The. End.

This week is a little hectic between finishing up my internship, packing up my apartment and trying to get some last minute social time with everyone down here. I don't have loads of time to blog so I'm making this my last post *tear*. I have absolutely loved it here at Auburn and I have learned so much.  The staff at the veterinary hospital is amazing. There are so many people that are so knowledgeable about what they do and are excited to teach anyone who is willing to learn.  I wanted to thank everyone there that trusted me to do all kinds of things,  taught me a ridiculous amount of stuff and let me help them even when they didn't really need it.

I will always have a little soft spot for my peeps in Neuro and Anesthesia who will forever know me as "Eeyore" and to my pals in Onco who let me run their anesthesia and do an epidural and blood draws on their patients all the time. It was a tough decision not to stay at Auburn (especially with the incessant guilt trips about it!!) and I will definitely miss all of the people there that I had the opportunity to work with.

For all of the Bel-Rea kids going into internship, here's a tidbit or two of advice from my experience. First, be willing to learn different ways of doing things that what we were taught in school. It's important to communicate that you have a good base of knowledge without being the dreaded "know-it-all", asking questions that make is clear that you have some sense of what you're talking about but that you don't already know the answer to is not only a great way to do that but to also communicate that you are willing and eager to learn.  Second, TAKE INITIATIVE! Sure, it'll take a few days to adjust, but do not spend the first several weeks like a bump on a log because no one is specifically asking you to help with things. Ask people "hey is there anything I can help with?", "do you need help?", "let me know if you need anything"; they will get you involved if you keep asking.  Third, don't be afraid to make mistakes or ask for help if you don't know how to do something. Hello? You're a student, you're learning, they are there to help and teach you. Last, have fun. Enjoy it, this is the beginning of your career, you might as well make it a good one.

For all of my blog readers. Thank you so much for reading this and giving me your feedback. I hope that it's been informative, educational, maybe mildly entertaining?? I may start blogging again in the future...we shall see.

That's it for me! Good luck to all the Bel-Rea kids whether it's passing tests or finding jobs. To my Auburn peeps, goodbye FOR NOW and thank you so much for everything you've taught me and for making me feel welcome. I heart you all :)

We've got a bleeder!

Friday was my last day on Sports Medicine and it started out pretty chill. I learned about various physical therapy modalities and then the kennel workers brought Bob the greyhound in so we could do his therapy. After we took the splint off on Tuesday, Bob's leg was looking really good. We did therapy on his leg every day and were hoping to increase the range of motion in his joints and get him using that leg again. Then, on Thursday the entire medial side of his leg was swollen and had a huge hematoma (big bruise looking thing-when blood collects under the skin outside of the blood vessels) covering the inside of his thigh down past the joint that had been surgically repaired. He also had a fever, his temp was 104.8 and normal is about 101-102. So we continued giving Bob an antibiotic and also gave him an anti-inflammatory/pain med then rebandaged his leg to prevent any further injury.

Ok, now back to Friday. Bob comes in and the vet asks me to remove the splint/bandage and call him when I get it off. The vet also made a comment about how he wouldn't be surprised if the wound broke open and started draining while we were doing therapy today. Great. So I'm cutting the bandage off and Bob is just chilling, letting me do what I need to do. I pull the splint off and pick up my phone to call the vet. Before I could call him, blood starts POURING out of Bob's leg, it was like a fire hose people! At first, I thought it was just draining and the flow of blood would stop, or at least slow down, soon. Nope. Nope, that did NOT happen. So, I grabbed two huge handfuls of gauze (the closest absorbent material I could find) and put some pressure on the crazy shooting ridiculous blood pouring forth. While doing that, I called the vet and was like "Hi, I got the bandage off of Bob and--" he cuts me off before I can say "and he's bleeding profusely". He says he'll be right down and hangs up. Wonderful. Bob bleeds through the gauze in about 10-15 seconds so I grab a towel to put on there until the vet comes down. Fortunately, it wasn't long.

When he saw the bleeding and that it was shooting out like it does from an artery like you see in a crazy chainsaw massacre movie, he decided we needed to sedate Bob and figure out what was happening.  He called in the other vet and we sedated Bob. They initially thought that the area was draining and that they could quickly go in, remove any blood clots and such and close up the wound that had been created by the shooting blood.  After removing a few golf ball sized gelatinous blood clots, it became clear that there was a severed artery.  Blood continued to pulse out of the wound and they tried to get some some hemostats clamped down on it to stop the bleeding, but they couldn't find it because it was too far up the leg to be able to access.  At one point, Bob stopped breathing and we all just kind of stopped for a second and stared at his side just waiting...waiting...waiting. Then he breathed! Thank goodness. Then the craziness continued. At some point, it was decided that we needed to intubate Bob and get him on gas anesthesia. Let me just say that they don't often do surgery that requires gas anesthesia down in Sports Med-land. So we didn't really have any monitoring equipment and only the bare minimum of surgical instruments. I'm "monitoring" anesthesia by checking Bob's femoral pulse, looking at the reservoir bag for respirations and checking his mucous membrane color. At first, Bob's pulse was strong and regular but his mucous membranes were really pale due to the blood loss. As things proceeded, his mucous membranes turned grey (really bad!), his mouth was literally cold and his pulse became weak and "thready". All very bad things. We were giving Bob fluids, a full liter pretty much wide open.   We were doing everything we could for Bob but things were a little scary. The vets were able to slow the blood flow but still couldn't find the artery. They decided there wasn't anything else they could do so they sutured up the wound and left part of it open to drain.

Bob's pulse and color started to come back to normal as he recovered but he was still pretty cold when I took his temperature. We bundled him up and got him snuggled into a crate. I checked on him periodically, his temp came up to normal and his color was looking really good by the end of the day.

I've never seen so much blood come out of one animal in such a short period of time and it was definitely scary at times. I maintained my composure throughout and felt like I had some sense of what I was doing, which is good considering internship is almost over and I have to get a real job in this field soon. Hopefully, Bob does ok this weekend. I'll definitely be checking in on him next week.

Adventure into the land of horses

Alright, before I delve into this, I want to preface it with the soon to be obvious fact that I am more of a small animal person.  I know just enough about large animals to be dangerous. So as I stumble through this anatomy and jargon keep that in mind, and if you are a large animal person, feel free to correct me and try not to wince too much. Also, this may be horribly boring to some of you who couldn't care any less about this stuff, that's ok, I'm not offended. Thanks!

I mosied on over to the lameness arena at the large animal hospital today to watch a study that was being done on horses that are prone to laminitis (aka founder). Laminitis is, literally, inflammation of the laminae.  But, what also occurs is that the laminae also breaks down and cannot support the structures of the hoof and provide the shock absorption which is designed to do. Here's a diagram of the structures of the horse's distal limb:

See how the "sensitive laminae" surrounds all those bones and tendons within the hoof? It's uber-important. When the laminae breaks down, it often allows the coffin bone to rotate and this whole process is very painful for the horse and creates significant lameness.  There are many causes of laminitis ranging from diet related issues to type of pasture to conformation.  Conformation refers to a horse's basic structure, how they are put together.  Did they get Aunt Edna's knock knees or Grandpa Frank's hunch back, etc. Horses that are conformationally prone to laminitis tend to walk more on their toes which reduces the use of the tissues in the heel area that do a lot of shock absorption (the "frog" plays a big role in that).  Because of that, there is much more stress and trauma inflicted on the structures of the hoof. From my understanding, (this is where horse people are welcome to interject or make corrections) there is no real effective treatment for this condition.  On horses that have laminitis issues due to conformation, special shoes and pads are often used that try to correct the angle of the hoof but still do not allow pressure on the heel and the frog.  However, this approach doesn't actually treat the problem and, in some ways, makes it worse.

This vet at Auburn is doing a study to determine the effectiveness of "natural hoof care" on laminitis issues. So instead of using special shoes and such, they are trying to determine if there is a way to trim the horse's hoof and NOT use shoes so that the horse is actually healing itself by using all of the structures of the hoof as they were designed to be used.  This is how the vet explained it to me: bones in a healthy animal/person will adapt to how much load/strain is put on them and, over time, bone density will increase to account for increased load or activity whereas, bone that does not have a significant load placed on it will begin to breakdown (Wolff's Law for those of you that may be familiar with it). Similarly, if we don't use our muscles we lose them, right? Same deal with the soft tissue in a horse's hoof, if they are not able to use it, it will breakdown and will no longer be able to perform it's ever important functions.  

Here's the cool stuff that I got to see.  This horse who had severe lameness after becoming a lawn ornament (not being worked) for several years was being asked to work again.  The owners hadn't realized he was so lame because he was fine just hanging out in the pasture and such.  So when they wanted to ride him again and realized the issue, they brought him to Auburn. Today, he was outfitted with a bunch of cool little dots on all the major joints of his limbs and three little balls stuck on his front hooves.  A slow motion camera was used to record his foot fall before a hoof trimming, after a hoof trimming and with special boots on.  The other dots were used while filming his full body movement at each stage.  The full body film will use the dots on the horse to create a digital image that, I am guessing, can be analyzed with some crazy computer something. They will use it to evaluate the horse's gait and hoof position as it relates to soft tissue structures like tendons that play a large role in lameness issues.  The angles at which the horse's hooves are trimmed will be evaluated to see if it helps with the horse's issues or not.  There is a lot more to the anatomy and science of the study but, basically, this is a major study that incorporates some cutting edge information on the treatment of laminitis in horses. Here are a few links about the study if you care to know more...

http://hoofrehab.com/AuburnUvetschool.htm

http://easycarenews.com/06-15-2009/press-releases/laminitis/

Hopefully, I didn't just severely disappoint my large animal instructors or bore the mess out of anyone. I thought it was cool so I felt like sharing, that's kind of how this whole blog deal works I suppose.  One more week of internship left! Unbelievable!

Thermographic zebras!

OK this is a quick, fun-filled post before I get to my real post (which, of course, is also fun-filled but somehow different)

Earlier this week, I went with one of the vets out to the area where the dogs are roaded and imprinted.  He brought a thermographic camera with him to get some pictures and video. A thermographic camera shows the image in various colors that represent temperature. It's kind of like something you see in movies like "Predator" and other Arnold Schwarzenegger/Sylvester Stallone type deals. They've done some studies about temperature zones and the importance of being aware of them when working and training dogs.  Basically, we have to consider the temperature of the environment where the dog is working (close to the ground) not the temperature that the weather man tells us that it is (from some thermometer way up high off of the ground).  It's often much hotter close to the ground, and various things like tall grass or asphalt can increase the temperature even more.  Overheating is a major concern with working dogs of all kinds.

So while we were waiting for some dogs to come back from roading, he was telling me about all these studies that have been done with wild animals and thermographic imaging.  Apparently, when polar bears are filmed with these cameras, all you can differentiate is their eyes because they are so good at regulating their temperature to their surroundings. Kangaroos will dig down a few inches in the dirt, to where it can be more than 20 degrees cooler than the ground surface.  Then, the kangaroos will lick their forearms and the moisture from their saliva increases the heat that is released from the blood vessels underneath, and you can see that on a thermographic camera! Ok and last, but most definitely NOT least. Zebras. So there are two main reasons why zebras have black and white stripes. One is so that when they are in a herd, predators can differentiate an individual zebra, it just looks like a big heap of black and white stripes. The OTHER reason has to do with all things thermographic.  When there isn't a breeze out on the plains or wherever zebras hang out they are still able to keep cool. Do you know how? No?? Well I'm gonna tell you.  The heat difference between the areas of black fur and the areas of white fur actually CREATES A BREEZE! A little zebra sized personal breeze. Amazing, totally and utterly amazing.

Oh and FYI the main areas that dogs expel heat from (aka "thermal windows") are their eyes, nose, groin, and armpit area.

**This blog is dedicated to my brother Kris who, I am certain, will have a great appreciation for its title**

Workin' with the workin' dogs!

This week I'm spending some time in the Sports Medicine Department aka Animal Health and Performance Program. They have all kinds of stuff going on at the same time and it's a totally different world than your standard small animal vet med.

Yesterday, I went with the director of the program (he's a vet) up to their breeding and training facility about two hours north of Auburn.  They breed Labradors for their training program so there are loads of cute puppies all over the place.  These kids pretty much begin training right away.  They are put outside in little fenced in areas while the lawn mowers, leaf blowers, weed wackers and all kinds of vehicles are going by to get them used to loud noises and such.  Then they literally play on one of those plastic play sets with the slide and clubhouse and what not so that they get used to different surfaces.  THEN, when they are a few months old, they are temporarily adopted by a prisoner at a local prison in order to help with socialization and again get used to a new environment.  Eventually, dogs are trained to do various jobs depending on which studies are going on or what various government agencies need them for.  So you've got dogs that can sniff out bombs in war zones, dogs that sniff out narcotics in airports/cars/buildings, dogs that sniff out fungus that's destroying trees, dogs that sniff out boa constrictors in the everglades that used to be someone's pet but got released by their silly owners and it's destroying the whole balance of the ecosystem in that area and loads of other stuff. There were some military veterinarians at the facility checking out dogs to see if they met various physical standards to become military dogs.  The dogs had to be radiographed to check for hip dysplasia and various vertebral issues (like an extra lumbar vertebrae that one of the dogs had...whaaaaat?!?) and they also underwent a basic physical exam and had blood drawn for testing.  Depending on how dire the need for dogs is in war zones, the leniency of the standards that these dogs have to meet changes. Verrrry interesting.

Today I stayed on campus to see some of the things that they have going on here in Auburn.  They have several studies going on with various breeds of dogs that are being trained to do different jobs. First, we went out to see the dogs that were being "roaded". Roading is a form of conditioning in which metal extension bars are attached to golf carts, the bars hang out over the side of the cart and dogs are attached by lines to these bars.  The dogs then run along side the cart while it's driven around for various amounts of time.  It seems a little harsh at first, but the dogs are constantly monitored for fatigue and signs of overheating.  It is imperative that the dogs be in excellent physical condition in order to do their jobs effectively under various conditions.

At the same time, different dogs are being "imprinted".  Imprinting is a dog's initial training to learn to recognize and respond to a specific scent (explosives, narcotics, fungus, etc).  Studies have shown that dogs can pick up a scent when there are only a few parts per billion in the air they are sniffing.  That could mean that something was buried underground or is in some type of container.  In order to imprint the dog, they first have to choose a reward.  They are given the option of all types of toys...tennis ball, squeaky tennis ball, kong, doodly bopper, whatever.  The dogs choose by seeking out a specific toy when a whole bunch are tossed out for them to pick from.  During their training, they are given that toy each time they correctly find and respond to a scent.  So there's a line of about 6 wooden boxes on the ground with holes in the top.  In one box, there is a petri dish holding whatever it is the dog is to be trained to detect.  While the dog is learning, the trainer will tell the dog to sit and then give the reward each time the dog sniffs the box with the target scent in it.  The boxes are moved around and this whole process is repeated until the dog sniffs the right box and sits on his/her own.  During the process, it's important that the person moving the box with the scent in it around touches several boxes so that the dog is not being trained on that person's scent (that's cheating! and it won't help in a real situation). It's also important that a dog be trained on only one scent.  An example where it may become a problem is if a dog were trained on narcotics and say...explosives.  So Rex (my imaginary scent dog) is sniffing through a parking lot in Shadyville, USA.  Rex stops and sits next to the trunk of an abandoned car, good boy Rex! But, the problem is that we don't know if he picked up the scent of explosives or narcotics so his handler may go open the trunk expecting narcotics and have a bomb explode in his face. Not cool.  It's also very difficult to UN-train a dog on a scent so you had better be sure you're using the correct scent to train Rex with or you'll be in for loads of additional training to reprogram his nose.

Ok THEN. I went back and worked with a tech doing some rehab on Bob the greyhound (he's owned by the school so I can tell you his name). Bob tore his ACL while doing a running trial back at the end of April.  He had TPLO surgery to repair the injury and he has been receiving different types of therapy and his leg has been in a splint.  The type of therapy we did today is called TENS therapy- Transcutaneous (through the skin) electrical nerve stimulation.  So we put little pads with electrodes on his leg above and below the stifle joint (where the injury occurred) and we turn the electrodes on and increased the intensity of the pulse they emit until we see the muscles actually twitching.  This therapy can be used for various things, but our intention was to decrease pain. I'm not going to go in to the whole science of TENS therapy but you can easily do an online search for more info if you're interested. We did two ten minute TENS sessions and did passive range of motion exercises in between.  Passive range of motion or PROM is done to assess and potentially increase the movement of a joint without the participation of the patient.  Obviously, that last part is more difficult to get an animal to cooperate with, but we do what we can.  After being splinted for several weeks, Bob's joints had a significant decrease in their range of motion.  In order for him to regain strength and use of his injured leg, his ROM had to be increased.  Two points of concern for me were his stifle (obviously, that was where the injury was) and his tarsus. The tarsus is the joint just above the digits that allows the foot to be flexed and extended. Bob's tarsus had decent ROM in regards to flexion but not in extension.  This means that he wasn't able to bend his foot forward in order to place it normally, he was basically on his tippy toe on his injured leg. He was already hesitant to put weight on the leg, but not being able to place his foot normally is a further deterrent that needs to be addressed to get him on the road to recovery.  Bob got this treatment twice today AND we took his splint off for good, so hopefully he'll think about using that leg a bit more.

I also got to massage another greyhound, Hannah.  She's an old lady (11 years old) and is sporadically having issues with hind end weakness and lameness.  The radiographs on her did not show any structural issues, so it's unclear what is going on with her.  She started out all wide eyed and stiff, giving me weird looks and refusing to sit or lay down while I worked on her front end (I'm used to this initial reaction). But, I just kept working on her non-affected areas to get her used to the massage and to me.  I worked my way back to her hips, lumbar area and hind limbs (weird looks and stiffness continue with moments of relaxation). After a few minutes of working on this area, Hannah laid down on her side on the blanket and became as much of a pile of mush as she could be. She had several areas where, when I applied pressure, the entire muscle body would visibly spasm.  I did some stretching and some secret ninja massage techniques and was able to significantly reduce the spasming.  I also addressed significant tension in her iliopsoas, quadratus lumborum (most fun muscle name EVER--another band name, Kris??), quadriceps and adductor group (Homework: go ahead and look those muscles up...it's time to learn on your own friends). I probably worked on the kid for 45 minutes and she was ASLEEP and having dream twitches. It was adorable and reminded me that, even with every available technology and gadget out there, a good massage can do wonders and, if you know what you're looking for and feeling it can give you loads of information about your patient. I may be a bit biased towards massage given my training in human and small animal massage, but I'm pretty sure Hannah (and Bob, because I massaged him too) would agree with me.

Ok that's all I have time for today. Hopefully, I will get a chance to post about thermographic imaging and zebras later this week. Yes, zebras. Also, kangaroos and polar bears. (Ooooh, now you're on the edge of your seat just WAITING for my next post aren't you???)

Goat dermatology!

Yeah buddy, goat dermatology! We were finishing up our day of dermatology on Thursday and were about to begin what would have, without a doubt, been a riveting lecture about antibiotics when the vet received a phone call.  The vet students and I heard some key words: "barn", "goat", "non-pruritic" and, perhaps my favorite word of the entire conversation...consult. SCORE! We're going to see the goat!

We get down to the barn and we find this goat, this poor miserable goat.  The kid is emaciated despite a hearty appetite due to his diarrhea issue.  His hair coat is awful and his skin is equally bad.  He has bilateral (on both sides) bald patches along the top of his back leaving a little mohawk strip of hair on top of his spine. He also had  a few other bald patches here and there.  The skin on his back peeled off of him kind of like dried paint with a tad more flexibility to it.  Based on the condition of his skin, we thought it maybe dermatophilus, which is actually caused by a bacteria.  But, considering the symmetrical alopecia (hair loss) we had to consider a metabolic issue.  The reason that the symmetrical alopecia was a concern is that it's not something that the animal could have done  just by rubbing up against a fence to get to his itchy spot.  Also, the large animal vet said that the animal presented as non-pruritic (remember, pruritic= itchy) so he wouldn't be trying to take care of a persistent itchy back anyway.  However, to cover our bases, we took all kinds of samples and made our usual slides in addition to a few of some hair clumps.  We took it all back to the lab to check things out, although we were pretty sure we weren't going to find much due to the symptoms we had observed.  We were checking out slides, not finding stuff, not finding stuff, boooooooring.  Then one of the students is looking at one of the hair clump slides and she sees something and has the vet look at it.  He looks at it and thinks it's nits, little baby lice! COOOOOOOL! Ok so the vet went back out to the barn to get some tape preps from the goat and sent us all home for the day.

I come in today and the student who had originally seen the little lice babies tracked me down and showed me the tape prep slides and THIS is what I saw:

Ewwwwwwcoooooooooolewwwwwwwawesome! Now, this kid and his friends were not the cause of the goat's issues, we aren't sure exactly what is just yet, but it's not often that you get to see goat lice in a small animal hospital! Fun times people, fun fun times.

Next week is my second attempt at a Sports Medicine rotation. I'm pumped for it, variety is the spice of life right??

The joys of dermatology

Well it's been an erythematous, exudative and cerumenous week on derm. Translation: Redness, oozy ickiness and earwax!

We've had some very interesting patients so far this week and I've learned that derm is often like an episode of House.  We have to go through the patient's entire history from when the dermatological problem began including every attempted treatment and it's effect on the issue, any possible exacerbating factors, any other health issues and the corresponding medications that may be on board and the patient's current state.  We also have to consider the owner's compliance when determining if previous treatments have been effective and if the possible treatments we are suggesting will be carried out effectively by the owner.  Once we have a list of potential diagnoses, we try to start crossing them off the list by doing all the cytologies and scrapes that I mentioned in my previous post. If we don't find anything there we have to consider other things like food allergies, environmental allergies or flea allergies.  It's always an adventure!

One of our patients yesterday presented with chronic otitis externa (external ear infection).  Aside from her ears, she had some irritated areas on her abdomen and between her toes (dogs lick the spaces between their toes excessively when they are itchy!).  In addition to the otitis, this kid (I will call her Bertha) had previously been diagnosed with hypothyroidism, Addison's disease and had recently had an issue with pancreatitis potentially due to the ridiculous amount of steroids she had been on for a looooong time. On her laundry list of medications along with Prednisone (steroid) was Rimadyl (non-steroidal anti-inflammatory).  Traditionally, it's a major no-no to give an animal both of these because it wreaks havoc on their GI system (ulcers, bleeding, general ickiness), but Bertha was on both of those plus quite a few others.  However, our main concern was the otitis.  Given her circumstances, we took samples to look for the usual bacteria, yeast and parasites.  We didn't find anything fun or exciting despite her ears being disgusting and full of debris and discharge.  Some ear cleaning solution was put into her ears, after we took samples, and was allowed to sit in there for a bit to break up the cerumen (earwax, remember?) before we cleaned all the ickiness out.
She is an older dog so we also had to consider neoplasia (i.e. a mass in her ear canal) as well as other growths like a cyst or polyp. We didn't find anything in the outer canal using the otoscope but the owner OK'd us to run a CT scan.  On the CT, it's easy to see the entire ear canal and the bullae which is the large opening in the middle ear (past the eardrum).  Fortunately for Bertha, we did not find anything of concern on the CT.  We went back to do a more in depth cleaning of her ears while she was still sedated.  You would not believe the amount of junk that came out of there.  Once we had a clear path, we used the video otoscope to see down into her ear canal to the eardrum (and take some sweet pictures!).  We could tell that the more problematic ear definitely had a thickened and unhealthy eardrum (tympanum/tympanic membrane), but it was still intact (yay!). The other tympanum looked healthy and happy.  So basically, all we could do for this dog was give the owner some ear drops to keep the ears clean and free of debris and give her some topical treatment for the itchy toe problem.

Today we had a pit bull (well-known for having dermatological issues) with MAJOR pruritis all over and clear signs of chronic itching and irritation.  The most glaring issue was the dog's vulva (maybe I should prepare everyone, this is gonna get graphic).  According to the owner, the dog had such intense pruritis in that whole area that she would literally go outside and drag her lady parts along the concrete seeking relief.  Because of this, her vulvar area was hyperpigmented (black, when it should have been pink), hyperplastic (enlarged, it looked like she had boy parts) and super sensitive.  In addition to this, the area between her toes was erythematous and swollen, her belly was red, the area around her eyes and ears was swollen and she had several areas where her fur was thinning due to her scratching.  So so sad to see a dog like this.  The worst part is that her current state was an improvement over how she presented on her initial visit.  We took all kinds of samples from all over the place and we really thought we would find some crazy stuff.  We essentially found nothing. No crazy parasites, no overwhelming bacterial or yeast infection, nothing.  According to her history, the dog had previously been on high doses of steroids for a long time which had caused her to gain A LOT of weight and lead to the development of congestive heart failure.  Also, because she was on the steroids for so long and was not weaned off of them properly, she had issues with iatrogenic Cushing's disease which is basically when there is too much cortisol in the blood.  Iatrogenic simply means "caused by treatment".  So by giving steroids long term we pump the body full of cortisol to the point that it stops producing it on it's own and kind of forgets to do it when we abruptly take away the steroids. Understandably, the owner was hesitant to put the dog back on anything involving steroids.  This makes it a little difficult from the dermatology end of things, because it is common in cases of severe pruritis to prescribe steroids to get it under control.  The steroids work to reduce inflammation and control the itchiness to a manageable level.  So we went another route to try to help this dog.  First, the dog will be bathed weekly with a shampoo that contains an anti-histamine and an anti-fungal agent.  That is allowed to sit on the skin for 10 minutes before being washed off.  Right after that, the dog is sponged down with a Lime-Sulfur dip which is often helpful in treating a wide variety of dermatologic issues.  Then, for her vulvar area, she was given Silver Sulfadiazine cream.  SSD is a topical antibiotic that is often used on burns because of it's ability to soothe irritated skin.  We suggested that the owner put a diaper on the dog after applying the SSD to ensure that it was not licked or rubbed off of the area.  Lastly, the dog is being started on a food trial to attempt to eliminate any food allergies.  She was given a hypoallergenic food and will not receive any other food or treats of any kind during the food trial.  Usually, a food trial lasts at least 8 weeks. It can go longer depending on the severity of the dermatitis and various other factors.  Hopefully, some of these things help this dog and she gets some relief.  Despite her obvious discomfort she was such a sweetheart when we were getting samples and doing a physical exam. Poor kid!!

That's it for today. No doubt, there will be more dermatological excitement tomorrow!

Intro to Dermatology!

This is Derm week kids.  Dermatology is a pretty big deal in veterinary medicine.  It's common to see animals with all kinds of skin issues related to environmental allergies, flea allergies, food allergies, bacterial infections, yeast infections and, of course, parasites!

What I've gathered from Day 1 of my derm rotation, is that getting a detailed and accurate patient history is imperative in appropriately diagnosing and treating an animal.  Things like age of onset, location of skin lesions on the body, seasonality of the issue, how itchy it is (pruritic) and so on.  Then, we can do all kinds of cool cytology stuff! Depending on what the issue is, or what we think it is, we'll do different types of sample collection.  Some options are skin scrapes, ear swabs, scotch tape preps, biopsy and then your basic squooshing the slide around on a lesion with some yuckiness leaking out of it. Some of those slides, like the scotch tape preps and the squooshy slides are often stained to make identifying various things easier.  Once all the slides are prepared, we look at them under the microscope.  We're looking for bacteria, yeast, certain types of white blood cells and parasites at various stages of their life cycle.  From there, we can decide how to treat the animal.

One of our patients today, who was in for a recheck had been previously diagnosed with Demodecosis (I'll explain in a moment, don't get all huffy about big words just yet) and atopy (or atopic dermatitis).  Atopy is basically just a genetic predisposition to allergies from environmental...well, allergens.  Demodecosis, on the other hand, is an infestation of Demodex, which is a burrowing mite. Yucky!  For these guys, we have to do a deep skin scrape (because of the whole burrowing thing).  A deep skin scrape involves scraping the skin with a scalpel blade then kind of squeezing it and scraping again.  It's important to get some blood in the sample to ensure that we got deep down in there where the mites hang out.  We also did some scotch tape prep slides between the dog's toes and in the inguinal (groin) area where it is common to find yeast and bacteria.  A scotch tape prep is pretty much what it sounds like.  You take a piece of tape, stick it on the area in question a few times to pick up whatever goodies you can, then put a little stain on the slide and stick the tape to the slide and take a little looksy on the 'ol microscope.  Good news for this dog is that we only saw one Demodex on the slide, which is a big improvement over previous visits.  We only found a few little yeast buds and some bacteria, but nothing too crazy. Yay!

I'll get into treatments later this week when I have a better sense of what's going on with that.  At this point, I can tell you that one of the patients left with two paper bags (lunch bag size) full of medications, medicated shampoos, drops and shots and all kinds of fun stuff!

So far so good, I'm glad to be getting back to some lab type stuff.  I missed my old pal, the microscope. Thanks for reading! Only a few more weeks of blog-related fun to be had :(

Dixie!

This is Dixie, the prep room mascot.  Dixie is short for "Dixie cup", which is what the techs who found her on the highway initially thought she was.  Yes, she has one green eye and one blue. Ahhh-dorable!

Long time, no post!

Hello my blogacious pals! Sorry for the lack of posting this week, apparently this site has been having technical difficulties, so I haven't been able to write any posts.  That doesn't appear to have deterred people from visiting the blog because it's now had well over 500 visits. Ridiculously awesome!

Anyway, back to business. Anesthesia week has been great, I really enjoy running anesthesia because it's different every time, regardless of the procedure being done.  Sometimes it's straightforward, easy peasy and SOMETIMES it's a little crazy and you have to do all kinds of trouble shooting and problem solving and anticipating potential issues and solving those potential issues before they are actual issues.  Crazy.

So earlier this week, I was running anesthesia for an oncology case.  It was a cat that had a mass in it's mouth so, in order to ensure that all of the tumor was removed, it underwent a hemi-maxillectomy.  That basically means that half of the cat's upper jaw was removed.  Ok so that's pretty invasive and involves cutting of bone, which is very painful.  As an anesthetist, that's something we have to think about and plan for.  It's important to keep the patient at a safe depth/plane of anesthesia (so not too deep and not too light), but we also have to ensure that they are not feeling too much pain during even the most invasive of procedures.  We were cruising along for a while, frolicking through anesthesia land while lymph nodes were being removed and margins of the mass were being determined.  Then began the cutting of the bone and with it, the frolicking in anesthesia land quickly ended.  At first, the cat's vitals went all wonky, blood pressure, heart rate, respirations all way out of our happy ranges.  Ok, pain response, understandable.  We increased the vaporizer setting and when that didn't help, bolused some of the morphine CRI.  That brought us back to a workable level for a little bit.  The next time that the cat's vitals spiked we had to give dexmedetomidine, an alpha-2 agonist (sedative) to chill her out.  Naturally, each time that these things occurred, I was by myself in anesthesia-ville but luckily an anesthesia tech would roll in just in time.  Ok so yay for Dex, she was chilled out and we were cruising again and the techs left me again.  So then, as I watch the respirations slowly climb and the heart rate increase as well and I've just decided to again bolus some more morphine, the surgeon says "Mara, she's getting light again." Fab.  During a hemi-maxillectomy, there's really no way that I'm going to assess depth by looking at jaw tone, eye position or palpebral reflex because the surgery and, thusly, the sterile field is all up in that area. So after the morphine and the increased vaporizer haven't helped, the surgeon asks me to give another dose of Dex. Done. Except this time, not only does it not really make a huge difference but we have the added joy of VPCs. That's ventricular premature contractions by the way.  A VPC looks different from a regular heartbeat on the ECG monitor and it means that the heartbeat itself is being generated from a different place in the heart than a normal beat.
Here's a normal ECG trace:

Here is a trace with VPC's:

The VPC's are the ones with the big arrows pointing to them. See how they are distinctly different from the rest of the heartbeats? They are often described as "wide and bizarre".

One or two VPCs here and there is not something we get worked up about because the drugs that we use during anesthesia can cause VPCs and some other arrhythmias.  But friends, this was not one or two here and there, it wasn't even one or two every screen.  It was all VPCs, all over the place, with one or two normal looking beats mixed in. Great, fab, awesome. Ok so I'm thinking, I need some Lidocaine for this cat (and maybe for myself, because I think I just pumped out some stress related VPCs myself). The anesthesia tech that came in agreed that we had an issue and we got the kid some Lidocaine.  Alright so things were ok for a little bit (I know, longest surgery of MY LIFE) and it was at the point that an anesthesia tech was staying with me full time now, thank you!  Ok so then, THEN we start seeing some other funky ECG trace.  It was kind of VPC-ish but different. Apparently, it was funky enough and rare enough that it merited taking a video of the ECG monitor and subsequently showing that video to a cardiologist who diagnosed it as a right bundle branch block. Whaaaaat??? I don't recall that one from Vet Sci 4 class!!
Here's what it looked like:

Just look at the top line. That is alllllll right bundle branch block.  This is more or less what my patient's ECG looked like. Now, these can easily be mistaken for VPCs because they have a similar form.  Our first thought was to give another dose of Lidocaine.  But, one of the fabulous anesthesia techs who is magnificent at her job thought we may have a good 'ol bundle branch block going on.  She was right.  The treatment? Look the other way.  That's according to the cardiologist. So we did just that (figuratively, not literally) and we also counted the seconds until that surgery was OVER.  It finally ended and the cat woke up and eventually went home and I left with a lot more knowledge and, potentially, a stress induced ulcer.  They told me that I did great and that if I was freaking out, they couldn't tell.  This is apparently a sign of a good tech, if this is true then I would expect another sign is chronic ulcers.

Thankfully, the next surgery of the day went beautifully aside from the tube to the circulating water blanket shooting off and spewing water everywhere in the middle of surgery.  That, I can handle.

Yesterday was a much less stressful day.  There were a few basic surgeries: castrations, spays, etc.  I helped moved patients in and out of surgery and recover them.  The anesthesia techs apparently have confidence in me that I have some sense of what I'm doing, because they left me to assist some of the vet students as they were monitoring anesthesia.  I felt like I was able to successfully correct some minor anesthetic issues and share some of my anesthesia knowledge with the students, so that was pretty spiffy.

Then today I jumped back in with the oncology kids.  The head onco tech, who incidentally is fantastically awesome and lets me do all kinds of fun stuff, asked me if I wanted to help out on their surgery case.  Um, YEAH. Despite the insanity of the previous surgeries, I was ready for more.  They had a little dachshund that was in for a mastectomy.  She had two masses in the inguinal (groin) area.  I placed an IV catheter in her little dachshund leg (not the easiest of tasks), induced her with Propofol, successfully passed her ET tube and THEN, hold on to your hats people because this is cool. I got to administer epidural pain meds! Cool cool cooooooool!  This procedure involves palpating the space in between the last lumbar vertebrae and the first sacral vertebrae, getting a spinal needle through that space and into the epidural space which is between the vertebrae and the layers of tissue that surround the spinal cord.  It's done mostly by feel. You insert the needle and then put some fluid in the hub of the needle, once you get in to the correct spot, the fluid should get sucked down into the needle.  There is a little pop when you get through the tissue and into the epidural space. So my massage therapist skills were kicked in to high gear, I palpated the wings of the ilium (part of the pelvis) as a landmark and then found the space between the two vertebrae (even through a chubby dachshund bum).  I had to "walk" the needle around a little bit to get down between the vertebrae and then get to the proper depth to get into the epidural space. I felt a little pop and my fluids got sucked down. We tested the placement by attaching a syringe with some air and fluid in it and seeing if it got sucked down as well, it did! So then the pain meds were administered.  I must mention that I was instructed by the rock star onco tech throughout this procedure and would have been clueless as to what to do if it were not for her. Success! I was pumped!  Afterwards, one of the anesthesia techs was palpating the dog and asked how I even felt the various bony landmarks because the dog had a big 'ol fat pad right where we were working. Hello? Massage therapist over here, uber sensitive ninja fingertips! Kachow!  Alright, enough tooting my own horn. I was just really excited that I got the chance to do that and that I did it successfully on the first attempt. The anesthesia part of things was smooth and fantastic (no doubt due to a stellar epidural...ok for real that's the last comment on that).  With that, anesthesia week drew to a close.  Sad day. I really enjoyed that rotation.  There is a chance I will get a few more days in anesthesia land the last week of internship, so we shall see.

Next week? Dermatology!

Crazy town= Week 7

Ok sooooo I WAS supposed to be doing a sports medicine rotation this week, but the vet who runs the show there is out of town and wants me to come back a different week when he is there. Therefore, I am now actually on anesthesia rotation. So, I'm going to pretend that the sports medicine related events of yesterday and this morning never occurred and instead focus on the anesthesia related events of the rest of the day.

At first, I was helping transition patients from the prep room to the surgery suites and back with some supervision of anesthesia mixed in.  The whole transition deal takes some getting used to.  The first couple of times I "helped" with it, I was mildly overwhelmed by all of the shenanigans that were going on. Tubes and lines flying and being attached all over the place, fluid rates being set, limbs being taped down, surgery sites being scrubbed etc, etc. Now, I actually am one of those tube placers, line attachers, lead connectors, fluid rate setters, limb taper-downers and surgery site scrubbers. There are at least six different monitoring devices that we connect to every surgery patient (in no particular order): ECG leads, CO2 monitor, temperature probe in the esophagus, BP cuff, fluids/CRI and the pulse ox...there are potentially others, but these are pretty standard.  When we transfer a patient from the prep room to surgery, we often completely disconnect them from the anesthetic gas if they have sufficient pre-medication and are at a desirable depth of anesthesia. Because of that, time is of the essence.  We can't lollygag in the time between disconnecting from anesthesia and reconnecting because we may risk our patient waking up and causing them undue stress.  We also can't waste time getting our monitoring equipment up and running in case the patient's condition begins to change. So the first priority once we are in the surgery suite is to get the patient hooked back up to anesthesia and then, quick like bunnies, get all the monitoring probes and lines and what nots hooked up.

The first surgery I monitored today was for the oncology kids.  The dog had a large tumor on it's left lung that needed to be removed.  As far as awesome factor goes, I think this surgery is in my top 3 of those that I've seen during internship.  Various neurosurgeries occupy the other two spots.  Ok so, the surgeon opened up the dog's chest to expose the lungs.  The tumor on the left lung was so large and had overtaken the lung to the point that basically the entire left lung had to be removed.  Meanwhile, from an anesthesia point of view, we had this dog on a ventilator due to obvious concerns with it's ability to self-ventilate.  The ventilator was a touch on the finicky side so we were having issues with it delivering consistent breaths to the patient and exceeding the ideal pressure within the circuit (and what is our ideal pressure anesthesia students??? That's right! 15-20cm of H20 and what gauge do we read that pressure on??? The PRESSURE manometer!).  Here's another question for you all: Why, when the ventilator caused our pressure manometer to go to 25-30 cm of H2O on our open-chested lung exposed patient, were we not overly concerned?  Right again! The vet student is holding the right lung in her hand so it's not contained within the limited space of the thorax where it might burst in to a zillion pieces should the pressure get out of control. (yeah, I did say that the vet student was holding it in her hand...yeah, that is awesome...yeah, that is why this surgery ranks in my top 3 for awesomeness) Eventually, we got the ventilator to behave relatively well.  We went from having two onco techs, two anesthesia techs and little old me in the room dealing with the anesthesia situation to just me all by lonesome.  Things were peachy keen for a while, the ECG was gorgeous, ETCO2 was ideal, blood pressure had been low but the reading off of the arterial line had leveled out to acceptable levels and we were coasting along.  The surgeon asks me how the patient is doing and I responded that she was looking good.  I kid you not, less than 30 seconds after that response escapes my mouth, blood pressure PLUMMETS.  We went from great numbers to low 40's for both systolic and mean super fast (systolic should be above 80 and mean above 60). Cue Mara freak out.  So I hollered (that's one of the southern words I'm picking up down here) for one of the anesthesia techs to please come help me.  In the meantime, I have a zillion thoughts going through my head. Why did the BP drop so quickly? Why is everything else still peachy? Should I be bolusing fluids right now? Will that really help at this point? Where the crikey is that anesthesia tech???? So my hand is 3/4 of the way to the fluid pump when the tech comes in and tells me to hold my horses. Tech: Ok let's look at this monitor. Do you see a waveform for our arterial line? Mara(silly pants): Um, crap. No.(waveform, duh, why didn't I think of that???) Tech: So that means that the arterial line isn't reading properly.  Of course, of course that's what that means. I know this, I should have looked at that, I should have realized that because the BP went downhill so quickly and everything else was fine that there was a good chance the numbers weren't accurate. Buuuuuut, unfortunately that didn't happen. This is why we do internship and we build confidence through experience and we learn how to think rationally when things aren't perfect. So the tech kind of made fun of my mild freak out (it's not like I was yelling and running around like a crazy person...most of the freaking out was in my head which apparently was conveyed through "some tension" in my voice which was noted by the tech) as did I after the fact, but next time I will not freak out and that, my friends, is what's important.

The. End.

The duck, day 5!

I just wanted to post a quick duck related update. I have named him Chuck. Chuck, the duck. Here we are together on day 5 of treatment!

 We've been putting some stuff called Duoderm in his wound. It creates a layer within the wound to encourage the tissue underneath to stay moist and develop granulation tissue.  We have also considered doing a little plastic surgery on him.  It would include moving the tissue in front of and underneath his crest forward to cover some, if not all, of the wound.  I probably won't see him again since today was my last day of Raptor rotation but I think he's in good hands!

QT with the raptors

We were back at the raptor center today and there was a ton of stuff to be done.  First, we got a more in depth tour of the facility and we met all of the birds used in the education program as well as the Auburn University mascots (The War Eagles!).  There are a bunch of different types of birds used in the education program. They have two barn owls, a turkey vulture, a black vulture, a few types of hawks (some of them are found in the US and some of them are only found outside of the US), the aforementioned eagles, barred owls and the little screech owl (itty bitty and oh so adorable).  This is a picture of two bald eagles. I don't know how well you can see from the picture, but one looks like your stereotypical bald eagle with the white head and the one on the ground is still almost entirely dark colored with no white on his head.  He is a juvenile bald eagle and won't get the characteristic bald eagle coloring until he is a few years old and officially an adult.

We then got a short lecture on falconry. I, personally, had no sense of what falconry involved so it was interesting to learn more about it from two people who have been falconers for a long time.  Basically, falconry is hunting using birds of prey that are trained to some extent.  Before the development of firearms, using birds made hunting for small game much easier.  Today it's more of a sport but, depending on what their bird catches, the falconer may eat what is caught.  Training of these birds builds off of their natural hunting instincts and abilities and mainly focuses on getting the bird to allow a person to accompany them during the hunt.  Falconers are required to have government permits in order to legally own wild birds.  Veterinarians are also required to have permits to treat wild animals, however, they can treat a bird owned by a falconer without one of these permits because they are essentially working off of the falconers permit. Cool stuff!

Next, we took two of the rehab birds over to the main hospital for neurology exams. One bird was a baby barred owl who, we believe, suffered his injury during the recent tornadoes. This is him:

                                           

He's a cutie pie, right? Earlier this week, we did radiographs on him because he wasn't standing and didn't seem to have the ability to use his legs at all.  On the radiograph, we found that he had a compression fracture in the thoracic area of his spine. Here's the radiograph, you can't really see the fracture without blowing up the image, but the rad itself is interesting.  The thing on his head is the mask that we use to administer gas to keep the birds unconscious during the procedure. We aren't really concerned with the head so we don't worry about getting textbook perfect radiographs.

His neuro exam revealed that he did not have an appropriate deep pain response in his feet and was lacking the ability to grip with his left foot.  His left wing was also not functioning properly.  Unfortunately, given this result and the evidence from the radiograph, there is nothing that we can do to help this bird.  We had to euthanize him. It was a major bummer, but his quality of life would have been poor.

On a lighter note, we were able to take two of the birds out of the critical care ward and place them in outdoor aviaries.  This is done when the birds are recovering well from whatever injuries they may have had and are able to coexist with other birds (and ideally, they can fly again).  It's basically the next step in what will hopefully lead to re-release in to the wild.  We put out a Great Horned Owl and  a Barred Owl.  We did a physical exam on both birds to ensure that they were ok to go in to the aviaries and we will continue to monitor how they adjust to the new setting.  Here is the Great Horned Owl with a ridiculously attractive human just prior to being placed in an aviary (jk, this is a less than stunning pic of me because I'm half smiling and half concerned that he's going to break free from my grasp and tear me into little bite-sized owl treats)

See how he's staring me down with his big owl eyes?!?! Seriously though, I'm wearing thick leather gloves to handle him because their beaks and their feet/talons are so strong that they can exert hundreds of psi of pressure and I rather like having ten fingers thank you very much.  Those little tufts on his head are what give the Great Horned Owls their name...the tufts look like little horns.  You can seem them better in this picture of a different owl in the aviary.

We checked in on our duck friend from Monday and he seems to be doing well! The tissue around his wound is starting to looking healthier and less dried out.  It looks like there is some granulation tissue starting to form in the wound which is just ducky! Ha. Ha. Ha.

In the afternoon, we had to catch all of the birds in the aviaries in order to weigh them and assess their body condition.  The aviaries are large outdoor enclosures that are probably 15-20 feet high.  Inside them are perches at various heights that provide a more natural environment for the birds.  That's peachy keen for the birds, but makes catching them slightly more challenging.  We use the big gloves and our ninja like skills to get the birds.  It's important to put one arm up to shield your face (should they decide to fly right at you) and use the other hand to grab one of the bird's legs. You get control of their legs first, holding them both in one hand, then use the other hand to hold around their neck and keep their wings pressed to their body.  It's not the easiest thing ever but the staff person that was with us said we did a great job, go us!  We weighed all the birds (15 or so maybe??) and assessed their body condition.  There is a body condition scale (BCS) that is used for birds and it ranges from 1-5.  One being emaciated and five being obese.  The anatomical point of reference for this scale is the keel bone.  The keel bone is located on the bird's body...here's a diagram:

The keel is that big, blade shaped bone labeled "keel"...crazy, I know.  So we palpate the keel bone and, based on how prominent it is/how fleshy the area around it is, we assign a BCS score.  This, coupled with the weight of the bird, is an important way to track potential health changes in the birds.  If these values decrease, it can be an indicator of illness in the bird. At the same time, increases in these values can indicate that the bird is thriving and healthy.  Most of the kids we worked with today were either at an ideal score of 3 or a bit on the tubby side...that's ok too.

The last event of the day was doing fecal exams on the birds.  We use a special solution that is mixed with a fecal sample to help any parasite ova or other bacteria and protozoans to float to the top and be picked up on a slide cover slip which is placed on top of the little container.  The cover slip is then placed on a slide and the slide is examined under the microscope.  We didn't find anything of note on the slides that we looked at, which is good for the birds.  In wild birds, it is fairly common to see some bacteria and coccidia, but no such luck today.

Busy day! Hopefully, you guys are able to see the pictures that I posted in here fairly well. It can be difficult to get good pictures, especially in the aviaries, but I'm doing my best for the betterment of the blog! Good night all!

To the zoo!

A note to my blogateers: This blog contains comments about breeding and artificial insemination and the anatomy associated with such events, it also contains a brief description of the dissection of a dead monkey. If you can't handle reading this sort of thing, I give you permission to not read this post...but just this once!

The three vet students on the raptor rotation and I went to spend the day at the Montgomery Zoo today.  It's a small to medium sized zoo with about 500 animals.  We started out by doing rounds on the animals that had some sort of medical issue going on.  The first one was a giraffe who had injured her leg.  She had been spooked and fallen in the stall area and as a result had shortening of the tendons in one of her lower legs.  When the injury initially happened, she was basically walking on the tippy toe (that's a medical term) of her hoof.  But, with some splinting of the area to provide support and encourage flexion of her fetlock joint (kind of like our ankle...large animal people ease up! I know it's not the same), her stance was much closer to normal.

We then went to see a pregnant bison.  They aren't sure of her due date because the she and the bull mated several times.  We discussed some signs that we see in any bovine (cows included!) when parturition (birth) is approaching.  I wish I could say that I remembered all the things that we talked about in my large animal class but aside from terms like "winking vulva" and "waxing"...the whole reproduction thing was a bit fuzzy (sorry Brenda! I'm going to redeem myself in another paragraph just wait!).  As we talked about some signs, it definitely came back to me.  So, in case you're dying to know here's a few things the zookeepers will look for: about a week out- swollen vulva, mucousy discharge, "bagging up" or lactation then a day or so out: stop eating and separate herself somewhat from the others.

Next we went to do a neonate exam on a 3 day old big horn sheep.  A few important things to look for are: mental status (i.e. are they alert, running around, curious, etc.), have they pooped, does the umbilicus look healthy and free from infection/inflammation, is it a male or female, ears/eyes/mouth (it's important to look for a cleft palate, which I guess is common enough to be a problem and can cause issues with feeding), conformation issues (limb deformities, etc.) and cardiovascular issues. So for the cardiovascular part, we use our stethoscope to listen to the heart.  Neonates of all species can be born with heart defects that can severely affect their ability to thrive and may be fatal. We listened to this guy's heart and heard a pretty significant murmur (Here it comes Brenda!).  After we all listened, the zoo vet asked us what kind of murmur we thought it was and what grade we would give it.  The way we categorize murmurs depends on where it occurs in the beat. So the normal heart beat is a "lub dub", the lub represents the "systolic" and the dub is the "diastolic" so if a heart beat sounds like lub sssshhhh dub there is a systolic murmur and if it's lub dub ssssshhhh it's diastolic.  I felt that it was a systolic, grade 3 murmur (the grade has to do with how easy it is to hear/it's intensity) and darn if Mr. Zoo Man didn't say the same thing! Kachow!  That's about the only time today I felt like I had any idea what I was talking about so I'm going to revel in that for a moment...

Ok, I'm good. Later in the day, we got called over to the enclosure for the Scarlet Ibis birds...they look like this:

The enclosure is a huge meshy looking tent-like dealy ( I don't know how else to describe it).  Apparently, one of these birds was up towards the top of the enclosure (15+ feet high) when a hawk swooped down towards it from the outside.  The hawk obviously couldn't get to the Ibis (we'll call him Jorge) but Jorge was startled and fell from where he was perched down to the concrete ground below.  According to the zookeeper, he landed on his head.  When we arrived, Jorge was stunned and not able to stand on his own.  We did a quick exam to try to assess his condition.  Now, if anyone remembers back to one of my neuro posts, I talked about pupil size and response to light as part of a neuro exam.  The hard thing with birds, especially wild birds, is that the pupils will most likely be fixed and dilated just due to the stress of being handled by people and secondly, birds have the ability to voluntarily contract and dilate their pupils.  As far as I know, no mammal can do this.  It's a cool parlor trick but it makes it difficult to assess neurological damage based on the eyes.  Since Jorge couldn't stand on his own, we took him back to the clinic, and by "we" I mean that yours truly got to hold the little guy on our short drive back (I felt cool for a brief moment).  As you can see in the picture, these birds have quite the beak.  That kid was not messing around with it either, he nipped at everyone that came anywhere near him, so I had to be sure to get that beak on lockdown.  When we got back, we weighed him (1.09 kg) which is important in determining doses if it's decided to administer medications.  We then just put him in a cage and observed him over the next hour.  He seemed to show signs of recovery rather quickly.  Within an hour, he was upright and sitting kind of on his haunches.  Given, this is not exactly normal for a bird, but it was a huge improvement from his initial condition.  Since he was showing signs of recovery, he was not given any medications and will continue to be under observation.

We also talked, at great length, about artificial insemination (AI).  The staff is preparing to do AI on an Indian Rhinoceros that they have at the zoo.  Thus far in the US, no AI procedures on Indian Rhinos have been successful.  The rhinos have gotten pregnant but the babies have not survived.  The difficult thing about AI is determining when the animal is ovulating, i.e. when is the appropriate time to inseminate.  So there are tests done on the animal's urine and heat cycles are tracked and behavior is monitored and so on and so forth. But, when it really comes down to it, it's still a bit of a guessing game. It was at some point during this conversation that I received a fairly odd compliment-like statement.  Mr. Zoo Man was describing the process of AI and explaining that he, being a large man (he's apparently a professional power lifter in his spare time) with large yet short trunk-like arms insufficient for plunging into the depths of an animal's reproductive tract, would not be the one physically performing the AI.  He then pointed to me and said, "You have the perfect build for doing AI work." My reply? "Ummm, good to know."  Now, spending my time palpating the inner workings of a large animal's hind end has never been a dream of mine, but it's good to know that, should it ever become my dream, I have a distinct physical advantage over many other job applicants.

Last event of the day was a monkey necropsy! A necropsy is just the animal form of an autopsy.  This little squirrel monkey had been found dead in the enclosure that morning.  Apparently, he was an older monkey but there was no outwardly apparent cause of death.  One of the vet students had been through a necropsy rotation so she did the procedure under the guidance of the zoo veterinarian (previously referred to as Mr. Zoo Man).  Often, no definitive cause of death can be determined from a gross (not microscopic) examination of the tissue that is done during a necropsy.  However, we are looking for any obvious abnormalities in the organs such as masses, hemorrhaging, necrosis (dead tissue), various signs of trauma, fluid where it shouldn't be, foreign bodies, etc.  The organs that are removed are preserved in formalin and submitted to a lab for closer examination.  We found some areas of hemorrhage in the small intestine (looks like bruises kind of), the lungs were slightly hardened and the lung tissue did not look healthy in some areas and the right side of the heart appeared to be thin-walled and flaccid indicating possible heart disease.  There was also a fair amount of fluid in the thoracic (chest) cavity that should not have been there.  Any abnormalities that are found are noted on the report that is sent to the lab so that they have a better idea of what organs/tissues to pay closer attention to. 

That was the end of our zoo adventures. It was definitely interesting to get a glimpse into zoo medicine and how different it is from small animal medicine. I used to think I wanted to do zoo med, but I'm pretty sure that I like small animal med much better.  Though there is that whole AI thing...maybe I missed my calling.

One of the "mascots" of the Raptor Center

This guy is a hawk. The call that they often use in movies as an eagle call is actually from these guys. Apparently, eagle's have lame-o calls.

Week 6- Raptors! Cacaw!

This week I'm hanging out down at the Southeast Raptor Rehabilitation Center.  The facility takes in wild raptors (i.e. birds of prey) that have been injured or little nestlings that have been separated from their parents.  The birds that are taken in usually have radiographs, a fecal (poop examination) and a CBC (bloodwork) done to assess their condition.  Sometimes, there is nothing that can be done for the birds and they have to be euthanized.  But often, they are able to give the birds medical attention and eventually re-release them or find an appropriate place for them to live.

This morning we learned how to properly restrain the birds so as not to be impaled by their talons and lose a finger to their beaks (kidding...kinda). We use big leather gloves and support their head/neck while holding their legs.  After that, we went through and weighed all the babies (A-DOR-ABLE).  There was one baby screech owl, two vultures (NOT adorable) and two great horned owls.  The screech owls are itty bitty and they come in three colors: grey, red or brown.  The vultures are...well sorry but those things are ugly.  The great horned owls look like your stereotypical owl, they are just plain cool.  So we weighed all the wee ones and then we did the morning feeding.  Some of the birds are in pretty bad shape and won't eat on their own so we have to "assist feed" them.  The owls, hawks and vultures eat rodents.  Due to some school regulation, they aren't allowed to feed live animals at the facility so the birds get gourmet frozen rodents, yummo!  Maybe this is disgusting to normal people, but I found it super awesomely cool to be able to hand feed rat parts to an owl.  You kind of have to stuff it down their throat to get them to eat it, but who can resist a tasty rat head??

After feedings, we had to get blood from a few of our winged pals.  We drew blood from the jugular vein of the birds.  The jugular vein can actually be seen through the skin because there is an area with no feathers and their skin is super thin.  Birds usually have about 6-10mls of blood per 100 grams of body weight and it's safe to take about 10% of that.  However, we don't usually need more than 0.5mls for a CBC and some blood smears.  The birds we were working with ranged from about 450-900 g so 0.5mls is no big deal.

Later on, some people brought in a duck (definitely NOT a raptor) with a head wound that was deep enough to expose his skull.  Sometimes, the Raptor Center is able to accept non-raptors if they choose to do so.  We decided to keep the duck and do what we could to address his wound.  He didn't show any signs of pain and besides having a horrendous aroma, he was actually pretty cute. Here's a picture of him!

And here's his wound...

Ouch buddy! We put some topical antibacterial cream on his wound and we're hoping that some granulation tissue will form and the wound will be able to close.  We are concerned that there isn't enough tissue to cover the area and that it may pull what tissue is still there making it difficult for him to blink/close his eyes. We'll just have to wait and see how he does.

We also did some radiographs on two of the birds but I'm hoping to get pictures of those to post so I'll save that for another day this week. Tomorrow, we're headed to the Montgomery Zoo. Apparently, it can be hit or miss whether they have things for us to see so we'll just have to wait and find out.

Good night to all and good luck to my pre-clin pals on your CPE tomorrow! You're gonna rock it!

Week 5 is over?? What the what??

The end of the week was pretty slow in ICU so, in my usual style, I hung out with the neuro crew. They had an itty bitty little Chihuahua who had been attacked by her housemate, a Boxer.  She had puncture wounds on her neck and luxated cervical vertebrae (which is what lead to it being a neuro case).  We did full spinal radiographs and a CT scan of her cervical spine.  Throughout these procedures, we had to transfer her several times to and from the gurney.  With an injury like hers, we had to be extremely careful in moving her.  She only weighed about 7 pounds, but we had one person putting traction on her neck and supporting her head while another person moved her body.  We easily could have caused further damage had we not been extremely careful about how we handled her. Fortunately, she was a sweetie pie and cooperated with us.  As the CT tech put it after looking at the images of her cervical spine, it looked like "two miles of bad country roads" (that's an Alabama-ism if I ever heard one).  It literally looked as if two trains had smashed into each other head on.  Her C5 vertebrae was all wonky and the rest of her neck didn't look much better.  We took the wee one to surgery where her vertebrae was basically manipulated back in to place while someone applied traction (i.e. pulled on her head to help stretch the area out). The surgeon then installed a plate on her spine and closed her up.  Because the area is still very fragile, we wanted to make sure that she had very limited ability to move her head and neck.  We kept her anesthetized while a customized thermoplastic splint was made for her. Thermowhowhat? Break it down people...thermo= heat/temperature, plastic= well, plastic...malleable plastic, splint=device designed to support or restrict the movement of a joint. Got it?  This splint material is heated in hot water and molded to the dog's body to create a splint that prevented her from moving her head and neck.  Velcro straps were applied so it could be adjusted slightly and cast padding and vet wrap were placed between the splint and her to prevent rubbing and general ouchiness.  The poor thing looked SO pathetic the next day in the ICU.  She was all propped up on her pillow looking out of her cage and all she could do was move her eyes to look at you.  All the other dogs are definitely going to pick on her, but at least she won't be paralyzed!

On Friday, we had a prime example of why it's important to socialize animals.  We get this Dachshund in that belongs to an elderly woman.  The dog has not been socialized, never sees many other people or dogs and up until this week has lived it's happy little life in relative isolation with little need to develop the ability to play well with others.  That's totally fine and dandy with me until it injures it's back (as Dachshunds so often do) and yours truly nearly gets her face ripped off when I open the cage door to get her prepped for surgery.  Holy Toledo! I didn't even touch the thing and it tried to eat me!  Thank goodness for e-collars because I had already been bitten once this week and I don't care to repeat it in the near future.  So we had to get this dog out of the cage and give her the pre-meds ASAP so that she would calm down and not further injure herself.  A little Dexmedetomidine and Hydromorphone helped to make her slightly more manageable but we still induced her with Propofol pretty quickly after the pre-meds were given.  We did our usual diagnostic stuff and then went to surgery with her.  During surgery, she was having some heart arrhythmias.  In this case it was a 2nd degree AV block which I am not even going to explain because it requires a lot of background info on normal ECG traces and yahdee dah.  Anyway, sometimes the inhalant anesthetic that we use can cause some arrhythmias (which is one of many reasons we try to use as little as possible) and other drugs can sometimes cause them as well.  The dog was given Glycopyrrolate to try to increase the heart rate and get rid of the arrhythmia.  It was successful and the rest of the anesthesia was relatively uneventful.  Ok so then we have to wake this kid up.  One person has the e-collar, one person has a second dose of Dexmedetomidine (sedative!), one person is at the ready to pull the ET tube and the other person is restraining the dog's hind end.  We put the e-collar on before the dog is ready to be extubated, and not a moment later she wakes up in a hurry.  Keep in mind this dog has just had BACK SURGERY so she can't be flailing around.  We do our best to hold her down while she is given another dose of Dex but we have to continue restraining her in her cage after she tries to do some crazy ninja flipout move the second we let her go in there.  Usually, a post-op patient like with this type of surgery is kept in ICU for at least 36-48 hours following surgery. This kid? Going home at 8:30 am the very next day to reduce her stress and avoid injury to the people working with her.  Yikes!

Tomorrow I start my rotation at the Raptor Center.  It's part of the Auburn University Animal Hospital but they work with wild birds that have been injured and brought in to them.  I've gotten to see them here and there over the past few weeks, but I'm looking forward to really getting to work with them.  I'll be sure to post pics and keep all my bird-loving blogateers updated on my adventures.

Chewy on the outside, crunchy on the inside...

I was assigned two patients to monitor today in ICU. Neither of them were really critical, but it was good experience to have some patients I was responsible for. One of my patients was the cutest little (ok little is more a term of endearment than an actual measure of size...he's a little tubby) bulldog puppy in the wide world. I'm going to call him Gus. Gus had surgery earlier this week to resect his soft palate and his alar fold which is cartilage inside his nose.  A resection is a surgical removal of tissue, these particular resections allow our squish faced (aka brachycephalic) pals to breathe a little easier.  The soft palate resection opens up the animal's airway by removing excess tissue that may cover a large portion of their epiglottis. The alar fold resection addresses the common issue of stenotic (narrowed) nasal passages, which also contribute to difficulty breathing. So, good 'ol Gus can breathe a little easier now...he still snorts a bit but he's adorable nonetheless. He had some issues with regurgitating kibble following surgery (even though he wasn't supposed to eat before surgery...naughty Gus!) but he made it through the day with no regurging. Woohoo! He did have some diarrhea in the morning but it started to improve by the end of my shift (everything is about poo, ok non-vet people? don't get all grossed out). A couple of IV meds and a catheter flush here and there and Gus was good to go.

My other patient was a standard Poodle. We'll call her Polly. Polly was in for some pretty vague symptoms of lethargy and coughing. Also, at her referring vet, her temp was 103 and they tested her PCV which was apparently 93%, 93!?!? That's craaaaaazy! As I said in yesterday's post, normal PCV for a dog is 37-55% so, when it's twice that, it's mildly concerning.  However, when she came in to the Auburn ICU, her PCV was tested and it was 53%. On the high side, sure, but certainly nothing to get worked up over. We monitored her and she had an ultrasound performed on her abdomen which showed a hyperechoic spleen. Hyperechoic basically means that the tissue of the spleen appeared abnormal on the ultrasound. However, no other issues were found and no definitive diagnosis was made. So Polly is basically getting ready to go home and I decided to take her out to the yard to do her business and run around a bit. Me, being the genius that I am, decided to let Polly off the leash in the fenced in area (she was the first and last dog that I will ever do that with). Polly decided that she was going to prance around the yard and not allow me to catch her. After about ten minutes of having Polly make an idiot out of me, we corralled her in a smaller area near some outdoor runs. At this point, she really had no way out and I just had to get the leash on her and be done with it.  She was none too pleased about being cornered which she made apparent by growling at me and trying to escape. I attempted a Poodle lasso with the slip lead I had but my forearm was a touch too close to her mouth, which I discovered as I felt her canine teeth clamping down on it. Fan-flippin-tastic. She bit me. I lassoed her nonetheless and we returned to the ICU. She apparently bit her tongue or gums or something because she had blood in her mouth that (thankfully) did not belong to me. She didn't get me too badly thankfully and I washed my arm with soap then scrubbed it with chlorhex, then one of the techs insisted on scrubbing it with Betadine and alcohol. It was a little ouchy and swollen around the lovely tooth marks but nothing too serious.  We didn't have Polly's full record in ICU so we had to wait for the vet student on her case to find out when her last vaccinations were administered. Finally, she came back to let us know that Polly had received her 3 year rabies vaccination late last year...sweet! No foaming at the mouth and crazy times for me! Polly went home later that day but only because I said she could!! Apparently, if you're bitten by a dog, you get to decide if they need to stay at the clinic to be quarantined or if they should be euthanized. I understand why Polly flipped out and I know that it was my fault for letting her off the leash when I didn't know her that well, so off she went...with a muzzle for her walk up to the front.

All in all a good learning day. I even got to round on my cute little pal Gus! I am feeling oh so professional...minus the teeth marks on my forearm, for that, I just feel dumb.  But hey, another tech was bitten by a cat yesterday (NOT up to date on Rabies) sooo it could be worse. Stacey at Bel-Rea was certainly pleased to find out it was a dog bit and not a cat bite.

Now, in what seems to be normal Alabama fashion, there is a fast approaching and widespread tornado warning so I'm going to go prepare for that without proofreading this entry. I apologize now for any glaring grammatical or spelling issues. Good night to all!