by Malky Weil (VM Class of 2016)
Hello wildlife enthusiasts! Have you ever wondered how we record our treatments for our patients? We maintain a complete medical record, just like at your doctor’s office and use a method called SOAP. Here is how it works:
S/O: Subjective and Objective observations. This is where we talk about a patient’s mentation. We can call them BAR-bright, alert, responsive (if they are moving around in their cage), QAR-quiet, alert, responsive (if we find them resting but still responding to us), or non-responsive (which would be a bad sign with a patient). We also note if there were feces and urine in the cage and with birds of prey if there were casts. A cast is the non-digestible hair and bones of mice or other prey that are regurgitated while the rest of it is digested. As gross as it may seem, it’s important to note when an animal has normal excretory and bowel movements, because if those movements are absent, it can be a sign of gastrointestinal or urinary system abnormalities. We will note if there is food left over from the previous treatment, if the water appears touched, if the patient shredded all of the newspaper in the cage, and any other observation before we have our hands on the patient. Some observations are objective, such as whether or not there are feces in the cage, and others are subjective, such as what the mentation of the patient is.
The next parts of the SOAP are based on a problem list we keep for our patients. I will give an example for a bird with a broken wing as the problem. If there is more than one problem, we label it A1, A2, P1, P2, and so on.
A: Assessment. This is where we talk about our physical assessment of the problem. For the broken wing patient, we may be observing if the bird is holding its wing upright or drooping it or how the wing bandage looks. This is where we would describe how the physical therapy on the muscles is progressing. For example- “We did passive range of motion on the right wing and the muscles are inflamed, stiff, but the extension is better than it was yesterday.” We also talk about the medicine we gave for the specific problem here. With a broken bone we usually give pain medicine, because broken bones are painful. So we might add here that we gave 0.6ml of tramadol (and give the dosage in mg/kg, and concentration in mg/ml). We may also be giving a non-steroidal anti-inflammatory to help with pain and inflammation in the wing.
P: Plan. This is where we talk about what we plan on doing in the future. So for this bird case, we would say- “Continue to monitor posture, continue passive range of motion every other day, continue tramadol, and continue meloxicam until swelling recedes. Change wing wrap in 2 days.”
ADD: Addendum. This is the section we use to add anything else that does not connect to the problems, but still needs to be recorded. For example: “We cleaned the cage and refreshed the water bowl. We checked the feet and did not see any signs of bumblefoot. We left 3 mice (total 27 grams) in the cage. Patient flapped his good wing when we returned him to his cage.”
Recording our treatments is very important. There are multiple people on a team caring for our patients, and not everyone is there for every treatment. Those not there need to stay current on the case, see how the patient has been behaving, and note if there are any changes to the treatment plan. Having all that information is important when making decisions on the case as well. No one’s memory is perfect, so it is important to have a place to look back on what has been done and how the patient responded. I hope this gives you a little glimpse into what goes into keeping a complete medical record for our patients. The skills we gain doing this important work will be used throughout our careers as veterinarians.
By Maddy Erba, VM17
To the Future Veterinary Students of the University of Illinois College of Veterinary Medicine:
It was a hot day in the middle of orientation week when Dr. Foreman explained the benefits (and setbacks) of joining clubs. It had been several long days of sitting in the classroom, listening to information about my new academic life and wishing I could go outside for a bike ride. Dr. Foreman was cautioning us about joining extracurricular clubs, especially the Wildlife Medical Clinic (WMC) which is operated by volunteer veterinary students under faculty guidance and mentorship. Dr. Foreman listed the many reasons why we should think twice about joining the WMC. He explained that to be a member you needed to go to rounds, meetings, treatments, be on a pager shift, and care for orphans. I recall the phrase “time suck” being used multiple times. The administration gave us a schedule at the beginning of first year, which I have supplied for you. If you look closely there isn’t even time to eat dinner let alone find all this magical non-existent time in the week for the wildlife clinic.
Being new to Illinois and unfamiliar with the curriculum, I heeded Dr. Forman’s advice. However, that didn’t stop me from going to the club fair and listening to the forbidden fruit of WMC. There Jenny Kuhn stood with a great horned owl perched on her arm, Nokomis. She told me the wonderful benefits of joining – how we can practice physical exams, learn to write SOAPS, practice communicating within a team, and care for a variety of species. And those are just a few of the perks. Yes, WMC is a time commitment, but it also solidifies what we learn in veterinary school.
After careful consideration, I decided to join. We were told we could leave at any time if school became too challenging, or if we decided wildlife medicine wasn’t for us. However, as long as we were members, we were expected to do all the work, go to the meetings, and be a team. On my team were five amazing team leaders – Stephanie Zec, Erica Morton, Teresa Schecker, Laure Monitor, and Amanda Kuhl. This group of experienced individuals taught me everything I know about wildlife medicine. We practiced wing wraps, how to calculate medications, how to make a splint. I learned how to put in an interosseous catheter on raptor! I practiced communication skills, something everyone can improve upon. I was applying concepts from school, asking intelligent questions, and learning by doing! By the end of my first year I had gained an enormous amount of self-confidence.
On May 1st 2014, just sixteen days before the end of the semester, I appreciated the fact that I was laying the foundation to be a skilled veterinarian. I was nervous because an undergraduate student and I were the only two people on PM treatments. I was nervous because as the veterinary student, I was in charge, and I don’t normally like taking the lead. Our patients at the time were an opossum with a distal tail amputation, an orphaned squirrel with a maxillary swelling, and an orphaned squirrel with lung crackles that we thought were from aspirating food during a feeding.
We decided to feed the two orphaned squirrels first, because we thought they would be the less challenging patients. We examined the squirrel with the swelling first, and fed him. He looked alright.
It was time to feed the second squirrel. She suckled roughly two thirds of her meal, and then started shaking. We quickly re-heated a rice sock to keep her warm as she ate dinner, and she seemed to be okay after that. But when I auscultated her heart and lungs, I knew there was a problem. The crackles in the left lung field were still present, but the more alarming observation was her heart. Normally you should not be able to count the number of heart beats per minute on a squirrel. I counted about 120 bpm. Normally the heart makes a “lub-dub” sound, but on our squirrel you could only hear the “lub” and the heart sounded like it was struggling to pump blood throughout the body. We also noted a sinus arrhythmia (which may be normal in young animals) but is still worth noting.
What do we do? We call in help from our team leaders. We rallied the troops. It is never wrong to ask for help or clarification. Amanda confirmed our observations. We determined that our furry friend was not dehydrated, and therefore did not need fluids to increase her cardiac output. So we took radiographs, which revealed an enlarged heart. This young animal had signs of a cardiomyopathy, or abnormality in her heart. It is possible that this was a congenital anomaly that had been present all along but became apparent as time went on. It was only through this valuable clinical experience that I was able to appreciate the signs of a problem in this squirrel and apply my classroom knowledge to a real case scenario.
Congratulations on making it into veterinary school. Part of being in a professional graduate program is being able to think critically, and to think for yourself. The Wildlife Medical Clinic provides you with the opportunity to learn from more experienced students. You won’t always have all the answers in vet school, but you should never feel afraid to ask for help. School is what you make of it. Your education is up to you. Learning by doing is not only enriching, it solidifies understanding of classwork. I strongly implore you to consider Wildlife Medical Clinic, take a chance, save a life, and strengthen your veterinary education.
Did you encounter an apparently orphaned animal?
Animal loving people naturally want to help when they find an apparently orphaned animal, but special care must be taken to make sure we are doing less harm than good. It is important to remember often the animal is not abandoned at all. Mothers can leave their broods for long periods of time to search for food or avoid attracting predators to the nest. For more information on whether or not an animal is a true orphan and if further action should be taken, view the video below:
The Wildlife Medical Clinic’s Walk was recently featured on the c i Living network! Check out the video here:
Take a “Walk on the Wild Side” in support of local wildlife and tomorrow’s veterinarians. You will have a chance to bid on adventure packages, animal encounters, and outstanding art including one-of-a-kind animal art! The Clinic’s own resident hawks and owls will be in attendance too! New to the program this year, we will have a Bird of Prey Program with a flight demonstration!
A group of veterinary students representing the Wildlife Medical Clinic were one of many teams that cleaned up Boneyard Creek as part of Boneyard Community Day Saturday. It was a great way to take a break from studying and assist with conservation of our community waterways.
We were featured in the local news for our efforts. For the full story and how you can participate in the cleaning effort next year, Click Here
by Zach Kline (WMC Manager – VM16)
Imagine a scene, if you will, where a heart-pounding tension is building. Three dusty gunslingers grimly face off; they stand equidistant from one another, forming the points of a large, dangerous triangle. Somewhere unseen, an instrumental piece by Ennio Morricone grows steadily louder. The men’s faces begin to come into view, “is that Clint Eastwood?” you ponder, examining the gruff looking cowboy with a poncho draped over his shoulder. Closer inspection reveals that this man is no man at all: he is an eagle, a Bald Eagle—cleverly disguised as a 1960’s movie icon. Similarly, the familiar visages of Eli Wallach and Lee VanCleef are notably absent, the wide brimmed hats sit instead on the heads of a pulsating fly larvae and a Canada goose, respectively.
A tumbleweed bounces hurriedly through the center of the triangle as the would-be combatants nervously eye each other and brush the grips of their pistols with their fingertips. The music builds to a climax as this Mexican standoff teeters on the edge of devolving to a Mexican shootout, when suddenly the illusion is broken and you are abruptly transported back to the place you once were—staring intently at a computer screen full of animal themed sentences.
Looking around the room, you can’t help but feel a little bit glum. Indeed, real life generally prohibits the possibility of wildlife cowboys engaged in shameless references to spaghetti westerns, but you take solace in the apparent fact that this particular blog post has a few dozen more animal-themed sentences to share—so this thrilling literary ride ain’t over yet! In fact, it’s just getting started.
So, who am I, exactly? I am second year veterinary student Zach Kline: Sergio Leone film enthusiast and student manager of the Wildlife Medical Clinic. At this moment I have just about completed my first full year since being hired as a student manager, and felt compelled to share some of my most memorable experiences from the past year. A year of being a manager has been a veritable roller-coaster ride. Of course on this roller coaster you have to replace loop-the-loops with getting covered in animal excrement, and replace all of your fellow coaster riders with hundreds of orphaned baby rabbits, but to stay true to the simile: like a roller coaster, this job has its ups, downs, and times when you feel like you might vomit. So, to keep with the Western theme, I present to you the “Good, the Bad, and the Ugly” of Wildlife Medicine.
Is there a purer, shinier good than Freedom? Ha-ha, rhetorical question—of course not! My Ultra-Red American blood wouldn’t allow my fingers to type something else, anyways (trust me, I tried!). Now, if freedom could take a physical form, how would it appear? Obviously it would take shape as a majestic Bald Eagle. Just try to imagine a beast with a more profound aura of freedom—it simply can’t be done.
That’s why “The Good” of my first year as wildlife manager has been the excellent opportunity to treat two injured bald eagles! These magnificent birds (Haliaeetus leucocephalus) occasionally pass through Champaign County during their species’ migration, but seldom stay for longer than a week. So, while it was serendipitous to have two individuals arrive at the clinic in a short span of time from one another, it was far from extraordinary. Both individuals suffered severe trauma to their wings. The first to arrive: a presumed male nicknamed “George”–was presented with a broken humerus from a vehicle collision, while the other, a presumed sub-adult female came to us from Peoria, IL with a fractured major metacarpal (“hand bone”). Wing injuries are perhaps the most common cause of admission for birds to the WMC, and can vary substantially with respect to the potential to successfully treat and release the animal.
As a general rule: fractures that occur at the level of a wing joint, those that are old enough to the point where the tissue has begun to decay, or those where the force of trauma shatters the bone into many small fragments are considered to be prohibitive to successful re-release of the animal. Thankfully, we felt that the fractures on these two amazing birds could be successfully managed, and thus the long period of medical rehabilitation began.
Both eagles underwent surgical procedures wherein metal pins were inserted into the adjacent bone fragments and held together with an external crossbar to ensure stabilization of the break and allow appropriate healing. As one can imagine, a bird with the wingspan equivalent to that of an adult human could be considered a formidable foe. Add to the equation that the bird is injured, angry, and has an equivalently large and upset relative in the next room, then multiply that by 2-3 months of daily treatments and you would find yourself in quite a situation! A bald eagle has a large, powerful beak (even compared to other eagles) and 2-3 inch long talons on each toe that can easily pierce through the heavy protective gloves we wear to handle birds of prey. Just to make things more interesting—our eagles would flip over on their backs and grasp out with their talons when going on the defensive, ensuring that restraining the bird meant having to pass through a protective bubble of razor-sharp claws!
While the size, strength, and high stress levels of these birds could be daunting, I placed the WMC eagle experience on my “Good” list because of the way in which working with them hones one’s clinical skill. To properly restrain an eagle, one must be swift, precise and strong; yet gentle, silent, and empathetic. Too little force allows the bird to escape and injure itself or others, yet too much force/noise causes tremendous stress to the animal—delaying healing times. Essentially, those birds were my feathery, patriotic Senseis, my Avian Mr. Miyagis, if you will. With the valuable knowledge gained from working with those powerful creatures, one may then disseminate the teachings of the eagles to other WMC members, ensuring a better quality of life for all future birds of prey in captivity.
In veterinary medicine, as in human medicine, there is an ever present risk of additional complications arising during a patient’s treatment. Secondary pathologies may arise due to a weakened immune system from a disease, from self-mutilation due to stress in captivity, or from the inability to move around the enclosure while recovering. A notable example found in Veterinary and human fields are pressure sores. Known more commonly as “bed sores” in human medicine, pressure sores arise from constant applied force on a localized area of tissue. Reduced blood flow to the area combined with cellular damage begets inflammation, and if the pressure is rarely alleviated from the area then inflammation never subsides and the tissue begins to die.
Pressure sores present a daunting challenge in injured waterfowl since a significant number of admissions are due to debilitating trauma to the legs. Heavy birds such as Canada geese initially spend a large amount of time resting on their torsos while recovering from a leg injury. Further complicating the issue is the prominent keel bone of waterfowl. This blade shaped bone sits at the center of the bird’s chest and abdomen and provides an anchoring point for the major flight muscles. However, the thin edge of the keel also serves as a point of acute pressure when the bird spends a long time lying down, and potentiates the formation of sores. Although adding padding, anti-inflammatory drugs, and hydro-therapy will help to stave off the occurrence of sores temporarily, patients requiring long periods of treatment require extreme monitoring and advanced wound care to counteract sore formation. Even then, there is no guarantee that pressure sores can be avoided. Sadly, that was the case with two Canada geese that were long term patients over the past year. The worst part is that secondary problems seem to rear their heads just when you were starting to feel hopeful about the improvements with the primary problem. Not cool, man. Not cool.
Let me start off this segment by letting you all know that I love bugs. I find the incredible diversity found in arthropods fascinating. Heck, I spent one of my first social experiences of Vet School excitedly describing a recent encounter with a brown recluse spider, so believe me when I say that I hold invertebrates in rather high regard compared to your average Joe. With that being said, I still experience a negative visceral reaction when examining a wild animal with a festering wound full of fly larvae.
Yes, maggots and other pestilent arthropods are, in my opinion, the ugliest aspect of Wildlife medicine. As we approach the warm weather season, so shall the flies begin to emerge from their wintery slumber and proceed to lay eggs on any and every suitable piece of flesh they can find. Occasionally, a lacerated wild animal evades death long enough to be captured by a kindly human and admitted to the WMC. While revolting in appearance, maggots can play a useful diagnostic role when assessing wound severity.
The quantity and size of the larvae crawling around within a wound space can give clinic members clues as to how long ago the injury occurred which plays a role in deciding how to move forward with treatment. Additionally, some species of fly larvae only feed on dead flesh, in essence debriding the wound from decomposing tissue that can become a center for bacterial infection. In fact, some maggots have evolved to secrete antibiotic compounds which eliminate bacterial competition for the glorious smorgasbord of skin and muscle.
These particular traits have been used to great effect in human wound care, as the maggots clear necrotic tissue and prevent harmful bacteria from growing! However, fly larvae that feed on live flesh are just as abundant in the wild, so we take care to remove all external parasites when an animal enters our care.
Don’t worry; the bug fun doesn’t stop at baby insects either! We now come to the adult Pigeon Louse Fly (pictured right). These housefly sized insects are flattened and have long, crablike legs that help their movement around feathers of the birds they feed on. Their discoid bodies and tough exoskeletons make these bugs hard to kill: not only for birds grooming their feathers, but for the handlers of those birds as well. What’s worse, the little bloodsuckers have a tendency to leap out of plumage during avian physical exams and always seem to aim for the face. I’ve seen groups of clinic members thrown into disarray at the emergence of a pigeon louse fly from a wild bird—usually followed by a haphazard fly-hunting mission by one of the students as the others continue with the exam.
Naturally, there is an abundance of invertebrate parasites which call the bodies of our patients “home”. Fleas, ticks, lice, mites and notably Cuterebra (pictured below): a fly larva that uses the skin of small mammals as a cozy little sleeping bag as it pupates. Oh, did I mention that they can reach the size of a quarter? Yeah, so that’s a thing. Fortunately for us and the animals, external parasites are relatively easy to manage, so this ugly aspect of wildlife treatment doesn’t stay that way for too long.