quickly improve in condition and go on to lead a happier healthier life.

Sandra Removing the Uterus

Millers Knot

Uno

The afternoon was just as exciting due to a little dog we named Uno. He had a tumour of the nictitating membrane likely to be a melanoma and the globe itself was affected requiring enucleation. He was an unlucky little dog in that he was unilaterally cryptorchid as well, but his luck certainly changed as Sandra carefully removed the affected eye and searched for the hidden testicle under Aurelians careful and exacting guidance. His anaesthetic went smoothly thanks to Katy’s close monitoring despite not being able to access some of the indicators of anaesthetic depth with Unos head being covered in drapes and vets!

Our totals for the day were four males and six females as well as the enucleation. Sandra and Lidia were becoming more confident but careful surgeons with the techniques they were developing and Katy was really using her background knowledge demonstrating both care and skill with her patient preparation and anaesthetic monitoring. Again I did not realise how long the day had been or that I was really tired until we got back to Bucharest but I still couldn’t wait for what the next day had in store for us!

Day 1: Camp September 2011

It was looking like it was going to be a really hot day as I rode the Bucharest metro to meet our eager veterinary training camp attendees in the huge bustling square, Piata Unirii. We watched the crazy Bucharest drivers as we waited for Aurelian to pick us up for the 45 minute drive to the town of Giurgiu. I was excited about the small group we had joining us on this camp and was sure we were going to have a lot of fun.

Left to Right Lidia Nistor, Katy Orton and Sandra Patzner

As we settled into the journey we got to know a little better the people we would be sharing out skills and experiences with over the next 5 days. We were joined by two vets and one student VN. Sandra Patzner, a vet originally from Namibia now available as a locum based in Warwick, UK, Lidia Nistor, a Romanian vet from Botosani and Katy Orton a Student VN at Harper Adams University College, UK.

The journey passed quickly despite a slight scenic detour at the start and we soon arrived at our destination. Giurgiu is a small town near to the river Danube on the Romanian border with Bulgaria. Dr Petrisor Stefan (a.k.a Pepe) was waiting for us at the shelter with all of the equipment. We worked quickly in the little porta-cabin to set up our theatre for the week so we could go and meet the dogs we would be helping.

Giurgiu Shelter

You could feel the excitement in the air as we picked up the bottles of anaesthetic agents and a selection of syringes and needles and went out into the sun to meet and select the first dogs for surgery. We agreed on a pair of friendly young females and after a brief discussion on international differences in muscle choice for IM injections our dogs were asleep and ready to be prepared for surgery. Each dog was placed on IV fluids, intubated, clipped and scrubbed ready for spaying. The vets selected their instruments, draped the patients and we were ready to begin our first surgeries of the week.

The Team at Work: Katy Orton, Pepe Stefan, Lidia Nistor and Ruth Osborne

The concentration in the small room was intense as Aurelian and Pepe began to impart their surgical knowledge and the nurses got to grips with injectable anaesthesia. The morning’s surgeries went smoothly with the time passing by so quickly. After a fantastic lunch at a small restaurant in the town we got back to work. Despite it only being the first day we had already settled into a routine and we were working well as a team. Jokes and banter were beginning to flow freely as we became used to the new environment and drugs that we were using.

We were pleased with the start we had made on our first day with six females being spayed and two males castrated. The vets learned several new techniques and were ready to start perfecting them in the morning. We got back to Bucharest tired but satisfied with what we had achieved and already thinking about the dogs that we wanted to work with the next day.

Post Surgery