How I prepared for Basic And Clinical Science Exam- BCSE

Every foreign veterinarian who has a degree from a non-accredit veterinary school has to give ECFVG exam (Educational Commission for Foreign Veterinary Graduates). In this ECFVG exam, a foreign veterinarian has to clear 4 steps- 

1) Document verification and submission

2) English language assessment- Academic IELTS or TOEFL (Minimum band requirement is there)

3) BCSE- 5-hour long test including check-in process.

4) CPE- Clinical Proficiency Examination- 3-day process.

 NAVLE- After ECFVG foreign vets need to clear NAVLE (North American Veterinary Licensing Examination)- a 7-hour long exam! After all these steps they get a license to practice in the United States Of America.

BCSE is also known as mini NAVLE and unfortunately, many people are unable to clear it in the first attempt. It was the grace of God, my efforts, and clinical analysis which made it possible for me to clear it in one go.

So let me share with you how I prepared for my exam.

A) How many hours did I study?

I made a target to clear my BCSE in the year 2021 and it was not very easy as I left my studies 10 years ago and the last I studied was for Public Service Commission(cracked the written exam) in 2016. I passed my IELTS exam in February 2021. After then my year was totally busy with pregnancy (doing this announcement just to motivate other test takers that if I can do it they can do it too) and house shifting, etc. I somehow got time at year-end but it was like I had very little time to prepare seriously. In pregnancy, you need to avoid stress and irregular sleep. But I took a chance and started studying 3 weeks before my exam date. Made my timetable to complete the preparation mode and test mode of the Zuku review app and I got success to do the same. 

I studied almost 18 or more hours sometimes including breaks and cooking time( my husband helped me with dinner) 

I will not suggest studying this tight. I had no choice but to study. I am grateful to my unborn baby who allowed me to sit this long for my studies.

B) Study apps and resources I used.

# Applications- I had both Zuku Review and Vet Prep but I hardly got the chance to read vet prep before my examination. So I entirely used Zuku questions, explanation, links for detailed study, and some notes only. I couldn’t get time to go through videos. I completed 90% preparation mode and 100% test mode of Zuku. 

I personally liked Zuku for the tricks it provided to learn some of the most difficult and confusing things and also highlighted the points which are necessary to differentiate one case or disease from the other.

Subscribe to Zuku and Vet Prep 'question of the day' which helped me a lot.

# Magazines, journals, books, and notes- I had this very good hobby to read veterinary magazines both in print and online. It helped me a lot to know the types of cases, the prevalence of diseases, and the pattern of veterinary practice in the USA. To name a few- Merck Veterinary Manual, Today's Veterinary practice, JAVMA, Clinician brief, DVM 360, Veterinary Practice News & Today's Veterinary Nurse.

# Social media groups- I also used my social media platform like Facebook and Instagram to follow and read veterinary-related articles. 

I created the Watsapp and Telegram study group for ECFVG & NAVLE aspirants to help foreign vets exchange information and resources related to the examination. Many veterinarians got benefitted from the group.

# Notes- I also had some good notes but couldn’t get time to go through them. So my suggestion is to stick to only one thing instead of many apps, books, and notes. It will help you to be clear-minded and will avoid confusion.

#Cards- Used Radiology and Lab cards by Dr. Gerardo Poli.

C) Webinars- During COVID free webinars were the blessings for the students who were preparing for the exams. They helped me a lot to understand many topics and to get some good study resources with free CPD (Continuing professional development credits) as an extra bonus.

D) Clinical exposure- You must have some previous clinical exposure for better clinical analysis. Fortunately, I had a good clinical exposure of more than 4 years as a surgeon and physician which made it easy for me to pass this exam.

E) Lastly, study as hard as you can. Do a detailed study of each topic.

I hope this blog will help those who are preparing for this exam. All the very best.👍

 

Cushing’s Disease In Dogs:

A few months back we got a case in our hospital with clinical signs of polyuria, polydipsia, and inappetence in dogs of middle-age. This was the shelter dog who was recently adopted by a kind family. Although the above-mentioned clinical signs could be caused by a bundle of other reasons we ultimately narrow down our diagnosis to Cushing’s disease after several other differential diagnoses came negative. Let's understand this disease in brief:

What is Cushing’s disease?

It is a condition caused by the overproduction of the cortisol hormone. It is very common in middle-aged and older dogs.

Why does it happen?

We have some ductless glands in our body which are like manufacturing units of chemical messengers called hormones that are distributed by the blood throughout the body. In a healthy body, these hormones are produced in balanced in the equilibrium of these chemical messengers can muddle the functions of the organ they supervise and results in illness or disorders.

Cushing occurs through one such imbalance in the cortisol hormone. This cortisol hormone is released by the triangular-shaped adrenal gland present all over the kidney. Adrenal glands exchange messages to produce cortisol by the pituitary gland located on the base of the brain. Any tumorous growth or chronic stress can disturb the normal production of the cortisol hormone results in a number of symptoms.

In the majority of cases, the tumorous growth in the pituitary causes Cushing’s disease. Tumor of the adrenal gland is less common only fifteen percent of dogs are diagnosed with this type.

Susceptible breeds-

Some breeds are more prone to suffer from Cushing’s disease than others like-
§  Poodle
§  Dachshund
§  Yorkshire terrier
§  German Shepherd
§  Boxer
§  Cocker spaniel
§  Labrador retriever

What is the function of the cortisol hormone?

Cortisol hormone is released in response to stress signals in the body and because of this reason, it is called the stress hormone. It is released in a normal ‘flight and fright’ response which helps in the survival of living beings. When a body of an animal sense stress, the cortisol hormone is released by adrenal glands which in turn reduces the glucose storage and inhibits insulin production, a lumen of arteries gets narrow and together with epinephrin, it increases heart rate.

Now when we know the function of this hormone let's see the consequences and symptoms it, when it is present at a constantly high level.

Consequences of high cortisol levels for a long time-

1.     Constant high level of cortisol,  low level of insulin, and high level of blood glucose.

2.     As glucose increase in blood, the cells in the body get starved as they are not able to utilize this glucose because of low insulin level which causes false hunger signals. Animals will eat more and there is extra glucose in the blood which will store in the form of fat in the body result in weight gain.

3.     There will be an increase in the heart rate and blood pressure which leads to damage of arteries and can even lead to heart attack or stroke.

Symptoms:-

1 polydypsia

2 Polyphagia 

3 panting

4 hair loss 

5 lack of energy, lethargic, dull, and depressed.

Diagnosis

There are three main tests that veterinarians prefer to do for a confirmed diagnosis of Cushing's disease :

1.     ACTH Stimulation Test – It is a very popular test for the diagnosis of Cushing's disease but it is generally used for hypofunction of adrenal and not hyperfunction of the adrenal gland. Sometimes, this test fails to catch positive animals with this disorder,  around 20-30 % pituitary abnormality and 50% of adrenal tumors. Only use this test when the animal is showing clinical signs. This test helps to determine the release of cortisol from adrenal glands in response to ACTH injection.

2.     A. Low dose of dexamethasone suppression test ( LDDST)  – It is used for hyperadrenocorticism In this, the man-made synthetic cortisol i.e dexamethasone is given. ACTH is secreted by the pituitary gland and it stimulates the adrenal to produce cortisol in response to any stress. When the level of cortisol increase in the blood it sends signals to the pituitary to lower or cut down the production of ACTH but in the case of Cushing’s Syndrome this negative feedback loop does not work properly results in trouble controlling the level of cortisol as per the need of a body. This test exploit** troubled negative feedback mechanism to diagnose Cushing’s disease.

B. High-dose dexamethasone suppression test (HDDST) — In the confirmed case of Cushing’s disease when the low-dose test couldn’t able to differentiate the type of Cushing’s, we use the HDDS test.

* If cortisol level decrease during 4-8 hours interval of giving a high dose of dexamethasone this indicates pituitary origin.

* If levels do not come to reduce from the preinjection sample the diagnosis is the adrenal origin of Cushing’s.

  

3.     Urine Cortisol/ Creatinine ratio:-

In Cushing’s disease, the Cortisol and creatinine ratio elevated. This can also increase due to stress. So, we should not take it as a confirmative diagnosis.

The above tests are extensive tests for Cushing’s disease. Before performing these tests, initial screening is done in which veterinarian perform- 

• ·      Complete Blood Count
• ·      Serum Biochemistry (protein, lipids, alkaline phosphatase, glucose, and  metabolites)
• ·      Urinalysis ( specific gravity,  cell culture, and glucose). Cystitis occurs due to high levels of cortisol which suppresses the immunity system in dogs with Cushing’s and develops bacterial infection, especially bladder infection.
• ·      Xrays and Ultrasonography- to check adrenal glands and liver. 

Treatment-

The focus of treatment in Cushing’s is generally to reduce clinical signs and to improve the quality of life of the patient. 

Treatment should be given only to patients showing any symptoms of this disease.

If clinical signs are absent and the test is positive treatment is not indicated.

Treatment protocol varies with the type of Hyperadrenocorticism*.

• v Oral – Life-long medication like trilostane is prescribed to manage the pituitary type of Cushing’s disease. Induction is done once or twice weekly for life.
• 
  
• v Radiation- Is given to shrink the pituitary tumor. It is particularly helpful in small tumors of the pituitary.
• 
  
• v Surgery – In adrenal dependent, Cushing’s disease the affected adrenal gland is excised but if it is malignant then it is not removed to prevent its spread to other organs. Oral medication is given to reduce the hormone level before surgery.
• o   Trans Sphenoidal surgery is done for pituitary gland tumors.

Prognosis-

Chances of recovery are generally good if treatment is given. It may take weeks to months to completely recover the appetite, water intake, and fur. After tumor excision hormonal imbalance and symptoms related to it alleviate.

Just keep in mind that treatment for one type of Cushing’s disease cannot treat the other type.

Conclusion-

This disease needs lifelong treatment and regular monitoring, which is compulsory as your veterinarian need to keep screening your pet’s general health, side effects of medication, and hormonal level after giving treatment. It requires a lot of dedication, love, and punctuality to keep your fur baby in a healthy state. But, as we know every cloud has its silver lining so

the prognosis of this disease is generally good even if, it seems to be difficult. It can get better with proper treatment and regular checkups by your veterinarian. All you need is, to be regular with the treatment protocol and vet’s visit.

Foxtail - A grass which sting !

"We will forget the sun in his jealous sky as we lie in the field of gold" - Sting.

Do you enjoy the summer and outdoor activities like walking or playing with your fur-kids in the field of lustrous green grass or wild grasses shining like gold in the sun? If, yes then the fields of wild barley (foxtail grass) might also have mesmerized you and successfully deceived you with its innocuous look but once you become a pet owner you could see the macabre side of the same grass which gives you an obnoxious feeling linked with pain and injury.

During the summer, we enjoy most of our time in outdoor activities like walking or playing with our fur-kids in lustrous green grass or field of wild grasses shining like gold in the sun. Till we do not have pets the wild barley fields (foxtail grass) always mesmerize us in the summer and it successfully deceives us with its innocuous look but once we become a pet owner we could see the macabre side of the same grass which gives us an obnoxious feeling linked with pain and injury.

What is foxtail grass and its distribution?

Foxtail grass is a weed that is widely distributed in parts of South East Asia, Europe and North America. In India, it is popular as Kangni. It pops up its head proudly during summers. Generally, it consists of a bunch of seeds with their spikes facing upward and resembles to the foxtail. Most of the time we ignore it even if it is excessively present around us. We could spot it in the parks, lawns, trails, fields or any open area.

Why should we be petrified of the foxtail grass?

Not all foxtail grasses are perilous in fact some of them are even popularly cultivated. Most of the menacing foxtail grasses fall under the genus Hordeum e.g., Hordeum jubatum.

Seedhead of this grass also known as awns has quirky barbs which get lodged irreversibly and progress forward into tissues and internal organs after entering through nostrils, eyes, ears, mouth, paws, toes, vagina, or anus. Due to its penetration and migration, it causes painful, infectious wounds on the skin and abscesses in vital organs. In a spine, the spinal abscess can cause paralysis while abscesses in the lungs and brain can even result into a life-threatening situation. It is difficult to cure the infection as long as the foxtail is embedded inside a body therefore it is needed to be removed as soon as possible. 

Clinical signs and symptoms according to the route of entry of the foxtail :

1. Ears - Sniveling and trying to move away when you try pat on a dog's head, pawing, head shaking and tilting, inflammation, or any sort of discharge from ears.
2. Paws - Limping, swelling on paws or in between toes, licking paws continuously
3. Nose - Sneezing, coughing or there is discharge from a nose, difficult expiration, and inhalation.
4. Eyes - Swelling, inflamed, irritation in eyes, pawing
5. Genitalia - licking of genitalia and blood-tinged discharge

Treatment :

As soon as you suspect that your pet got a foxtail sting that is not easily removable and embedded deep inside the tissue, you should rush to the nearest veterinary clinic for proper removal of it. If it is ignored or removed inefficiently, it may cause more discomfort and complication to your pet. Your veterinarian will plan the removal of it after taking an X-ray to accurately trace the path of the foxtail awn and the damage it induced inside. Sometimes, it requires surgery or multiple surgeries to find and remove the foxtail, migrated and embedded deep into internal organs. Supportive treatment is given to check the infection and inflammation caused by the foxtail awn.

Prevention :

* Check your yard or lawn for the presence of the foxtail by trimming it or using herbicide to prevent its growth and regrowth.

* Avoid your pets to walk or play in areas where the foxtail grass is present.

* Protect your pet's paws with booties.

* Check pet's coat for the presence of any foxtail awn on it.

* Trim pets hair during the summer to easily spot the foxtail awn or any injury caused by it.

* Examine, groom, and brush your pet regularly especially after returning from a walk

Enjoy your summer with your furry friends without getting stung by the foxtail!

Feline Immunodeficiency Virus/ AIDS Of Cats !

What a greater gift than love of a cat ~ Charles Dickens.



There are many of us who love cats more than a dog or any other pet. Their mewing and cuteness is absolute bliss. But like any other pet, cats too are prone to many serious diseases and require proper care and management by cat owner.

If you too are from cat lover community, you may have vague familiarity with one such deadly viral disease- Feline Immunodeficiency Virus, a lentivirus which is very closely related to Human Immunodeficiency Virus (HIV) and have very similar effect on body but it is not transmissible between one species to another. It cause T-cell deficiency in domestic cats which in turn make them immunodeficient and they get prone to illness from even normally harmless bacteria, fungi and virus which are found in environment.

Origin of FIV in domestic cats is believed to be from African lion as this virus is even found in a non domestic felidae family. Brown  et al. (1993) mentioned about one such study which revealed about the existence of antigenically similar lentivirus in a large number of non domestic felidae family like it is endemic in East and South African lion population and free range population of cheetah but it do not cause disease in African cats.
     
High incidence of FIV is directly associated with density of cat population, more the density of cat in an area more is a chance of FIV cases.

     Figure 1. Showing distribution of pet cat population in world  © Mapsofworld.com

Q. How it is transmitted?

A. Primary mode of transmission is through bite wound and intact feral male cat is more predisposed to FIV virus than that of female cat. It do not spread by sharing food and water in a same bowl, cuddling or grooming but it is better to keep two cats away to reduce the chances of fight which can give bite wound. If your cat mingle with stray or feral cats unsupervised it is better to have it tested for FIV. As the virus is highly species specific it do not transmit from cats to human or other pets of different species like dogs. 

Q. How you can know if your cat have FIV?

A. You may notice one or more of these following clinical signs and symptoms :

* Enlargement of lymph node often accompanied with fever. Sometimes this stage pass unnoticed unless lymph nodes are greatly enlarged.

* Progressive deterioration of cat's health or recurrent illness.

* Loss of appetite.

* Poor coat condition.

* Inflammation of gums (gingivitis) and mouth (stomatitis).

* Recurrent infection of skin, eyes, urinary bladder and upper respiratory track.

* Diarrhoea

* Some cats may show seizures or other neurological disorders.

Q. How FIV is diagnosed ?

A. Blood sample is examined for antibodies to FIV by Enzyme Linked Immunosorbent Assay (ELISA ) or Immune Fluorescence Assay (IFA). Positive ELISA is reconfirmed by Western blot. Kittens of infected mother cat can receive positive test result for several months after birth but rarely any kitten may actually get infected. Therefore, kittens younger than six months should be retested at 60 days for six month interval.

Q. Is there any treatment for FIV?

A. Unfortunately, there is no definite cure of FIV. Cat can carry virus for a long time before symptoms appear. Even if survival is  unpredictable FIV affected cats can lead a normal life if managed properly. Once diagnosed with FIV a Veterinarian will start symptomatic treatment like anti inflammatory, immune boosters, antifungal, antiparasitic to control the secondary illness. Some anti viral drugs have also shown good results in controlling stomatitis and gingivitis. Dental care is must for these cats.

Now, vaccines are also available like Fel-O-Vax^® FIV to protect cats from this disease but it have its own limitations as it is not a core vaccine of cats and do not protect against all the subtypes of virus hence, even vaccinated cats need other precautionary measures against disease. Vaccine induced sarcoma (kind of cancer) is another complication related to vaccine. You must discuss in detail about treatment options and their outcome with Veterinarian.

Q. How to manage or care the FIV affected cat and how good chance of survival of such cat is?

A. You can manage or care such cats very well by following ways:

* Confine infected cat indoor to prevent spread of disease to other healthy cats.

* Environment should be stress free.

* Home should have only this cat or other pets of different species like dogs.

* Spay or neuter your cat.

* Feed balanced commercial diet.

* Uncooked food, raw meat, eggs and unpasteurised milk products should be avoided to reduce the risk of food borne bacterial and parasitic infections.

* Cat should be dewormed or have active parasitic control.

* Veterinary checkup at every six month interval is advisable for overall health screening. 

Prognosis - If there is persistent fever and weight loss the chance of survival is generally poor but if managed appropriately cat can survive like any other non FIV positive cats.

Q. Can you adopt FIV positive cats?

A. Yes, you can adopt an FIV positive cats with some precautions to keep in mind like this virus is species specific and can spread from one cat to another through bite wound, so if you have more than one cat in your home and they don't get along then it is better to not allow them to interact or should not be kept in one place. If needed one cat should be re-homed.

Such cats can live normal and healthy life if managed nicely. 

FIV is completely harmless to humans or your pets of different species other than feline as it only harm cats. 

FIV positive cats are safe to adopt and by adopting such cats you can save them from euthanasia which is used as a last option by shelters for such cases.

I hope this article can help people to know about FIV thoroughly and succor in adoption of  many FIV positive cats.These cats want your love and euthanasia should not be their fate.

Reference:

1. Brown, E., Miththapala, S., & O'Brien, S. (1993). Prevalence of Exposure to Feline Immunodeficiency Virus in Exotic Felid Species. Journal of Zoo and Wildlife Medicine, 24(3), 357-364. Retrieved from http://www.jstor.org/stable/20095289