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.