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!
Wednesday, April 27, 2011
Tuesday, April 26, 2011
Week 5- ICU
This week I'm working in the small animal ICU. It's very different from the other services in the hospital because there are all kinds of patients there and they have varying levels of treatments/care required. It can be a little rough at times-- we've already had 4 animals euthanized this week (it's only TUESDAY!) and there are a few others with poor prognoses. On the other hand, we've also discharged several patients that have recovered and are going home with a good prognosis. Wahoo!
Some of the patients that come to ICU are not emergencies but have just come out of surgery, so they require closer monitoring than what they would get on a regular ward. They are monitored for signs of pain and signs of surgery related complications (signs of internal bleeding, dehiscence of an incision, regurgitation before the patient is fully recovered, etc, etc). Often, these patients are also continuing to potent pain medication intravenously along with regular fluids. All of these things have to be monitored along with the standard stuff like temperature, pulse, respiration rate, catheter patency, whether the catheter is still properly placed, urination, defecation and apparent mental/emotional status. That's just for a standard post-op recovery patient! Patients that have critical conditions often require a lot more attention.
All ICU patients, post-op or otherwise, have a specific chart that shows what treatments need to be given or diagnostics need to be done each hour. So, for example, we have a dog that's been in the ICU for a few weeks who has been getting regular blood transfusions due to severe anemia. We'll call her Gertie. Gertie is on a plethora of medications that are given at various intervals, one may be every 8 hours, every 12 hours, once a day and so on. Also, because we are concerned about her anemia, we need to do regular blood tests to evaluate how effective the blood transfusions are and how/if her body is making an effort to counteract the anemia. We run a group of tests called "quats", this is a group of four tests that can be done from a single blood sample of only about 1 ml or so. The four tests are blood glucose, packed cell volume (PCV), total protein/total solids and lactate. With Gertie, we are most concerned about her PCV because it tells us the percentage of red blood cells that make up the blood and therefore can indicate the severity of her anemia. For a dog, the normal range is 37-55%. Gertie's PCV when I did it this morning was 18%, which is about where it's been hanging out. The blood transfusion are being given in an attempt to keep her PCV up as high as possible while it is determined what exactly is causing the anemia. At this point, it is believed that she has some form of cancer that is causing a lack of red blood cells in her body, but we won't know for sure what the cause is until some diagnostic tests come back. My point here is, it's important for Gertie's quats to be done at regular intervals in order to monitor her status and it's also important for her vital signs to be monitored at regular intervals and medications administered at the appropriate times so we know if her status is becoming more severe. So, every hour, an ICU tech specifically assigned to her goes through her chart and ensures that every thing that needs to be done that hour is done. It's imperative to note any changes or trends that are occurring with critical patients because it may aid in determining a definitive diagnosis or be a sign of deterioration...or improvement!
ICU is definitely a hands on kind of rotation. There's plenty of med administration, fluid administration, physical examination, blood and other body fluid evaluation, catheterization and beeping fluid pump aggravation! (and so returns the nerdiness...) Anyway, it's been great experience so far. I shall keep all of you in my ever growing audience up to date as the week progresses.
PS- Good luck to all my pre-clin pals on your first mini-CPE next week! You'll do greaaaaaat!
Some of the patients that come to ICU are not emergencies but have just come out of surgery, so they require closer monitoring than what they would get on a regular ward. They are monitored for signs of pain and signs of surgery related complications (signs of internal bleeding, dehiscence of an incision, regurgitation before the patient is fully recovered, etc, etc). Often, these patients are also continuing to potent pain medication intravenously along with regular fluids. All of these things have to be monitored along with the standard stuff like temperature, pulse, respiration rate, catheter patency, whether the catheter is still properly placed, urination, defecation and apparent mental/emotional status. That's just for a standard post-op recovery patient! Patients that have critical conditions often require a lot more attention.
All ICU patients, post-op or otherwise, have a specific chart that shows what treatments need to be given or diagnostics need to be done each hour. So, for example, we have a dog that's been in the ICU for a few weeks who has been getting regular blood transfusions due to severe anemia. We'll call her Gertie. Gertie is on a plethora of medications that are given at various intervals, one may be every 8 hours, every 12 hours, once a day and so on. Also, because we are concerned about her anemia, we need to do regular blood tests to evaluate how effective the blood transfusions are and how/if her body is making an effort to counteract the anemia. We run a group of tests called "quats", this is a group of four tests that can be done from a single blood sample of only about 1 ml or so. The four tests are blood glucose, packed cell volume (PCV), total protein/total solids and lactate. With Gertie, we are most concerned about her PCV because it tells us the percentage of red blood cells that make up the blood and therefore can indicate the severity of her anemia. For a dog, the normal range is 37-55%. Gertie's PCV when I did it this morning was 18%, which is about where it's been hanging out. The blood transfusion are being given in an attempt to keep her PCV up as high as possible while it is determined what exactly is causing the anemia. At this point, it is believed that she has some form of cancer that is causing a lack of red blood cells in her body, but we won't know for sure what the cause is until some diagnostic tests come back. My point here is, it's important for Gertie's quats to be done at regular intervals in order to monitor her status and it's also important for her vital signs to be monitored at regular intervals and medications administered at the appropriate times so we know if her status is becoming more severe. So, every hour, an ICU tech specifically assigned to her goes through her chart and ensures that every thing that needs to be done that hour is done. It's imperative to note any changes or trends that are occurring with critical patients because it may aid in determining a definitive diagnosis or be a sign of deterioration...or improvement!
ICU is definitely a hands on kind of rotation. There's plenty of med administration, fluid administration, physical examination, blood and other body fluid evaluation, catheterization and beeping fluid pump aggravation! (and so returns the nerdiness...) Anyway, it's been great experience so far. I shall keep all of you in my ever growing audience up to date as the week progresses.
PS- Good luck to all my pre-clin pals on your first mini-CPE next week! You'll do greaaaaaat!
Sunday, April 24, 2011
End of week 4
Friday was another busy day in the Ortho department. First, we had an overflow TPLO surgery that we didn't get to on Thursday. I was the circulator/anesthesia tech wannabe. I helped get all her monitoring equipment hooked up and set up her fluids, Cefazolin and Morphine CRI. Then the anesthesia tech pretty much left me to assist the vet student who was monitoring anesthesia which made me feel like a cool kid. The student had been on food animal rotations for the past few weeks and was mildly freaking out about monitoring anesthesia for small animals. Fortunately, we had a really smooth anesthesia and I utilized my jedi-like calming vibes to assure the student she was doing a great job and that everything was peachy keen.
Towards the end of the surgery, the vet let the vet intern and resident take over so that he could go do surgery on an owl. An OWL! It was a Barred Owl with a fractured wing. I didn't get to see the whole procedure because I was still in the TPLO surgery but I got a few pictures of the owl when he was intubated (had an ET tube in) and when he was recovering. The owl came from the Raptor Rescue that is part of Auburn. I'll be doing a rotation there in a few weeks and I can post pictures of those kids because they aren't owned by private clients. So basically they use a mask to gas down the birds instead of using an IV induction agent like Propofol that we traditionally use in small animal procedures. The bird is then intubated with an itty bitty super flexible ET tube. The only monitoring that was done was tracking the respiratory rate and using a stethoscope to monitor the heart rate (i.e. auscultation). Their normal resting heart rate is over 200 beats per minute which is uber fast. A dog usually runs somewhere from 60-160 bpm depending on size. Anyway, here is a picture of Mr. Owl. The blue thing is the ET tube and the orange stuff is the remnants of his bandage.
I added two arrows that point to the major issues for those of you who haven't spent much time looking at radiographs. The top arrow points to the space where two vertebrae have been forcefully separated. Just like our spine, a dog's spine should be connected from the skull all the way down to the end of their tail. Damage similar to what this dog suffered would most likely cause a loss of control of the ability to urinate and defecate and, potentially, some other neurological issues related to spinal cord damage. The bottom arrow points to the damaged pelvis. The pelvis is made up of a few bones that are all fused together: the ilium is the uppermost portion that forms little wings that flank the spine, the pubis is the middle portion and the ischium is what makes up our "sit bones" and is the lower part that is sticking out behind the femurs (leg bones). In this animal, all three of those bones were shattered on one side. Orthopedic surgery is not always done to repair a pelvic fracture, whether or not it is done depends on where the fracture is located. If the ilium or the acetabulum (remember that one? the part that makes up the socket of the hip joint...see, learning is fun!) then surgery will most likely be done. In this animal, surgery would definitely be indicated. However, following radiographs, epidural pain medications were administered and we were attempting to place a urinary catheter. During this procedure, the dog went in to cardiac arrest. CPCR (that's the new term for CPR) was administered until we received confirmation from the owner to stop, we weren't able to save the dog. That was the first time I had seen CPCR done on a real animal and it was difficult to watch. I know we did everything we could for that dog and that this is all part of being a vet tech and life in general but it's still hard to see an animal die right in front of you. In the long run, it's probably for the best that the dog didn't make it. Her quality of life would have been less than desirable even if surgery had been as successful as can be imagined. We just have to take comfort in knowing that we are doing our best to improve the lives of as many animals as we can. We are bound to lose some along the way, but hopefully there is more good than bad in the long run.
Towards the end of the surgery, the vet let the vet intern and resident take over so that he could go do surgery on an owl. An OWL! It was a Barred Owl with a fractured wing. I didn't get to see the whole procedure because I was still in the TPLO surgery but I got a few pictures of the owl when he was intubated (had an ET tube in) and when he was recovering. The owl came from the Raptor Rescue that is part of Auburn. I'll be doing a rotation there in a few weeks and I can post pictures of those kids because they aren't owned by private clients. So basically they use a mask to gas down the birds instead of using an IV induction agent like Propofol that we traditionally use in small animal procedures. The bird is then intubated with an itty bitty super flexible ET tube. The only monitoring that was done was tracking the respiratory rate and using a stethoscope to monitor the heart rate (i.e. auscultation). Their normal resting heart rate is over 200 beats per minute which is uber fast. A dog usually runs somewhere from 60-160 bpm depending on size. Anyway, here is a picture of Mr. Owl. The blue thing is the ET tube and the orange stuff is the remnants of his bandage.
And this is one of him after the procedure when he is recovering, isn't he cute??
After the owl, we had an emergency come in. The dog had been out on a walk with her owner when a neighbor drove by and accidentally hit the dog with the car. Her right hip and pelvis were crushed and the vertebrae (bones of the spine) in her tail were completely separated at one point of her spine. Below is a lateral radiograph of her pelvis and caudal (towards the hind end) spine.
Thursday, April 21, 2011
Ortho surgery extravaganza!
I spent some quality time with the orthopedics crew today. They do surgeries on Tuesdays and Thursdays so today was full of orthopedic fantasticness.
First up was a bilateral FHO or Femoral Head Osteotomy. Let's break that down- Femoral head= rounded head of the femur that is supposed to fit ever so nicely into the acetabulum or "hip socket" to form the hip joint, Osteotomy= surgical removal of a bone (in this case, chunk of a bone). FHO's are really pretty amazing because the head of the femur that forms the hip joint with the pelvis is literally removed so there is nothing in the hip joint, the musculature surrounding the hip area and the eventual development of scar/cartilagenous tissue forms a joint-like connection to support the area. Here is a link to a blog that has before and after radiographs(x-rays) of an FHO performed on one side--> Rads . Our patient today had both femoral heads removed, isn't that cool that the body can handle something like that??? No femoral heads? Awesome! Anyway, that was a nerdy outburst, sorry. So the reason for the surgery was hip pain caused by arthritis in the hip joints. Just looking at the pre-operative radiographs was painful. The head of the femur should be smooth and round and articulate wonderously with the (say it with me...) acetabulum. This dog's femoral heads were all uneven and rough and ouchy. So we got the dog anesthetized and I helped hook her up to all of our diagnostic goodies once we transferred her to the surgery suite (ECG leads, pulse ox, temperature probe down the esophagus, ETCO2, blood pressure cuff and fluids). I think I am finally getting the hand of hooking all of that stuff up in a timely manner. The dog was on fluids as well as a Cefazolin CRI and Morphine CRI (CRI= constant rate infusion, so it's flowing at a specific rate along with regular fluids during the surgery). Cefazolin is an antibiotic to prevent infection, we give about 100 mls during the first hour of surgery then stop it. Morphine is an analgesic (pain reliever) and is given throughout the surgery. It can also be given as a bolus or a larger amount given all at once if the animal is showing signs of pain during surgery. Prior to surgery, the dog was also given an epidural of pain medication which helps to stop pain before it starts and allows us to use less anesthetic gas to keep the dog anesthetized during surgery (for a safe-ER anesthesia right Janet?). All of these medications together worked beautifully and we had a pretty stellar anesthesia.
I was basically the circulator during surgery. The circulator (brace yourself Jessie, here comes a definition straight from your manual) is the mediator between sterile and non-sterile fields. What that means is that the circulator can pass instruments and supplies in a sterile manner to the people that are scrubbed in and must remain sterile. Instruments and other things are sterilized in packs, the outer layer can be peeled back by the circulator and the sterile person can remove the item to use in the surgery without introducing any type of contamination to the surgery site. Maintaining a sterile surgical site and sterile fields for the surgeon to work in is extremely important in preventing infection in the patient.
Anyway, one of the coolest circulator duties I performed today was catching the femoral head that the surgeon dropped into my open hands! COOOOOOOOOL! I could see all the remnants of connective tissue on it and the spongy bone part and the goo all over the bone and it was so neat! (Another nerdy outburst, sorry again) The anesthesia tech that was in there with us was not nearly as excited about the anatomical awesomeness that I held in my hands but everyone's nerdiness is brought out by different things so I'm ok with that.
The surgery went well and the dog recovered nicely. She will most likely not be able to be as active as she was at her peak, but she will be able to move relatively normally and do many of the things she did before. A major concern for post-op FHO patients is ensuring that they maintain a healthy but lean weight so as not to overstress the hip area that has been compromised. Pretty cool stuff if you ask me.
We did a few TPLO's today as well, which I believe I have mentioned before so I won't get back in to that. Surgery is pretty awesome and I'm constantly amazed at what the body can handle and recover from.
First up was a bilateral FHO or Femoral Head Osteotomy. Let's break that down- Femoral head= rounded head of the femur that is supposed to fit ever so nicely into the acetabulum or "hip socket" to form the hip joint, Osteotomy= surgical removal of a bone (in this case, chunk of a bone). FHO's are really pretty amazing because the head of the femur that forms the hip joint with the pelvis is literally removed so there is nothing in the hip joint, the musculature surrounding the hip area and the eventual development of scar/cartilagenous tissue forms a joint-like connection to support the area. Here is a link to a blog that has before and after radiographs(x-rays) of an FHO performed on one side--> Rads . Our patient today had both femoral heads removed, isn't that cool that the body can handle something like that??? No femoral heads? Awesome! Anyway, that was a nerdy outburst, sorry. So the reason for the surgery was hip pain caused by arthritis in the hip joints. Just looking at the pre-operative radiographs was painful. The head of the femur should be smooth and round and articulate wonderously with the (say it with me...) acetabulum. This dog's femoral heads were all uneven and rough and ouchy. So we got the dog anesthetized and I helped hook her up to all of our diagnostic goodies once we transferred her to the surgery suite (ECG leads, pulse ox, temperature probe down the esophagus, ETCO2, blood pressure cuff and fluids). I think I am finally getting the hand of hooking all of that stuff up in a timely manner. The dog was on fluids as well as a Cefazolin CRI and Morphine CRI (CRI= constant rate infusion, so it's flowing at a specific rate along with regular fluids during the surgery). Cefazolin is an antibiotic to prevent infection, we give about 100 mls during the first hour of surgery then stop it. Morphine is an analgesic (pain reliever) and is given throughout the surgery. It can also be given as a bolus or a larger amount given all at once if the animal is showing signs of pain during surgery. Prior to surgery, the dog was also given an epidural of pain medication which helps to stop pain before it starts and allows us to use less anesthetic gas to keep the dog anesthetized during surgery (for a safe-ER anesthesia right Janet?). All of these medications together worked beautifully and we had a pretty stellar anesthesia.
I was basically the circulator during surgery. The circulator (brace yourself Jessie, here comes a definition straight from your manual) is the mediator between sterile and non-sterile fields. What that means is that the circulator can pass instruments and supplies in a sterile manner to the people that are scrubbed in and must remain sterile. Instruments and other things are sterilized in packs, the outer layer can be peeled back by the circulator and the sterile person can remove the item to use in the surgery without introducing any type of contamination to the surgery site. Maintaining a sterile surgical site and sterile fields for the surgeon to work in is extremely important in preventing infection in the patient.
Anyway, one of the coolest circulator duties I performed today was catching the femoral head that the surgeon dropped into my open hands! COOOOOOOOOL! I could see all the remnants of connective tissue on it and the spongy bone part and the goo all over the bone and it was so neat! (Another nerdy outburst, sorry again) The anesthesia tech that was in there with us was not nearly as excited about the anatomical awesomeness that I held in my hands but everyone's nerdiness is brought out by different things so I'm ok with that.
The surgery went well and the dog recovered nicely. She will most likely not be able to be as active as she was at her peak, but she will be able to move relatively normally and do many of the things she did before. A major concern for post-op FHO patients is ensuring that they maintain a healthy but lean weight so as not to overstress the hip area that has been compromised. Pretty cool stuff if you ask me.
We did a few TPLO's today as well, which I believe I have mentioned before so I won't get back in to that. Surgery is pretty awesome and I'm constantly amazed at what the body can handle and recover from.
Tuesday, April 19, 2011
Week 4, yeah!
Today was a crazy, long, hectic yet fun day. Orthopedics had two surgeries, one of which was my little buddy from yesterday with the fractured femur and the other was a Tibial Plateau Leveling Osteotomy (lovingly known as a TPLO). The TPLO dog came in yesterday with hind leg lameness and underwent an orthopedic exam. The dog was very tense during the exam and the veterinarian didn't feel that he got an accurate sense of what was going on with the injured leg. Once the dog was sedated for x-rays, the vet re-examined the leg and determined through a drawer sign test that the dog had torn a ligament in its stifle ("knee"). A positive drawer sign test is when the two major bones of the hind limb that form the stifle joint can be moved forward and backward past each other (not normal!!) to indicate that the ligament(s) that usually support the joint are damaged and no longer doing their uber-important job. So, the TPLO surgery was set up for today. TPLO surgery involves removing part of the tibia (lower leg bone) and placing various plates and screws and other fun stuff on/in the bone to stabilize the joint. Cool! However, the ortho group had ample help so I joined up with the neuro kids.
The initial plan in neuro was to do diagnostics on two different dogs, which included MRI. Unfortunately, the MRI was not in the mood to function properly for the majority of the day so we ran a CT scan on dog #1 and had to hold off on diagnostics for dog #2 since the owners would not approve a myelogram and CT in lieu of MRI. Dog #2's (we'll call him Hal) owners came by to see him later in the day. Hal has significant weakness in his hind end and the vet felt that he may have lumbo-sacral disease. Lumbo-sacral disease is basically a general name for degenerative changes that occur in the spine of the lumbar/sacral regions (equivalent to the lower back). Hal's owners were very concerned about him but they were incredibly grateful for the care that he was receiving. We were able to wheel Hal out on a gurney and then assist him with a sling while he walked around the pet exercise area with his owners. A HUGE part of vet med is communicating and interacting with owners. Not all owners are fantastically awesome, but when you come across owners that want to do everything they can for their pet and truly appreciate the effort that we, as medical professionals are putting forth, it's motivating and makes you want to be a more caring, knowledgeable tech.
The MRI got over it's hissy fit around 3pm so we got Hal ready for diagnostics. This is where I learned the importance of ensuring that endotracheal tubes have been properly placed (yeah, really). I administered Propofol in order to induce Hal for spinal radiographs and his MRI and one of the vet students placed the endotracheal tube. Over the next minute or so (seemed like waaaaay longer), Hal began to turn progressively more purple, indicating that his tube was not properly placed...it was most likely in the esophagus (BAD). One of the vets stepped in, placed the tube properly and we began ventilating the patient until he returned to a nice pink color. He then took his dear sweet time to start breathing on his own, but once we got down to radiology, everything was a-ok. It's a little scary to think how many terrible things can happen during a "routine" procedure. One simple thing can be overlooked and an animal can die as a result. Maybe I'm getting all "made for TV movie" cheesy, but people, this is teamwork kind of stuff. Everyone has to be focused on the care and welfare of the patient first and foremost. Those few minutes of insanity when our patient was PURPLE were scary and I don't care to repeat them on a regular basis, thank you very much!
Alright so key points for the day: 1) Grateful people are great! 2) Intubating the esophagus is bad!
3) Teamwork is awesome and beneficial for all involved :)
The initial plan in neuro was to do diagnostics on two different dogs, which included MRI. Unfortunately, the MRI was not in the mood to function properly for the majority of the day so we ran a CT scan on dog #1 and had to hold off on diagnostics for dog #2 since the owners would not approve a myelogram and CT in lieu of MRI. Dog #2's (we'll call him Hal) owners came by to see him later in the day. Hal has significant weakness in his hind end and the vet felt that he may have lumbo-sacral disease. Lumbo-sacral disease is basically a general name for degenerative changes that occur in the spine of the lumbar/sacral regions (equivalent to the lower back). Hal's owners were very concerned about him but they were incredibly grateful for the care that he was receiving. We were able to wheel Hal out on a gurney and then assist him with a sling while he walked around the pet exercise area with his owners. A HUGE part of vet med is communicating and interacting with owners. Not all owners are fantastically awesome, but when you come across owners that want to do everything they can for their pet and truly appreciate the effort that we, as medical professionals are putting forth, it's motivating and makes you want to be a more caring, knowledgeable tech.
The MRI got over it's hissy fit around 3pm so we got Hal ready for diagnostics. This is where I learned the importance of ensuring that endotracheal tubes have been properly placed (yeah, really). I administered Propofol in order to induce Hal for spinal radiographs and his MRI and one of the vet students placed the endotracheal tube. Over the next minute or so (seemed like waaaaay longer), Hal began to turn progressively more purple, indicating that his tube was not properly placed...it was most likely in the esophagus (BAD). One of the vets stepped in, placed the tube properly and we began ventilating the patient until he returned to a nice pink color. He then took his dear sweet time to start breathing on his own, but once we got down to radiology, everything was a-ok. It's a little scary to think how many terrible things can happen during a "routine" procedure. One simple thing can be overlooked and an animal can die as a result. Maybe I'm getting all "made for TV movie" cheesy, but people, this is teamwork kind of stuff. Everyone has to be focused on the care and welfare of the patient first and foremost. Those few minutes of insanity when our patient was PURPLE were scary and I don't care to repeat them on a regular basis, thank you very much!
Alright so key points for the day: 1) Grateful people are great! 2) Intubating the esophagus is bad!
3) Teamwork is awesome and beneficial for all involved :)
Monday, April 18, 2011
Summing up end of week 3, begin week 4!!
So, I've been told that I got slack on my blog towards the end of the week so here's a quick run down on the fun stuff that happened Thursday and Friday.
On Thursday, we had a visit from the kids down at the Raptor Rescue. They brought in a Barred Owl and a Red Tailed Hawk, both of which had injuries to one of their wings. The birds were brought in for a test called an electromyograph (EMG) which test the electrical activity of skeletal (voluntary) muscles. The bird is anesthetized (nap time!) and small needles are inserted in to the affected muscles. The needles are connected to a monitor that displays the electrical activity of the muscles where the needles are placed. A normal skeletal muscle should not emit any electrical activity when it's not being voluntarily constricted. If there is electrical activity in a relaxed muscle it can be a sign of neuropathy (disease associated with the nerves/nervous system) and can happen when nerve fibers begin to reinnervate a damaged muscle fiber. Both birds had significant abnormal electrical activity in the muscles of their damaged wings and some muscle atrophy could be felt on both of them as well. We are hoping that they will improve with more rest and restriction on their activity.
On Friday, an upper GI endoscopy (little camera inserted through the mouth to explore the goodies that lie within!) was performed on a patient that had undergone neurosurgery earlier in the week. She had vomited up blood and pieces of mucosal tissue from her GI tract (either esophagus or stomach). There was inflammation and some sloughing of tissue in many areas of the esophagus and stomach and biopsies were taken (biting off little chunks of tissue for further examination).
We then observed a necropsy on a dog that had come in to us for severe ataxia and also seizures I believe, the second day that she was in ICU she also began having corneal edema in her right eye. On MRI they found some areas in the cerebellum and in the frontal/parietal regions of her brain that were abnormal. She was an older dog and euthanasia was probably the best option. The necropsy was a little rough to watch after working with the dog and loving on her the day before. They had to remove her head in order to dissect and get samples of her brain tissue, that was the hardest part to see. Otherwise, the dissection of the tissues and organs itself was interesting. Oddly enough, there was nothing to be seen in the brain tissue as far as gross evidence of what was seen on MRI. The doctor doing the necropsy said that it may show up once the tissue is fixed.
This week is Orthopedics/Neuro week.
Ortho had a little 4 month old puppy come in with a broken femur. The x-ray that had been done at the referring veterinarian showed that the femur was completely broken into two pieces. We did more x-rays and will most likely do surgery later this week to repair the fracture. The puppy was ridiculously adorable by the way.
I also rocked the socks off of a jugular blood draw and IV catheter placement on a neuro dog. Practice, practice, practice!
Ok hopefully this satisfies everyone's blog withdrawal (Dad!), I will try to be better in the future.
On Thursday, we had a visit from the kids down at the Raptor Rescue. They brought in a Barred Owl and a Red Tailed Hawk, both of which had injuries to one of their wings. The birds were brought in for a test called an electromyograph (EMG) which test the electrical activity of skeletal (voluntary) muscles. The bird is anesthetized (nap time!) and small needles are inserted in to the affected muscles. The needles are connected to a monitor that displays the electrical activity of the muscles where the needles are placed. A normal skeletal muscle should not emit any electrical activity when it's not being voluntarily constricted. If there is electrical activity in a relaxed muscle it can be a sign of neuropathy (disease associated with the nerves/nervous system) and can happen when nerve fibers begin to reinnervate a damaged muscle fiber. Both birds had significant abnormal electrical activity in the muscles of their damaged wings and some muscle atrophy could be felt on both of them as well. We are hoping that they will improve with more rest and restriction on their activity.
On Friday, an upper GI endoscopy (little camera inserted through the mouth to explore the goodies that lie within!) was performed on a patient that had undergone neurosurgery earlier in the week. She had vomited up blood and pieces of mucosal tissue from her GI tract (either esophagus or stomach). There was inflammation and some sloughing of tissue in many areas of the esophagus and stomach and biopsies were taken (biting off little chunks of tissue for further examination).
We then observed a necropsy on a dog that had come in to us for severe ataxia and also seizures I believe, the second day that she was in ICU she also began having corneal edema in her right eye. On MRI they found some areas in the cerebellum and in the frontal/parietal regions of her brain that were abnormal. She was an older dog and euthanasia was probably the best option. The necropsy was a little rough to watch after working with the dog and loving on her the day before. They had to remove her head in order to dissect and get samples of her brain tissue, that was the hardest part to see. Otherwise, the dissection of the tissues and organs itself was interesting. Oddly enough, there was nothing to be seen in the brain tissue as far as gross evidence of what was seen on MRI. The doctor doing the necropsy said that it may show up once the tissue is fixed.
This week is Orthopedics/Neuro week.
Ortho had a little 4 month old puppy come in with a broken femur. The x-ray that had been done at the referring veterinarian showed that the femur was completely broken into two pieces. We did more x-rays and will most likely do surgery later this week to repair the fracture. The puppy was ridiculously adorable by the way.
I also rocked the socks off of a jugular blood draw and IV catheter placement on a neuro dog. Practice, practice, practice!
Ok hopefully this satisfies everyone's blog withdrawal (Dad!), I will try to be better in the future.
Wednesday, April 13, 2011
Keepin' it brief
Ok kids, it's getting late and I haven't gotten a chance to get my blog on so this is gonna be a quick one:
1) Ms. Collie was confirmed negative for Lepto! Yaaaaaaaaaay!!
2) My newly discovered hidden talent is retrieving cats from underneath a bank of cages with ease. I knew these long chicken arms were good for something!
3) I think I am starting to pick up a bit of a Southern accent and it's starting to scare me. How did I resist it my entire life living in the South and now, not even three weeks in to internship, I'm y'all'ing and drawling and twanging uncontrollably?!? Unacceptable.
That is all. Have a great night!
1) Ms. Collie was confirmed negative for Lepto! Yaaaaaaaaaay!!
2) My newly discovered hidden talent is retrieving cats from underneath a bank of cages with ease. I knew these long chicken arms were good for something!
3) I think I am starting to pick up a bit of a Southern accent and it's starting to scare me. How did I resist it my entire life living in the South and now, not even three weeks in to internship, I'm y'all'ing and drawling and twanging uncontrollably?!? Unacceptable.
That is all. Have a great night!
Tuesday, April 12, 2011
Neuro-riffic!
Another busy day in Neuro today. We had two surgeries, two dogs that went through diagnostic tests to determine what surgery needed to be done and two patients were discharged. Sadly, neither of our discharged patients left with particularly good prognoses (I assume that's the plural of prognosis...).
One of the discharges was our Collie from yesterday. She was more alert and was able to walk with a little less assistance today but, due to her generalized muscle atrophy, she is still very weak. The neurologist thinks there is a chance that she could have Leptospirosis in addition to a neuromuscular issue based on her symptoms. Leptospirosis is a zoonotic (can be passed from animals to people!) bacteria that affects the liver and kidneys. The good news is that the canine combination vaccine that is/should be given every year protects against Lepto. The bad news? Well, that's the whole zoonotic thing. How is it passed you ask? Most commonly, urine. So, if you read yesterday's blog, you may recall that a vet student and I worked with Ms. Collie and her urine soaked cage and body in the attempt to place a urinary catheter(I was wearing gloves while clipping her but not so much when handling dirty pee pads, fantastic). Titers on the collie's vaccines and a specific Lepto test as well as tests for other fun parasite-ish things are underway. Should Ms. Collie's Lepto test come back positive, the vet student, all of the ICU techs, Ms. Collie's owners/their kids/their other animals aaaaand your favorite blogger may potentially also have Lepto. Yahoo! Lesson learned? Wear GLOVES when playing with pee. K? OK.
I helped prep for a hemilaminectomy (fun word eh?) surgery on the lumbar spine of a Doberman and covered monitoring anesthesia until one of the vet students could take over. The dog had been kicked by a horse in the front of his body but two weeks later he was showing signs of weakness and pain is his hind limbs. The MRI that had been done the previous day showed some material protruding from the spinal column from the left side, ventrally (belly side) all the way around to the right side. This is not how a herniated disk usually presents so the neurologist thought there was a chance it might be a tumor. Fortunately for the dog, the problem was a disk, not a tumor. There were signs that he had some bleeding in his spinal column which had clotted and possibly caused some of the dog's issues. The vet removed the disk material and the blood clot. It was an amazing surgery to see, the dog's spinal column was completely visible and he had about a foot long incision down his back. Awesome!
While I was monitoring anesthesia, everything was hunky dory. The dog's resting heart rate that morning had been 72 and he was given Hydromorphone and Dexmedetomidine for premedications. Dexmedetemodine has the tendency to cut an animal's heart rate in half so, according to the anesthesia techs, a heart rate of 40 on this dog was acceptable as long as his blood pressure and other vitals remained normal. However, his respiration rate was a snoodge low (like 2 per minute during a good minute sometimes 0 per minute) which we were not so happy with. We eventually decided to put the dog on a respirator, which was super cool to see. By regulating his respirations we also regulated his ETCO2 (end tidal CO2, how much CO2 is exhaled) which is muy importante. So, right about then the vet student rolls in and takes over monitoring anesthesia and I go off to help with other patients. When I saunter back in to check on things, the dog's heart rate is 100 and the mean blood pressure is 38 (it should be at least 60 and it was over 70 when I left)!! What the WHAT? Things were beautiful when I left, what happened? Apparently things went from perfectly fine to awful in a few seconds. The dog was given a huge amount of fluid as well as Hetastarch to bring up his blood pressure. It took some time, but it worked. Craaaazy!
The rest of the day was full of sedating dogs and getting them through diagnostics (spinal radiographs and MRI's). Lots of premedication, intubation, anesthetization, transportation and hydration! We were busy kids today but it was fun times.
One of the discharges was our Collie from yesterday. She was more alert and was able to walk with a little less assistance today but, due to her generalized muscle atrophy, she is still very weak. The neurologist thinks there is a chance that she could have Leptospirosis in addition to a neuromuscular issue based on her symptoms. Leptospirosis is a zoonotic (can be passed from animals to people!) bacteria that affects the liver and kidneys. The good news is that the canine combination vaccine that is/should be given every year protects against Lepto. The bad news? Well, that's the whole zoonotic thing. How is it passed you ask? Most commonly, urine. So, if you read yesterday's blog, you may recall that a vet student and I worked with Ms. Collie and her urine soaked cage and body in the attempt to place a urinary catheter(I was wearing gloves while clipping her but not so much when handling dirty pee pads, fantastic). Titers on the collie's vaccines and a specific Lepto test as well as tests for other fun parasite-ish things are underway. Should Ms. Collie's Lepto test come back positive, the vet student, all of the ICU techs, Ms. Collie's owners/their kids/their other animals aaaaand your favorite blogger may potentially also have Lepto. Yahoo! Lesson learned? Wear GLOVES when playing with pee. K? OK.
I helped prep for a hemilaminectomy (fun word eh?) surgery on the lumbar spine of a Doberman and covered monitoring anesthesia until one of the vet students could take over. The dog had been kicked by a horse in the front of his body but two weeks later he was showing signs of weakness and pain is his hind limbs. The MRI that had been done the previous day showed some material protruding from the spinal column from the left side, ventrally (belly side) all the way around to the right side. This is not how a herniated disk usually presents so the neurologist thought there was a chance it might be a tumor. Fortunately for the dog, the problem was a disk, not a tumor. There were signs that he had some bleeding in his spinal column which had clotted and possibly caused some of the dog's issues. The vet removed the disk material and the blood clot. It was an amazing surgery to see, the dog's spinal column was completely visible and he had about a foot long incision down his back. Awesome!
While I was monitoring anesthesia, everything was hunky dory. The dog's resting heart rate that morning had been 72 and he was given Hydromorphone and Dexmedetomidine for premedications. Dexmedetemodine has the tendency to cut an animal's heart rate in half so, according to the anesthesia techs, a heart rate of 40 on this dog was acceptable as long as his blood pressure and other vitals remained normal. However, his respiration rate was a snoodge low (like 2 per minute during a good minute sometimes 0 per minute) which we were not so happy with. We eventually decided to put the dog on a respirator, which was super cool to see. By regulating his respirations we also regulated his ETCO2 (end tidal CO2, how much CO2 is exhaled) which is muy importante. So, right about then the vet student rolls in and takes over monitoring anesthesia and I go off to help with other patients. When I saunter back in to check on things, the dog's heart rate is 100 and the mean blood pressure is 38 (it should be at least 60 and it was over 70 when I left)!! What the WHAT? Things were beautiful when I left, what happened? Apparently things went from perfectly fine to awful in a few seconds. The dog was given a huge amount of fluid as well as Hetastarch to bring up his blood pressure. It took some time, but it worked. Craaaazy!
The rest of the day was full of sedating dogs and getting them through diagnostics (spinal radiographs and MRI's). Lots of premedication, intubation, anesthetization, transportation and hydration! We were busy kids today but it was fun times.
Monday, April 11, 2011
Week 3- Neuro! Yessssss!
This week I'm on Neurology/helping in the various departments that are short a tech. Neuro is my very very favorite so I'm pretty pumped about it. I've been wandering on down there whenever things have been slow elsewhere previous weeks, but this week is a for real Neuro week.
This morning I helped the Oncology kids out receiving their chemo patients. Rocked a jugular blood draw on one Shar-Pei and did NOT rock it on the other (chunky monkey, fat rolls on the neck) Shar-Pei. I'm getting better though, it's all about being emphatic about your needle sticking.
Then I headed over to Neuro-town. First of all, let me give a little overview of a basic neuro exam. This exam is done when an animal is showing any of a gajillion neurological signs which can include limb weakness, lack of coordination or asymmetry in their face much like a human might have as a result of a stroke. A basic neuro exam is testing for the presence of normal reflexes, the absence of which may help narrow down where the problem is. Often, neuro exams will test pupil size (they should be equal), the Pupillary Light Reflex (PLR) which is ensuring that when a light is flashed in the left eye for example the left pupil as well as the right pupil constrict (get smaller), the dog's ability to track with it's eyes when spun around in a circle (this is done by basically dancing with the dog...it's mildly entertaining especially when done with a Chihuahua or other silly little dog), reflexes in the limbs are tested with that little hammer thing that your doctor whacks your knee with. Also, we test the animal's proprioception (knowing where your limbs are in space) by turning the paws under so the animal is standing on the knuckle of their paw. In a normal animal, they should immediately put their paw back in a normal position. We also test for a deep pain reflex which is done by squeezing the toe or webbing of the toe and look for the animal to withdraw the leg and/or show some sign that they feel the stimulus. There's also about a zillion other things that can be done but hopefully that gives you a sense of what we're looking for.
So, first up was a little Chihuahua that was getting spinal radiographs (x-rays) and a spinal MRI including his entire brain down to T6 (thoracic vertebrae #6...lower mid back i guess it would be). This kid had already had a neuro exam and was having these diagnostic tests to look for any specific abnormalities in his brain, spinal cord and/or spinal column (including disks!) that may be causing his issues. These tests have to be done with the animal sedated because it's essential that they do not move during the process and, for the radiographs (again, x-rays), the neck has to be flexed and then extended to a degree that an awake dog may not to be to keen on. Little Chi-Chi (that's what I'm calling him ok?) got Dexmedetomidine aaaaand I want to say Hydromorphone courtesy of yours truly. We then induced him (sent him to sleepy-town) using propofol, intubated him (put an endotracheal tube down his trachea) and hooked him up to the anesthetic gas Isoflurane. We took him down to radiology for his spinal radiographs which showed that he may have a narrowing of the spaces between the 4th through the 7th cervical (neck) vertebrae. Between the vertebrae is where there are cushy intervertebral disks which provide shock absorption for the spine and prevent bone on bone contact. Then off to MRI!! As you recall, Chi-Chi was getting his brain all the way down to T6 MRI'd (I don't know if that's a verb, but it is now), that's over half the dog people. It took a loooooong time, like a good hour and a half. They found some abnormalities in the same area as was abnormal on the rads. Surgery is an option for this dog, but he is an older dog which can increase complications and degree of recovery and there is also no guarantee that the surgery will "cure" the dog. It's up to the owner to decide what he wants to do.
Next project is a 12 year old Collie who is pretty close to non-ambulatory (can't walk on her own) and has a slew of other symptoms but no definitive diagnosis as of yet. Our mission with the collie was to place a urinary catheter for two reasons: 1) We needed a urine sample and every time someone went to get it she had already taken care of business on the pee pads in her cage 2) She was suffering from urine scald because she kept soiling herself. Seems easy enough right? Just throw in a catheter and be on our merry way...Ms. Collie had other ideas. First order of business was to clean the kid up a bit, her odoriferousness was obvious throughout the entire ward and was quite potent to those in close proximity to her (read: me and the vet student I was working with). Protocol is to sedate the patient before this procedure as it can be uncomfortable (catheterization is often done without sedation, it just depends on what the vet prefers and patient temperament). We gave her hydromorphone to sedate her and within a few seconds her breathing was very shallow and fast and her mucous membranes (gums) turned very pale (not cool). This is one of many bad reactions an animal can have to a drug, fortunately Hydromorphone has a reversal drug that can be given in a situation such as this. UNfortunately, the vet student had not obtained any of it from the pharmacy. We got some on the double (Naloxone or Narcan for my Bel-Rea pals) and gave it to her along with some oxygen and her breathing and color returned to normal. Yikes! Lesson to be learned? Always ALWAYS have your reversal agent handy when giving medications. We (read: lucky me) then shaved the poor kid down removing all kinds of ickiness and matted fur from her personal areas which she tolerated surprisingly well without any kind of sedation. However, she had other ideas about having a urinary catheter placed without sedation so that mission was aborted. Happy ending after all of this? Ms. Collie had a cleaner, less matted bum AND we got a urine via cystocentesis (needle through the abdomen directly into the bladder...shakow!).
We also had another Chihuahua that I helped take radiographs of, and let me just tell you that holding the head and toothpick like legs of a 7 lb Chihuahua while wearing ginormous lead gloves is none too easy. Oh AND getting an IV catheter into said toothpick legs is also not easy. I was mildly successful in my attempt but not so much so that I could get that cursed thing to advance into the vein, ah well, better luck next time.
I'm looking forward to the rest of my week on Neuro, tomorrow we have a bunch of surgeries and more diagnostic extravaganzas to get done. Wahoo!!
This morning I helped the Oncology kids out receiving their chemo patients. Rocked a jugular blood draw on one Shar-Pei and did NOT rock it on the other (chunky monkey, fat rolls on the neck) Shar-Pei. I'm getting better though, it's all about being emphatic about your needle sticking.
Then I headed over to Neuro-town. First of all, let me give a little overview of a basic neuro exam. This exam is done when an animal is showing any of a gajillion neurological signs which can include limb weakness, lack of coordination or asymmetry in their face much like a human might have as a result of a stroke. A basic neuro exam is testing for the presence of normal reflexes, the absence of which may help narrow down where the problem is. Often, neuro exams will test pupil size (they should be equal), the Pupillary Light Reflex (PLR) which is ensuring that when a light is flashed in the left eye for example the left pupil as well as the right pupil constrict (get smaller), the dog's ability to track with it's eyes when spun around in a circle (this is done by basically dancing with the dog...it's mildly entertaining especially when done with a Chihuahua or other silly little dog), reflexes in the limbs are tested with that little hammer thing that your doctor whacks your knee with. Also, we test the animal's proprioception (knowing where your limbs are in space) by turning the paws under so the animal is standing on the knuckle of their paw. In a normal animal, they should immediately put their paw back in a normal position. We also test for a deep pain reflex which is done by squeezing the toe or webbing of the toe and look for the animal to withdraw the leg and/or show some sign that they feel the stimulus. There's also about a zillion other things that can be done but hopefully that gives you a sense of what we're looking for.
So, first up was a little Chihuahua that was getting spinal radiographs (x-rays) and a spinal MRI including his entire brain down to T6 (thoracic vertebrae #6...lower mid back i guess it would be). This kid had already had a neuro exam and was having these diagnostic tests to look for any specific abnormalities in his brain, spinal cord and/or spinal column (including disks!) that may be causing his issues. These tests have to be done with the animal sedated because it's essential that they do not move during the process and, for the radiographs (again, x-rays), the neck has to be flexed and then extended to a degree that an awake dog may not to be to keen on. Little Chi-Chi (that's what I'm calling him ok?) got Dexmedetomidine aaaaand I want to say Hydromorphone courtesy of yours truly. We then induced him (sent him to sleepy-town) using propofol, intubated him (put an endotracheal tube down his trachea) and hooked him up to the anesthetic gas Isoflurane. We took him down to radiology for his spinal radiographs which showed that he may have a narrowing of the spaces between the 4th through the 7th cervical (neck) vertebrae. Between the vertebrae is where there are cushy intervertebral disks which provide shock absorption for the spine and prevent bone on bone contact. Then off to MRI!! As you recall, Chi-Chi was getting his brain all the way down to T6 MRI'd (I don't know if that's a verb, but it is now), that's over half the dog people. It took a loooooong time, like a good hour and a half. They found some abnormalities in the same area as was abnormal on the rads. Surgery is an option for this dog, but he is an older dog which can increase complications and degree of recovery and there is also no guarantee that the surgery will "cure" the dog. It's up to the owner to decide what he wants to do.
Next project is a 12 year old Collie who is pretty close to non-ambulatory (can't walk on her own) and has a slew of other symptoms but no definitive diagnosis as of yet. Our mission with the collie was to place a urinary catheter for two reasons: 1) We needed a urine sample and every time someone went to get it she had already taken care of business on the pee pads in her cage 2) She was suffering from urine scald because she kept soiling herself. Seems easy enough right? Just throw in a catheter and be on our merry way...Ms. Collie had other ideas. First order of business was to clean the kid up a bit, her odoriferousness was obvious throughout the entire ward and was quite potent to those in close proximity to her (read: me and the vet student I was working with). Protocol is to sedate the patient before this procedure as it can be uncomfortable (catheterization is often done without sedation, it just depends on what the vet prefers and patient temperament). We gave her hydromorphone to sedate her and within a few seconds her breathing was very shallow and fast and her mucous membranes (gums) turned very pale (not cool). This is one of many bad reactions an animal can have to a drug, fortunately Hydromorphone has a reversal drug that can be given in a situation such as this. UNfortunately, the vet student had not obtained any of it from the pharmacy. We got some on the double (Naloxone or Narcan for my Bel-Rea pals) and gave it to her along with some oxygen and her breathing and color returned to normal. Yikes! Lesson to be learned? Always ALWAYS have your reversal agent handy when giving medications. We (read: lucky me) then shaved the poor kid down removing all kinds of ickiness and matted fur from her personal areas which she tolerated surprisingly well without any kind of sedation. However, she had other ideas about having a urinary catheter placed without sedation so that mission was aborted. Happy ending after all of this? Ms. Collie had a cleaner, less matted bum AND we got a urine via cystocentesis (needle through the abdomen directly into the bladder...shakow!).
We also had another Chihuahua that I helped take radiographs of, and let me just tell you that holding the head and toothpick like legs of a 7 lb Chihuahua while wearing ginormous lead gloves is none too easy. Oh AND getting an IV catheter into said toothpick legs is also not easy. I was mildly successful in my attempt but not so much so that I could get that cursed thing to advance into the vein, ah well, better luck next time.
I'm looking forward to the rest of my week on Neuro, tomorrow we have a bunch of surgeries and more diagnostic extravaganzas to get done. Wahoo!!
Saturday, April 9, 2011
Some thoughts on being a vet tech...
Ah the rare weekend blog post, it's really happening people, try not to get too excited. I just wanted to write about a subject that seems to keep coming up lately and maybe get other people's thoughts/opinions on it. This is just my opinion on the subject and I'm totally open to other points of view so feel free to put your two cents in.
Amongst veterinary medical professionals, it's fairly common to hear people voice their frustration with pet owners who wait an excessive amount of time to seek treatment for their animals or fail to follow preventative health care guidelines or a host of other things. I am certainly guilty of this myself, but I had an experience this past week that made me reconsider how quickly I pass judgement on an owner.
Of course, there are and will continue to be cases of neglect, abuse and carelessness on the part of pet owners. Those situations frustrate and anger me just as much as they do everyone else and are not what I'm referring to. I'm talking more about instances in which the owner is just uneducated or unaware of the appropriate course of action or signs/symptoms/effects that need to be considered with regards to their pet. It's important to remember that we have extensive schooling and practical experience that helps us to know what is normal/abnormal, safe/dangerous, required/unnecessary when it comes to animals. All pet owners don't have that knowledge which is why they come to us. It's our job to educate them and help them to know what to do and what to look for in their pets, not to judge them and assume that they are negligent pet owners because they overlooked something that is obvious to us.
I try to think about what I knew and how observant I was of all things veterinary before I had any training or experience in the field. Would I have known that taking an unvaccinated puppy to a dog park could end up killing it? Would I have thought to pay attention to how much urine/feces I had to scoop out of a cat's litter box and if that amount changed or the consistency changed would I notice? If an elderly animal was progressively having more difficulty moving and doing their regular activities, would I take him to the vet at the first signs of change or would I attribute it to his age? If my animal ate something they shouldn't or ate way too much would I rush him to the vet or just wait it out? Would I know that aside from preventing baby-making there are many other reasons to have my pet spayed/neutered? Personally, I didn't have a clue about many of these things prior to having any training/experience. I think it's important to try to think about the situation from the owner's point of view and give them the benefit of the doubt when at all possible.
As veterinary professionals, we also tend to be hyperaware of what is going on with our own animals. We do full body palpations regularly, we check ears, eyes, mouths/teeth, we know how many times they usually urinate/defecate in a day, what it normally looks like and what it should look like and when to worry if it doesn't look like what it should. We have actual "normal" conversations entirely based on poop. Perhaps we have forgotten that most people don't talk about that on a regular basis. Owners may not look at all of these things on their pets regularly or even know what to look for. So that huge growth on the side of Fluffernutter's thorax didn't get noticed right away. Maybe 'ol Fluff doesn't like to be petted in that area or maybe the owner felt it after it had been there a while and waited to see if would change or get bigger before bringing them in.
Another point to consider is that many people don't trust authority figures (i.e. doctors and vets). There are a million reasons why people feel this way, but it's something to keep in mind especially when we are telling an owner that they need to spend x amount of money to help their animal or to prevent their animal from having issues down the road. It's been a hard economic time and people are more wary of parting with their money especially when they don't fully understand what they are paying for. We have to make an effort, at whatever point we first interact with owners to explain to them what their responsibilities are as a pet owner, what they need to do to keep their pet healthy and, perhaps most importantly, why they need to do these things. You can tell people a zillion times that they need to get their pets vaccinated but, until you explain to them the risks of not vaccinating and the ease with which their pet can contract a life threatening disease, they may not understand how important it is. Do I get my flu vaccine every year? Heck no! Have I died from the flu or know anyone who has? Nope (though I did have a near death experience that was flu related a few months ago, but that's beside the point!). So, again thinking like an owner, I don't get or need a flu vaccination every year so why does Spike need his vaccinations every year? And what is Distemper anyway? Spike's temper is perfectly wonderful.
Anyway, this is starting to progress into silliness. But my point is that before we get upset and frustrated with owners that didn't do what we would have done with their pets, we should take a moment to consider where they are coming from. Instead of getting upset with them, we should do our best to educate them.
Amongst veterinary medical professionals, it's fairly common to hear people voice their frustration with pet owners who wait an excessive amount of time to seek treatment for their animals or fail to follow preventative health care guidelines or a host of other things. I am certainly guilty of this myself, but I had an experience this past week that made me reconsider how quickly I pass judgement on an owner.
Of course, there are and will continue to be cases of neglect, abuse and carelessness on the part of pet owners. Those situations frustrate and anger me just as much as they do everyone else and are not what I'm referring to. I'm talking more about instances in which the owner is just uneducated or unaware of the appropriate course of action or signs/symptoms/effects that need to be considered with regards to their pet. It's important to remember that we have extensive schooling and practical experience that helps us to know what is normal/abnormal, safe/dangerous, required/unnecessary when it comes to animals. All pet owners don't have that knowledge which is why they come to us. It's our job to educate them and help them to know what to do and what to look for in their pets, not to judge them and assume that they are negligent pet owners because they overlooked something that is obvious to us.
I try to think about what I knew and how observant I was of all things veterinary before I had any training or experience in the field. Would I have known that taking an unvaccinated puppy to a dog park could end up killing it? Would I have thought to pay attention to how much urine/feces I had to scoop out of a cat's litter box and if that amount changed or the consistency changed would I notice? If an elderly animal was progressively having more difficulty moving and doing their regular activities, would I take him to the vet at the first signs of change or would I attribute it to his age? If my animal ate something they shouldn't or ate way too much would I rush him to the vet or just wait it out? Would I know that aside from preventing baby-making there are many other reasons to have my pet spayed/neutered? Personally, I didn't have a clue about many of these things prior to having any training/experience. I think it's important to try to think about the situation from the owner's point of view and give them the benefit of the doubt when at all possible.
As veterinary professionals, we also tend to be hyperaware of what is going on with our own animals. We do full body palpations regularly, we check ears, eyes, mouths/teeth, we know how many times they usually urinate/defecate in a day, what it normally looks like and what it should look like and when to worry if it doesn't look like what it should. We have actual "normal" conversations entirely based on poop. Perhaps we have forgotten that most people don't talk about that on a regular basis. Owners may not look at all of these things on their pets regularly or even know what to look for. So that huge growth on the side of Fluffernutter's thorax didn't get noticed right away. Maybe 'ol Fluff doesn't like to be petted in that area or maybe the owner felt it after it had been there a while and waited to see if would change or get bigger before bringing them in.
Another point to consider is that many people don't trust authority figures (i.e. doctors and vets). There are a million reasons why people feel this way, but it's something to keep in mind especially when we are telling an owner that they need to spend x amount of money to help their animal or to prevent their animal from having issues down the road. It's been a hard economic time and people are more wary of parting with their money especially when they don't fully understand what they are paying for. We have to make an effort, at whatever point we first interact with owners to explain to them what their responsibilities are as a pet owner, what they need to do to keep their pet healthy and, perhaps most importantly, why they need to do these things. You can tell people a zillion times that they need to get their pets vaccinated but, until you explain to them the risks of not vaccinating and the ease with which their pet can contract a life threatening disease, they may not understand how important it is. Do I get my flu vaccine every year? Heck no! Have I died from the flu or know anyone who has? Nope (though I did have a near death experience that was flu related a few months ago, but that's beside the point!). So, again thinking like an owner, I don't get or need a flu vaccination every year so why does Spike need his vaccinations every year? And what is Distemper anyway? Spike's temper is perfectly wonderful.
Anyway, this is starting to progress into silliness. But my point is that before we get upset and frustrated with owners that didn't do what we would have done with their pets, we should take a moment to consider where they are coming from. Instead of getting upset with them, we should do our best to educate them.
Thursday, April 7, 2011
Week 2 Part 3- Anesthesia-thon!
After some rehab related lecture in the morning I meandered on over to the surgery prep area. My pals in oncology had a bunch of surgeries going on so I got to help out with those.
The first surgery was on a 5.4kg little female poodle-like thingy to remove a rectal mass and the sublumbar lymph nodes which had been affected by the rectal mass. Fortunately for me, the vet student who was in charge of this patient was a little overwhelmed between this patient and her other one so I got to do a lot of the surgical prep with assistance from some great techs. She was bitty but I got the catheter in on attempt #2 then we got her induced and intubated then shaved down for surgery. I monitored anesthesia for the surgery (again, serious backup from the techs). Our patient's blood pressure was pretty low most of the time and her spO2 was really low as well. She had some pre-existing heart issues but nothing too serious so we gave her a fluid bolus and her BP responded well...for a while. We gave another fluid bolus a little while later then 25mls of Hetastarch which is a different kind of fluid that helps to keep fluid in the circulatory system better than the regular fluids we give during surgery. A few boluses later, her BP came up to an acceptable (but still low) level.
Then the spO2 level issue. Basically, spO2 or pulse ox is telling us how well the blood is being oxygenated (Brenda, Jessie, Janet...please keep in mind I'm explaining this to my non-medical peeps, so breathe and feel confident that I know the pulse ox definition that was drilled in to my head). So first we checked to make sure the pulse ox monitor itself was in place and reading properly...it's like that little thingamabob they put on your finger if you're in the hospital with the little red blinky light...except we usually put it on an animal's tongue. We wet the tongue a little and shifted the pulse ox but the reading was still low. We then considered that since the dog was tilted at an angle with her head down it might be causing the abdominal organs to compress the diaphragm making it more difficult for her to breathe. We manually ventilated her every few minutes to try to increase her spO2 which was mildly successful. All in all a successful anesthesia though not without its moments of excitement.
The second surgery was an exploratory neck surgery where some tissue was biopsied to determine if it was cancerous and required further surgery. This anesthesia was a little smoother. At one point, the end tidal CO2 (ETCO2) or amount of carbon dioxide that the animal breathes out at the end of each breath. We don't want this value to get too high because too much CO2 is uber-bad. So, it was creeping up but we nipped it in the bud by manually ventilating the patient at regular intervals. Done AND DONE!
Yay! Everyone lived and I learned fun stuff and got to do even more funnerer stuff!
The first surgery was on a 5.4kg little female poodle-like thingy to remove a rectal mass and the sublumbar lymph nodes which had been affected by the rectal mass. Fortunately for me, the vet student who was in charge of this patient was a little overwhelmed between this patient and her other one so I got to do a lot of the surgical prep with assistance from some great techs. She was bitty but I got the catheter in on attempt #2 then we got her induced and intubated then shaved down for surgery. I monitored anesthesia for the surgery (again, serious backup from the techs). Our patient's blood pressure was pretty low most of the time and her spO2 was really low as well. She had some pre-existing heart issues but nothing too serious so we gave her a fluid bolus and her BP responded well...for a while. We gave another fluid bolus a little while later then 25mls of Hetastarch which is a different kind of fluid that helps to keep fluid in the circulatory system better than the regular fluids we give during surgery. A few boluses later, her BP came up to an acceptable (but still low) level.
Then the spO2 level issue. Basically, spO2 or pulse ox is telling us how well the blood is being oxygenated (Brenda, Jessie, Janet...please keep in mind I'm explaining this to my non-medical peeps, so breathe and feel confident that I know the pulse ox definition that was drilled in to my head). So first we checked to make sure the pulse ox monitor itself was in place and reading properly...it's like that little thingamabob they put on your finger if you're in the hospital with the little red blinky light...except we usually put it on an animal's tongue. We wet the tongue a little and shifted the pulse ox but the reading was still low. We then considered that since the dog was tilted at an angle with her head down it might be causing the abdominal organs to compress the diaphragm making it more difficult for her to breathe. We manually ventilated her every few minutes to try to increase her spO2 which was mildly successful. All in all a successful anesthesia though not without its moments of excitement.
The second surgery was an exploratory neck surgery where some tissue was biopsied to determine if it was cancerous and required further surgery. This anesthesia was a little smoother. At one point, the end tidal CO2 (ETCO2) or amount of carbon dioxide that the animal breathes out at the end of each breath. We don't want this value to get too high because too much CO2 is uber-bad. So, it was creeping up but we nipped it in the bud by manually ventilating the patient at regular intervals. Done AND DONE!
Yay! Everyone lived and I learned fun stuff and got to do even more funnerer stuff!
Tuesday, April 5, 2011
Week 2 Part 2- Trial Run on Rehab
Today we worked with our potential rehab patient(75lb 11 year old lab) to get a sense of what she is able to do, what therapy approaches may benefit her and possible short and long term goals. We still don't have a definitive diagnosis and are also in the process of ruling out some other things that may be affecting her overall strength and muscle tone.
Here's a quick (ok quick-ish) list of the major things that we need to address/rule out before we can get a clear picture of her situation and potential for improvement:
1) Long term administration of steroids (Prednisone) may be causing some of her muscle weakness and preventing her from building muscle---Solution? She is being weaned off of the steroids over the next 2 weeks. Bam!
2) She has not recently had any bloodwork done to check for Hypothyroidism which may also be affecting her body condition and causing some of her neurological issues (lessened/minimal reflex responses in her limbs)---Solution? Blood work to run tests for T4 and TSH levels which give us an indication of how well the thyroid is functioning. Bam!
3) She is displaying some symptoms that are seen in Degenerative Myelopathy which is similar to ALS or Lou Gehrig's Disease. It's a progressive illness that affects the spinal cord causing the animal to be uncoordinated in muscle movement(ataxic) and can eventually cause paralysis. This disease could potentially be responsible for our patient's significant hind end weakness and the front end weakness. Unfortunately, this is not a disease that can be treated, so fingers crossed that this is NOT the problem. Solution for ruling this one out? There is a DNA blood test that is sent out to determine whether the patient has the genetic mutation causing this disease, results will probably take about two weeks. Bam!
So, in the meantime we did a little trial run of some rehab options just to see how she did. First, we tried her in a cart. We kind of figured that she would have a hard time in the cart since she has weakness in her front end and fatigues quickly. Aaaaaaaand, we were right. She isn't a good candidate for a cart at this point but she did initiate movement in all four limbs which is a good sign. Second, to the water!! We fitted her in a life jacket which she did not appear to be a fan of but tolerated nonetheless. We hoiked her along in to the underwater treadmill and with ample support started to add the water. The idea behind the water based therapy is that the water reduces the amount of body weight that the animal has to support by about 70% so it allows weaker or injured animals to hold themselves up and be more mobile than they would be without the water helping them. Her owner told us that she liked water so we were optimistic. She did as well as could be expected. She was able to push up her hind end and hold herself up for a few moments. We then gave her a little more support and moved her gently from side to side to see if she would shift her weight from her left to right legs. She did this for a short time and then began to pull up her back legs so they were no longer holding any weight. So that coupled with some majorly assisted walking from her run to the grass outside and back was more than enough for our patient.
We gave the owner a few exercises to do with his dog to maintain muscle mass and keep her moving as much as possible. She is going to be getting three injections of anabolic steroids over the next three weeks which are sometimes used in older dogs to help build muscle mass. We will be able to reassess her capabilities in a few weeks when she is completely off of the Prednisone, has had the injections and we have gotten results back on all of the blood tests. So that's it for that kid at least for a couple of weeks. We're hoping to get some answers from the blood tests and see some improvement once she is off of the Prednisone.
As a side note, I experienced my first tornado-like weather last night and, while observing the greenish-blue lightning illuminated sky, sideways and cylindrical sheets of rain and flying debris decided that I did not want to live in tornado country for any extended period of time. Judging by my cat's response (hunkering down behind the bathroom door and nearly leaving permanent claw marks in the floor), neither does she.
Here's a quick (ok quick-ish) list of the major things that we need to address/rule out before we can get a clear picture of her situation and potential for improvement:
1) Long term administration of steroids (Prednisone) may be causing some of her muscle weakness and preventing her from building muscle---Solution? She is being weaned off of the steroids over the next 2 weeks. Bam!
2) She has not recently had any bloodwork done to check for Hypothyroidism which may also be affecting her body condition and causing some of her neurological issues (lessened/minimal reflex responses in her limbs)---Solution? Blood work to run tests for T4 and TSH levels which give us an indication of how well the thyroid is functioning. Bam!
3) She is displaying some symptoms that are seen in Degenerative Myelopathy which is similar to ALS or Lou Gehrig's Disease. It's a progressive illness that affects the spinal cord causing the animal to be uncoordinated in muscle movement(ataxic) and can eventually cause paralysis. This disease could potentially be responsible for our patient's significant hind end weakness and the front end weakness. Unfortunately, this is not a disease that can be treated, so fingers crossed that this is NOT the problem. Solution for ruling this one out? There is a DNA blood test that is sent out to determine whether the patient has the genetic mutation causing this disease, results will probably take about two weeks. Bam!
So, in the meantime we did a little trial run of some rehab options just to see how she did. First, we tried her in a cart. We kind of figured that she would have a hard time in the cart since she has weakness in her front end and fatigues quickly. Aaaaaaaand, we were right. She isn't a good candidate for a cart at this point but she did initiate movement in all four limbs which is a good sign. Second, to the water!! We fitted her in a life jacket which she did not appear to be a fan of but tolerated nonetheless. We hoiked her along in to the underwater treadmill and with ample support started to add the water. The idea behind the water based therapy is that the water reduces the amount of body weight that the animal has to support by about 70% so it allows weaker or injured animals to hold themselves up and be more mobile than they would be without the water helping them. Her owner told us that she liked water so we were optimistic. She did as well as could be expected. She was able to push up her hind end and hold herself up for a few moments. We then gave her a little more support and moved her gently from side to side to see if she would shift her weight from her left to right legs. She did this for a short time and then began to pull up her back legs so they were no longer holding any weight. So that coupled with some majorly assisted walking from her run to the grass outside and back was more than enough for our patient.
We gave the owner a few exercises to do with his dog to maintain muscle mass and keep her moving as much as possible. She is going to be getting three injections of anabolic steroids over the next three weeks which are sometimes used in older dogs to help build muscle mass. We will be able to reassess her capabilities in a few weeks when she is completely off of the Prednisone, has had the injections and we have gotten results back on all of the blood tests. So that's it for that kid at least for a couple of weeks. We're hoping to get some answers from the blood tests and see some improvement once she is off of the Prednisone.
As a side note, I experienced my first tornado-like weather last night and, while observing the greenish-blue lightning illuminated sky, sideways and cylindrical sheets of rain and flying debris decided that I did not want to live in tornado country for any extended period of time. Judging by my cat's response (hunkering down behind the bathroom door and nearly leaving permanent claw marks in the floor), neither does she.
Monday, April 4, 2011
Week 2 Part 1- Rehab class
This week, and potentially next week, I am participating in a class/practical focusing on physical rehabilitation. I am specifically interested in doing rehab with neurology patients and hopefully incorporating my massage background in to my work as a tech at some point. It's just me and two senior vet students in this class given by a vet who specializes in physical rehab. This morning we talked about the use of carts to assist animals with mobility issues. Then, in the afternoon, we saw a patient with significant hind end weakness and muscle atrophy as well as some front end weakness. At this point, she is unable to support her hind end but can sit up using her forelimbs and can also pull herself around. She does not yet have a definitive diagnosis explaining the cause of her mobility issues but most likely has multiple things going on. The neurologist, orthopedist and her general practice veterinarian have suggested that she may have lumbosacral disease (that's the back end) and/or cervical myelopathy (cervical disc issue...that's the front end).
We got to do an assessment on her including mobility with various slings to assist with her back and front ends, palpation of muscle tone and general body condition, reflexes and range of motion as well as her general attitude and response to various types of encouragement to move and utilize her hind end. We discussed the appropriateness of a cart for her and possible physical therapy approaches that she may benefit from.
So, I have loads of research/homework to do tonight (unfortunately I sent Turbo Nerd Mara on vacation last week so only Semi Nerd Mara is here and her motivation level to do all of this stuff is WAY lower). We're responsible for researching the different types of carts and the pros and cons of each as well as their construction and required measurements. We also have to determine an appropriate plan to introduce a patient to a cart and how to slowly increase the time they spend in it over 2-3 weeks. PLUS we have to assess the potential problems for our specific real live patient and determine possible solutions. The vet running this class also wants me to put together a little presentation on small animal massage which should be a fun mini-project.
I did manage to squeeze in a successful jugular blood draw this morning as well, woohoo!
We got to do an assessment on her including mobility with various slings to assist with her back and front ends, palpation of muscle tone and general body condition, reflexes and range of motion as well as her general attitude and response to various types of encouragement to move and utilize her hind end. We discussed the appropriateness of a cart for her and possible physical therapy approaches that she may benefit from.
So, I have loads of research/homework to do tonight (unfortunately I sent Turbo Nerd Mara on vacation last week so only Semi Nerd Mara is here and her motivation level to do all of this stuff is WAY lower). We're responsible for researching the different types of carts and the pros and cons of each as well as their construction and required measurements. We also have to determine an appropriate plan to introduce a patient to a cart and how to slowly increase the time they spend in it over 2-3 weeks. PLUS we have to assess the potential problems for our specific real live patient and determine possible solutions. The vet running this class also wants me to put together a little presentation on small animal massage which should be a fun mini-project.
I did manage to squeeze in a successful jugular blood draw this morning as well, woohoo!
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