Veterinary Vertex

Exploring New Frontiers in Canine Surgery through Modern Imaging Technology

November 21, 2023 AVMA Journals
Veterinary Vertex
Exploring New Frontiers in Canine Surgery through Modern Imaging Technology
Show Notes Transcript Chapter Markers

Hosts Drs. Lisa Fortier and Sarah Wright with guest Dr. Julia Sevy discuss how abdominal CT and exploratory laparotomy have high agreement in dogs with surgical disease. Julia's groundbreaking research illuminates the critical need to question the status quo. This episode is a must-listen for practitioners ready to harness the power of modern imaging technology for the benefits of their canine patients.

But the episode is not just about the technicalities! Be ready to enjoy the authentic story of Julia's journey to becoming a veterinary surgeon. Her path, marked by determination and fueled by her love for dance, is a testament to her resilience. Listen to her personal experiences as a vet student and how she learned to question different approaches to finding the best solutions. You'll be left inspired, informed, and eager to hear more. We also promise a fun, lighthearted ending, as Julia reveals the most interesting item in her desk drawer. We guarantee this episode will redefine your understanding of the ever-evolving field of veterinary surgery. Tune in and prepare to be enlightened!

Full article: https://doi.org/10.2460/javma.23.08.0458

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Speaker 1:

You're listening to Veterinary Vertex, a podcast of the AVMA journals. In this episode, we chat about the agreement between computed tomography and exploratory laparotomy and dogs with surgical disease with our guest Julia Seve.

Speaker 2:

Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have a surgeon Yay Joining us today. Julia, Thank you so much for being here with us today.

Speaker 3:

Of course, thank you for having me All right, let's dive right in.

Speaker 1:

Julia, can you share with our listeners what they can expect from your JAPMA article?

Speaker 3:

Yeah, so it's. I like to think of it as pretty simple but in terms of you know, when you expect abdominal or surgical abdominal disease in the dog, you know your best friends are going to be imaging. So usually we think of radiography or abdominal ultrasound. But those of course have limitations and so when feasible and when available, a lot of clinicians are turning to abdominal CT. It's shown to be more sensitive for finding mechanical obstructions, for diagnosing pancreatic insulinoma, for monitoring response to therapy for various neoplasia. So there's a bunch of research out there that shows its superiority. And you know, every time I do a surgery and exploratory laparotomy, every time I enter into the abdomen, I've been taught to do a full exploratory laparotomy. So look at the liver, look at the whole GI tract, look at the kidneys, adrenals here in your bladder, gallbladder. But my mentor last year had sort of a different idea and was like we did a preop CT, you don't have to do that. And I was like huh, really. And I looked to see if there was any research published about sort of the agreement between, you know, an abdominal CT and an exploratory laparotomy. And there isn't. There's some looking at, you know, abdominal ultrasound and exploratory laparotomy, but none looking at actual CT, and so that's what we wanted to do. We wanted to look at the agreement and say, okay, you know if the patient fits and you are sure about the diagnosis and you're sure about your surgical plan. Do you really need to explore the whole abdomen each time if you do this really sensitive preoperative imaging diagnostic, it's going to be super helpful for our practitioners.

Speaker 1:

I do feel like more and more clinics are getting CT, or at least using the portable CTs, so I think this is really really good practical information. Yeah, and then, what were some of the important insights from this article?

Speaker 3:

I mean, again, we kind of already know that CT is sensitive, right, but I think a lot of the things that I learned as you know, someone who wants to be a surgeon is, oh, I'm going to have to learn a lot about. You know radiology and imaging, right, and so I learned about a lot about the CT that we used at the institution and you know what the beam pitches and how many. You know phases and studies there are, which generally I don't think about as much. And I learned a lot about radiological error too. You know there's non-error discrepancies, where something just precludes you from actually visualizing it in the CT scan versus actual, you know human error, which can be perceptive or cognitive, and you know we're. There's so many biases that you know can affect CT imaging, and so I think, as a surgeon, sometimes I look at the radiology report and I'm like, yep, they know what they're talking about, but there's so many things that can lead to different results. And just realizing that was important. And we actually had a radiologist. Look at the cases that disagreed with our exploratory laparotomy. Two of them, she found the lesion, so that was. You know more. So human error versus one. She couldn't find it, and so there are still limitations. Even if you use, you know, the perfect settings for this very sensitive pre-op imaging, you might miss it.

Speaker 2:

So, Leah, as a veterinary surgeon, we're still quite broadly trained. What sparked your research? At least your research interest in surgical abdominal disease?

Speaker 3:

Yeah, I think it was more so. Just that question that my sort of attending asked me is you know, why do we have to explore this? And I'm like because people told me to, and I think that it sort of made me realize that I can question things more. You know, as a baby surgeon or a vet student, you're told things and you're more likely to accept them because you've never done it yourself, whereas now, you know, I'm three years out of that school, I'm doing things myself and so I can think about questioning things and become more curious. And so it wasn't necessarily. You know I'm very, very interested in the abdomen. It was more just. You know, we've been doing this for so long, something as old as an exploratory laparotomy. Do we still have to do it if we have this very sensitive imaging done? So it was more just questioning something and then making sure that I had data to back up what I was actually doing.

Speaker 2:

Yeah, it's one thing really to be receptive, to like wow, that's an interesting question, but what really inspired you to then go dig back and write this manuscript?

Speaker 3:

Yeah, I mean as a searchable intern. Obviously I always want to have something that I'm working on and some kind of research is some kind of question that I'm trying to answer for my residency application, of course, and also, I think, the fact that it was interesting to me that there was no published data on it. It's a very sort of simple question like, okay, how much agreement is there between an abdominal CT and surgery? I thought I was going to have a bunch of hits, but that's sort of the nature of veterinary research, is that you kind of get to be the one to do that, and so it's such a simple and practical question and I think sometimes I get stuck in the sort of nitty gritty of research and I get lost. And it was a topic, that is. I always had the full picture in my head and it was something that I thought would again appeal to surgeons, but also general practitioners, who can do a smaller approach for systotomies or space or pyometres whatever you have going on and potentially decrease anesthetic time, decrease atrogenic risk or manipulation and cause less pain and a smaller incision if possible.

Speaker 1:

But, julia, we have a question for you. Have you heard about our journal awards? No, so it's a really cool awards program and it's for students and house officers, so interns and residents and if you author a manuscript in Javmar H-A-B-R it can be nominated and then, if you win, there's a monetary prize, you get social media promotion and you get a certificate. So it's a really cool opportunity. We highly encourage you to ask someone to nominate you or self-nominate Yep. Self-nominate as well Yep, yep.

Speaker 3:

Well, I didn't know about that, so I definitely will.

Speaker 1:

Yeah, we can send you the link after this. Cool yeah. So, speaking of advanced training, how did your advanced training prepare you to write theoul Challeng piece.

Speaker 3:

Yes, I think that, being someone who is interested in becoming a surgeon, you know that you're going to have a long road. You know that you're going to have to do at least a surgical internship, potentially, to which I'm doing, and so, because of that, I've worked with so many different surgeons, you know, from that school to my rotating, to my surgical internships, and all of them are so different. There are so many ways to do things and again, I think this comes back to the fact that you know, as a vet student, you're told sort of this is the way, and of course there's other ways, but we like to do it this way here. And so, being to so many different places, I've just realized that everyone kind of comes up. The hospitals are the same, of course, of surgery, but everyone finds their own way that works for them, and I really that's what I love about surgery too. I think it makes it sort of this like brings in this creative component where you can do what's best for the patient but also what's best for you, and that you can do, you know, the best job that you can, and so, again, I think it comes back to me being able to question things. You know, seeing people do things so differently makes me question okay, why are they doing it this way and someone else doing it this way? And which way do I want to do it? Or do I want to come up with a new way that works best for me that's still safe for the patient? And then I think that sort of leads into research too is just questioning things as the basis of research and realizing that you can change things and come up with new ways to do things, because that's what people have been doing forever. And just working with so many different clinicians and surgeons, I'm slowly realizing that I can sort of make things my own, as long as the principles stay the same.

Speaker 1:

This next set of questions is really important for our listeners. What is one piece of information the veterinarian should know before discussing this topic with the client?

Speaker 3:

I think that, of course, remembering to treat every patient like the individual they are. You know, I'm not telling you to skip every exploratory laparotomy If you have a preoperative CT scan. Of course, if you're confused or concerned about something, things aren't seeming right or it's not super straightforward, of course, explore the abdomen, make sure everything looks normal and feels normal. So you have to make sure that you are choosing your patients wisely. This is for straightforward cases. It's also for cases where maybe they're not doing well under anesthesia and you need to go quickly and you say, okay, I'm going to skip the explore, but it makes me feel better that there's this published data that I probably wouldn't have found anything else. And so just making sure that you're choosing your patients wisely and treating all of them as individual cases.

Speaker 1:

And then on the other side of the relationship was one piece of information that clients should know about abdominal CT for surgical disease.

Speaker 3:

Yeah, I mean I feel like I talked about this before, but of course there's always, you know there is. We found that there is a 3% chance that we could miss something, and so there's always that chance that you know you could not explore the abdomen and then maybe you know prognosis, diagnosis or surgical plan would have changed. As long as they know that, I mean, they know that the doctor is, of course, choosing the patient wisely and feels very good about their diagnosis and surgical plan, and then I think it's, you know, fair to skip it.

Speaker 2:

And Julia, you talked earlier about the long road to advanced training, not just surgery, but medicine and radiology that we're talking about as well. It takes grit and determination. Where do you think your resilience and determination came from?

Speaker 3:

I think two things. One would definitely be my parents. They instilled in me at a very young age that determination, persistence, is really important and that you know all you can do is keep going. And you know, if you don't get a residency this time, just keep working hard and you'll hopefully get one next time. And then I think the second thing is that I have been a dancer since I was six, and so that's something that is requires so much dedication and time and determination and work. It's a craft and it's something that you sort of reach for perfection but never really get to, which is why it's kind of fun, and that's kind of what surgery is too, and so I often say that surgery reminds me of dancing a way and that I really owe dance. It's the reason why I am the way I am and I am so persistent and driven.

Speaker 2:

Or maybe you were a good dancer because you were persistent and driven. Who knows which one came first. As we're winding down a little bit, our listeners and Sarah and I love this question what is the oldest or the most interesting item in your desk drawer?

Speaker 3:

So I have a weird one. I have some juggling balls in my desk drawer. During COVID, when my vet school sort of sent us home and we did online classes you know, there's only so much time you can practice suturing on a towel so I decided to pick up another skill and I taught myself juggling. It wasn't great, but it was fun and it was something I just wanted to like work with my hands and you know, keep my motor skills up and I actually pulled them out a couple months ago and still got it. The finesse is not there, but I can work on it.

Speaker 1:

She had them with you now. Can you see that? Wait, let me get to our listeners. Julia is going to grab the juggling balls, but it smells the test.

Speaker 3:

It came in this nice little pouch.

Speaker 2:

Your dog's watching you, julia, as your dog been the victim of a couple drop juggling balls by any chance.

Speaker 3:

Okay, I don't. I really haven't practiced in a while, so this could go really badly. She's doing it. It's our listeners. Julia is juggling it's awesome.

Speaker 1:

Well, thank you for sharing, Julia.

Speaker 2:

We appreciate it and just to thank you for sharing, julia, I appreciate it Well.

Speaker 1:

Thank you for sharing, julia. We appreciate it. And just thank you again for taking the time to be here today and for contributing your manuscript to JAPMA. Of course it's my pleasure. And to our listeners. You can read Julia's manuscript and print JAPMA on our journal's website. I'm Sarah Wright with Lisa40A. We want to thank each of you for joining us on this episode of the Veterinary Vertex podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple podcasts or on our platform. You'll getwatergoing易uk vier, section 2.

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