Wednesday, June 29, 2016

My not-so-graceful fall from the Ivory Tower


I spent the past two weeks working at a small animal/exotics practice in Johannesburg that primarily sees birds.  I was completing my “Primary Care” rotation, which can be done either at my school or out in the real world. Primary care consists of all the normal general practice things like vaccinations, itchy skin, and your average vomiting cat.  I chose to do this rotation in South Africa so that I could extend my stay in the country and also to get a feel for baseline care here.  I chose this practice because my good friend works here and I wanted to brush up on my birds. 

I have always loved bird-watching, but birds are not my favorite when it comes to dealing with them up close.  I find them kind of creepy.  Tiny dinosaurs, right?  However, since my degree says I can practice on any animal, I felt that maybe I should turn my bird frown upside-down.  I have been working at it slowly since I started school.  I definitely don’t hate birds now and, the more I learn, I can see that they are actually quite cool.  But, there are still large gaps in my most basic bird knowledge.    
Wings & nails
I spent the first few days observing from the exam room to the surgical suite (called “theater” here).  The majority of the birds we saw came in for “wings and nails” which consists of trimming the first 5 feathers of the wing and the nails either getting dremeled or soldered to an acceptable length.  The first 5 feathers at the tip of the wing help initiate flight and the next ones in help the bird turn and stop.  If you trim the first 5 then the bird can’t take off which helps keep pet birds from flying away. A bird that flies away here could easily survive in the wild because of the warm climate.  The most popular birds in SA (African Grey, Cockatoo, Cockatiel, Ringneck, Macaw) are not indigenous and could create problems for the local birds.  In fact a few “strays” came in while I was at the clinic.  Those birds were kept, tested for beak and feather disease, and sent out for adoption if the owner could not be found.

Some other frequently seen conditions:
Feather cysts (have to be removed surgically)
Injury from landing too hard on the ground
Fractures of the wing/legs
Feather chewing (can be fixed by “imping” or gluing on a surrogate feather)
The ol’ down-with-seeds nutrition talk

Bird emergency support care
There were a number of birds that presented in severe distress.  Birds are prey species and excellent at hiding their ailments.  When a bird is acutely & severely sick it is not likely that it will make it out alive.  At least 5 birds came in this way with various problems/clinical signs and none of them survived.  The Catch-22 is that the more you handle a sick bird to fix it, the more stressed it gets, and the more likely it is to die.  Sometimes you just can’t win.  This is hard for everyone, especially the owners who just saw their bird acting fine an hour ago and now it’s dead.  As they say in South Africa, “Ag shame, man.”   

Look at me, Ma!
(secretly freaking out inside!)
I did a lot of basic bird techniques during this rotation.  I practiced basic handling which, funny enough, is not that different in principle from handling any other animal.  The number one rule of animal handling is “control the head.”  When you control an animal’s head the rest *usually* follows.  Also you tend to get bitten less.  For birds it is best to use a towel so you can kind of burrito their wings and body as you grasp around the head with your thumb and forefinger.  Birds look like they have thick necks, but it’s all feather fluff.  They actually have quite scrawny necks.  For larger birds you can just hold them where the wings connect to the body.  If you are handling a raptor (like a hawk, owl, or falcon) then your primary goal is to control the feet (rather than the head) because they have spectacular talons to avoid.  Although handling is pretty fundamental it was actually quite scary for me.  I bet I had a funny look of concentration on my face most of the time and I know my heart was racing more than once.  I always value these moments because it feels good to best something you are kind of scared to do.  I got to hold a macaw and African Gray perched on my hand…which was AWESOME!!  I bet my friend was laughing at me because he does it every day, but man I was feeling myself in that moment. 

I also practiced gavage (tube feeding), all the different sites for euthanasia, taking blood from two sites, making blood smears, doing Trichomonas testing, and probably a lot more.  Heck, they even let me do “wings and nails” on a few birds.

There were plenty of dogs and cats to see…and even some rats, bunnies, monkeys (!), and guinea pigs.  I got to practice some of my skills and try new things like doing a dental on a dog.  From what I can tell, most of the care and drugs are pretty much the same as what I have seen/been taught in school.  I have a lot of knowledge gaps in small animal things.  In fact, I kind of suck at all of it.  I feel bad that my knowledge is crap, but I also do not want to work in this area.  Vet school is a constant battle between “knowing all of the things” and trying to invest some extra energy in the things that seem more relevant to your future.  The ER vet on call in the hospital is not a reproduction expert and the dermatologist is not up on her/his infectious diseases of cattle.  But, as a vet student we apparently need to know it all.  As they say in SA…”eish.”         

A native wild pigeon gets a superglue cast
One unique thing about this practice, besides the fact that they are one of the few bird practices around, is that they take any wild animal that comes through the door with no questions asked.  Well…maybe a few questions to get the history.  The clinic pays for treatment and hospitalization, but people can make a donation.  The majority of the animals that came in were…you guessed it…birds!  The majority of the birds that came in were pigeons, but we also saw some beautiful raptors and “garden birds.”  Pigeons in this country often carry a protozoa called Trichomonas and although it’s treatable, it often recurs.  If a bird comes in with Trichomonas it is euthanized because there is little that can be done to keep it from becoming infected again and it can give this protozoa to other birds in the clinic.  To do the test you swab the mouth and crop, prepare a wet mount slide, and have a look under the microscope.  I did not see any positives while there, but it is a fairly common occurrence.  Many of the birds had fractures and sadly many of the birds had to be put to sleep.  In other words I got to practice performing many physical exams and euthanasias.  Wild birds must be fit to stay wild, so if their medical problem (like a bad fracture) prevents a full recovery then they get put to sleep.  Birds that can be fixed are treated, handed off to volunteers or rehab centers, and then get released back into the wild.  This is a great service to the community, not only for the treatment these un-owned animals get, but also for the peace of mind the person that brings the animal in receives.  Win-win!

As far as clinic basics…most of the drugs were the same, although the trade names were often different.  Synulox is Clavamox and so on and so forth.  There are also different names for some common things like a catheter is called a Jelco, presumably because that is the brand name.  It was interesting to see the difference in labor here vs. at home.  There are veterinary nurses here (AKA vet techs), but this practice used hired workers that would normally be cleaners and nannies in South Africa as the people that did the animal care and handling.  I’m sure that is much cheaper, but you get what you pay for.  There was a lot of frustration from the vets about missed directions and slip-ups (like leaving cage doors open) that probably could be avoided if nurses were employed.  Having these workers also allows the vets to be more authoritative over the employees which is a distinctly South African phenomenon that I do not have time to explain here.  I guess I’ll just leave it at saying it was an interesting dynamic to observe.        

I learned that an African Grey that falls to the ground can often injure its beak or chest on impact because those birds are top heavy.  Cockatoos often injure their butts because they are bottom heavy.  Either way…falling can be a painful experience.  I think this would be an excellent way to describe my first venture out into private practice since gaining admission to the ivory tower known as vet school.  There were a lot of practices I observed that made me cringe.  One doctor repeatedly performed surgery without proper scrubbing, gowning, masking, or even wearing gloves.  I could not believe it because of how much this has been drilled into my head in school. (Remediate!)  I didn’t even see any gloves out if I wanted to use them, although further searching revealed some boxes in a cabinet somewhere.  Tables were rarely cleaned in between patients and sometimes even the thermometers were not cleaned.  There were many other basic hygiene things I observed that I thought were kind of lacking.  The epidemiologist in me was crying in a corner somewhere.  I realize that what I have been taught is the “gold standard” of care in the most pampered environment possible, but there is no substitute for basic hygiene.  Overall the care of the patients was decent, but I saw a lot of easy things that could be improved.  The practice is changing hands soon, so it is likely that a new set of procedures will be implemented as a younger set of vets run the show.  Any experience is one worth learning from whether it’s good or bad, so I can definitely say that this proved to be a very valuable learning experience overall, plus I got to see some amazing animals…like a crowned crane.  I wouldn’t trade my two weeks for the world.  I thank my friend for not only giving me the opportunity to work with him, but also for being patient with me.            

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