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!!
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