This is Derm week kids. Dermatology is a pretty big deal in veterinary medicine. It's common to see animals with all kinds of skin issues related to environmental allergies, flea allergies, food allergies, bacterial infections, yeast infections and, of course, parasites!
What I've gathered from Day 1 of my derm rotation, is that getting a detailed and accurate patient history is imperative in appropriately diagnosing and treating an animal. Things like age of onset, location of skin lesions on the body, seasonality of the issue, how itchy it is (pruritic) and so on. Then, we can do all kinds of cool cytology stuff! Depending on what the issue is, or what we think it is, we'll do different types of sample collection. Some options are skin scrapes, ear swabs, scotch tape preps, biopsy and then your basic squooshing the slide around on a lesion with some yuckiness leaking out of it. Some of those slides, like the scotch tape preps and the squooshy slides are often stained to make identifying various things easier. Once all the slides are prepared, we look at them under the microscope. We're looking for bacteria, yeast, certain types of white blood cells and parasites at various stages of their life cycle. From there, we can decide how to treat the animal.
One of our patients today, who was in for a recheck had been previously diagnosed with Demodecosis (I'll explain in a moment, don't get all huffy about big words just yet) and atopy (or atopic dermatitis). Atopy is basically just a genetic predisposition to allergies from environmental...well, allergens. Demodecosis, on the other hand, is an infestation of Demodex, which is a burrowing mite. Yucky! For these guys, we have to do a deep skin scrape (because of the whole burrowing thing). A deep skin scrape involves scraping the skin with a scalpel blade then kind of squeezing it and scraping again. It's important to get some blood in the sample to ensure that we got deep down in there where the mites hang out. We also did some scotch tape prep slides between the dog's toes and in the inguinal (groin) area where it is common to find yeast and bacteria. A scotch tape prep is pretty much what it sounds like. You take a piece of tape, stick it on the area in question a few times to pick up whatever goodies you can, then put a little stain on the slide and stick the tape to the slide and take a little looksy on the 'ol microscope. Good news for this dog is that we only saw one Demodex on the slide, which is a big improvement over previous visits. We only found a few little yeast buds and some bacteria, but nothing too crazy. Yay!
I'll get into treatments later this week when I have a better sense of what's going on with that. At this point, I can tell you that one of the patients left with two paper bags (lunch bag size) full of medications, medicated shampoos, drops and shots and all kinds of fun stuff!
So far so good, I'm glad to be getting back to some lab type stuff. I missed my old pal, the microscope. Thanks for reading! Only a few more weeks of blog-related fun to be had :(
Monday, May 16, 2011
Sunday, May 15, 2011
Dixie!
This is Dixie, the prep room mascot. Dixie is short for "Dixie cup", which is what the techs who found her on the highway initially thought she was. Yes, she has one green eye and one blue. Ahhh-dorable!
Friday, May 13, 2011
Long time, no post!
Hello my blogacious pals! Sorry for the lack of posting this week, apparently this site has been having technical difficulties, so I haven't been able to write any posts. That doesn't appear to have deterred people from visiting the blog because it's now had well over 500 visits. Ridiculously awesome!
Anyway, back to business. Anesthesia week has been great, I really enjoy running anesthesia because it's different every time, regardless of the procedure being done. Sometimes it's straightforward, easy peasy and SOMETIMES it's a little crazy and you have to do all kinds of trouble shooting and problem solving and anticipating potential issues and solving those potential issues before they are actual issues. Crazy.
So earlier this week, I was running anesthesia for an oncology case. It was a cat that had a mass in it's mouth so, in order to ensure that all of the tumor was removed, it underwent a hemi-maxillectomy. That basically means that half of the cat's upper jaw was removed. Ok so that's pretty invasive and involves cutting of bone, which is very painful. As an anesthetist, that's something we have to think about and plan for. It's important to keep the patient at a safe depth/plane of anesthesia (so not too deep and not too light), but we also have to ensure that they are not feeling too much pain during even the most invasive of procedures. We were cruising along for a while, frolicking through anesthesia land while lymph nodes were being removed and margins of the mass were being determined. Then began the cutting of the bone and with it, the frolicking in anesthesia land quickly ended. At first, the cat's vitals went all wonky, blood pressure, heart rate, respirations all way out of our happy ranges. Ok, pain response, understandable. We increased the vaporizer setting and when that didn't help, bolused some of the morphine CRI. That brought us back to a workable level for a little bit. The next time that the cat's vitals spiked we had to give dexmedetomidine, an alpha-2 agonist (sedative) to chill her out. Naturally, each time that these things occurred, I was by myself in anesthesia-ville but luckily an anesthesia tech would roll in just in time. Ok so yay for Dex, she was chilled out and we were cruising again and the techs left me again. So then, as I watch the respirations slowly climb and the heart rate increase as well and I've just decided to again bolus some more morphine, the surgeon says "Mara, she's getting light again." Fab. During a hemi-maxillectomy, there's really no way that I'm going to assess depth by looking at jaw tone, eye position or palpebral reflex because the surgery and, thusly, the sterile field is all up in that area. So after the morphine and the increased vaporizer haven't helped, the surgeon asks me to give another dose of Dex. Done. Except this time, not only does it not really make a huge difference but we have the added joy of VPCs. That's ventricular premature contractions by the way. A VPC looks different from a regular heartbeat on the ECG monitor and it means that the heartbeat itself is being generated from a different place in the heart than a normal beat.
Here's a normal ECG trace:
One or two VPCs here and there is not something we get worked up about because the drugs that we use during anesthesia can cause VPCs and some other arrhythmias. But friends, this was not one or two here and there, it wasn't even one or two every screen. It was all VPCs, all over the place, with one or two normal looking beats mixed in. Great, fab, awesome. Ok so I'm thinking, I need some Lidocaine for this cat (and maybe for myself, because I think I just pumped out some stress related VPCs myself). The anesthesia tech that came in agreed that we had an issue and we got the kid some Lidocaine. Alright so things were ok for a little bit (I know, longest surgery of MY LIFE) and it was at the point that an anesthesia tech was staying with me full time now, thank you! Ok so then, THEN we start seeing some other funky ECG trace. It was kind of VPC-ish but different. Apparently, it was funky enough and rare enough that it merited taking a video of the ECG monitor and subsequently showing that video to a cardiologist who diagnosed it as a right bundle branch block. Whaaaaat??? I don't recall that one from Vet Sci 4 class!!
Here's what it looked like:
Just look at the top line. That is alllllll right bundle branch block. This is more or less what my patient's ECG looked like. Now, these can easily be mistaken for VPCs because they have a similar form. Our first thought was to give another dose of Lidocaine. But, one of the fabulous anesthesia techs who is magnificent at her job thought we may have a good 'ol bundle branch block going on. She was right. The treatment? Look the other way. That's according to the cardiologist. So we did just that (figuratively, not literally) and we also counted the seconds until that surgery was OVER. It finally ended and the cat woke up and eventually went home and I left with a lot more knowledge and, potentially, a stress induced ulcer. They told me that I did great and that if I was freaking out, they couldn't tell. This is apparently a sign of a good tech, if this is true then I would expect another sign is chronic ulcers.
Thankfully, the next surgery of the day went beautifully aside from the tube to the circulating water blanket shooting off and spewing water everywhere in the middle of surgery. That, I can handle.
Yesterday was a much less stressful day. There were a few basic surgeries: castrations, spays, etc. I helped moved patients in and out of surgery and recover them. The anesthesia techs apparently have confidence in me that I have some sense of what I'm doing, because they left me to assist some of the vet students as they were monitoring anesthesia. I felt like I was able to successfully correct some minor anesthetic issues and share some of my anesthesia knowledge with the students, so that was pretty spiffy.
Then today I jumped back in with the oncology kids. The head onco tech, who incidentally is fantastically awesome and lets me do all kinds of fun stuff, asked me if I wanted to help out on their surgery case. Um, YEAH. Despite the insanity of the previous surgeries, I was ready for more. They had a little dachshund that was in for a mastectomy. She had two masses in the inguinal (groin) area. I placed an IV catheter in her little dachshund leg (not the easiest of tasks), induced her with Propofol, successfully passed her ET tube and THEN, hold on to your hats people because this is cool. I got to administer epidural pain meds! Cool cool cooooooool! This procedure involves palpating the space in between the last lumbar vertebrae and the first sacral vertebrae, getting a spinal needle through that space and into the epidural space which is between the vertebrae and the layers of tissue that surround the spinal cord. It's done mostly by feel. You insert the needle and then put some fluid in the hub of the needle, once you get in to the correct spot, the fluid should get sucked down into the needle. There is a little pop when you get through the tissue and into the epidural space. So my massage therapist skills were kicked in to high gear, I palpated the wings of the ilium (part of the pelvis) as a landmark and then found the space between the two vertebrae (even through a chubby dachshund bum). I had to "walk" the needle around a little bit to get down between the vertebrae and then get to the proper depth to get into the epidural space. I felt a little pop and my fluids got sucked down. We tested the placement by attaching a syringe with some air and fluid in it and seeing if it got sucked down as well, it did! So then the pain meds were administered. I must mention that I was instructed by the rock star onco tech throughout this procedure and would have been clueless as to what to do if it were not for her. Success! I was pumped! Afterwards, one of the anesthesia techs was palpating the dog and asked how I even felt the various bony landmarks because the dog had a big 'ol fat pad right where we were working. Hello? Massage therapist over here, uber sensitive ninja fingertips! Kachow! Alright, enough tooting my own horn. I was just really excited that I got the chance to do that and that I did it successfully on the first attempt. The anesthesia part of things was smooth and fantastic (no doubt due to a stellar epidural...ok for real that's the last comment on that). With that, anesthesia week drew to a close. Sad day. I really enjoyed that rotation. There is a chance I will get a few more days in anesthesia land the last week of internship, so we shall see.
Next week? Dermatology!
Anyway, back to business. Anesthesia week has been great, I really enjoy running anesthesia because it's different every time, regardless of the procedure being done. Sometimes it's straightforward, easy peasy and SOMETIMES it's a little crazy and you have to do all kinds of trouble shooting and problem solving and anticipating potential issues and solving those potential issues before they are actual issues. Crazy.
So earlier this week, I was running anesthesia for an oncology case. It was a cat that had a mass in it's mouth so, in order to ensure that all of the tumor was removed, it underwent a hemi-maxillectomy. That basically means that half of the cat's upper jaw was removed. Ok so that's pretty invasive and involves cutting of bone, which is very painful. As an anesthetist, that's something we have to think about and plan for. It's important to keep the patient at a safe depth/plane of anesthesia (so not too deep and not too light), but we also have to ensure that they are not feeling too much pain during even the most invasive of procedures. We were cruising along for a while, frolicking through anesthesia land while lymph nodes were being removed and margins of the mass were being determined. Then began the cutting of the bone and with it, the frolicking in anesthesia land quickly ended. At first, the cat's vitals went all wonky, blood pressure, heart rate, respirations all way out of our happy ranges. Ok, pain response, understandable. We increased the vaporizer setting and when that didn't help, bolused some of the morphine CRI. That brought us back to a workable level for a little bit. The next time that the cat's vitals spiked we had to give dexmedetomidine, an alpha-2 agonist (sedative) to chill her out. Naturally, each time that these things occurred, I was by myself in anesthesia-ville but luckily an anesthesia tech would roll in just in time. Ok so yay for Dex, she was chilled out and we were cruising again and the techs left me again. So then, as I watch the respirations slowly climb and the heart rate increase as well and I've just decided to again bolus some more morphine, the surgeon says "Mara, she's getting light again." Fab. During a hemi-maxillectomy, there's really no way that I'm going to assess depth by looking at jaw tone, eye position or palpebral reflex because the surgery and, thusly, the sterile field is all up in that area. So after the morphine and the increased vaporizer haven't helped, the surgeon asks me to give another dose of Dex. Done. Except this time, not only does it not really make a huge difference but we have the added joy of VPCs. That's ventricular premature contractions by the way. A VPC looks different from a regular heartbeat on the ECG monitor and it means that the heartbeat itself is being generated from a different place in the heart than a normal beat.
Here's a normal ECG trace:
Here is a trace with VPC's:
The VPC's are the ones with the big arrows pointing to them. See how they are distinctly different from the rest of the heartbeats? They are often described as "wide and bizarre".
One or two VPCs here and there is not something we get worked up about because the drugs that we use during anesthesia can cause VPCs and some other arrhythmias. But friends, this was not one or two here and there, it wasn't even one or two every screen. It was all VPCs, all over the place, with one or two normal looking beats mixed in. Great, fab, awesome. Ok so I'm thinking, I need some Lidocaine for this cat (and maybe for myself, because I think I just pumped out some stress related VPCs myself). The anesthesia tech that came in agreed that we had an issue and we got the kid some Lidocaine. Alright so things were ok for a little bit (I know, longest surgery of MY LIFE) and it was at the point that an anesthesia tech was staying with me full time now, thank you! Ok so then, THEN we start seeing some other funky ECG trace. It was kind of VPC-ish but different. Apparently, it was funky enough and rare enough that it merited taking a video of the ECG monitor and subsequently showing that video to a cardiologist who diagnosed it as a right bundle branch block. Whaaaaat??? I don't recall that one from Vet Sci 4 class!!
Here's what it looked like:
Thankfully, the next surgery of the day went beautifully aside from the tube to the circulating water blanket shooting off and spewing water everywhere in the middle of surgery. That, I can handle.
Yesterday was a much less stressful day. There were a few basic surgeries: castrations, spays, etc. I helped moved patients in and out of surgery and recover them. The anesthesia techs apparently have confidence in me that I have some sense of what I'm doing, because they left me to assist some of the vet students as they were monitoring anesthesia. I felt like I was able to successfully correct some minor anesthetic issues and share some of my anesthesia knowledge with the students, so that was pretty spiffy.
Then today I jumped back in with the oncology kids. The head onco tech, who incidentally is fantastically awesome and lets me do all kinds of fun stuff, asked me if I wanted to help out on their surgery case. Um, YEAH. Despite the insanity of the previous surgeries, I was ready for more. They had a little dachshund that was in for a mastectomy. She had two masses in the inguinal (groin) area. I placed an IV catheter in her little dachshund leg (not the easiest of tasks), induced her with Propofol, successfully passed her ET tube and THEN, hold on to your hats people because this is cool. I got to administer epidural pain meds! Cool cool cooooooool! This procedure involves palpating the space in between the last lumbar vertebrae and the first sacral vertebrae, getting a spinal needle through that space and into the epidural space which is between the vertebrae and the layers of tissue that surround the spinal cord. It's done mostly by feel. You insert the needle and then put some fluid in the hub of the needle, once you get in to the correct spot, the fluid should get sucked down into the needle. There is a little pop when you get through the tissue and into the epidural space. So my massage therapist skills were kicked in to high gear, I palpated the wings of the ilium (part of the pelvis) as a landmark and then found the space between the two vertebrae (even through a chubby dachshund bum). I had to "walk" the needle around a little bit to get down between the vertebrae and then get to the proper depth to get into the epidural space. I felt a little pop and my fluids got sucked down. We tested the placement by attaching a syringe with some air and fluid in it and seeing if it got sucked down as well, it did! So then the pain meds were administered. I must mention that I was instructed by the rock star onco tech throughout this procedure and would have been clueless as to what to do if it were not for her. Success! I was pumped! Afterwards, one of the anesthesia techs was palpating the dog and asked how I even felt the various bony landmarks because the dog had a big 'ol fat pad right where we were working. Hello? Massage therapist over here, uber sensitive ninja fingertips! Kachow! Alright, enough tooting my own horn. I was just really excited that I got the chance to do that and that I did it successfully on the first attempt. The anesthesia part of things was smooth and fantastic (no doubt due to a stellar epidural...ok for real that's the last comment on that). With that, anesthesia week drew to a close. Sad day. I really enjoyed that rotation. There is a chance I will get a few more days in anesthesia land the last week of internship, so we shall see.
Next week? Dermatology!
Tuesday, May 10, 2011
Crazy town= Week 7
Ok sooooo I WAS supposed to be doing a sports medicine rotation this week, but the vet who runs the show there is out of town and wants me to come back a different week when he is there. Therefore, I am now actually on anesthesia rotation. So, I'm going to pretend that the sports medicine related events of yesterday and this morning never occurred and instead focus on the anesthesia related events of the rest of the day.
At first, I was helping transition patients from the prep room to the surgery suites and back with some supervision of anesthesia mixed in. The whole transition deal takes some getting used to. The first couple of times I "helped" with it, I was mildly overwhelmed by all of the shenanigans that were going on. Tubes and lines flying and being attached all over the place, fluid rates being set, limbs being taped down, surgery sites being scrubbed etc, etc. Now, I actually am one of those tube placers, line attachers, lead connectors, fluid rate setters, limb taper-downers and surgery site scrubbers. There are at least six different monitoring devices that we connect to every surgery patient (in no particular order): ECG leads, CO2 monitor, temperature probe in the esophagus, BP cuff, fluids/CRI and the pulse ox...there are potentially others, but these are pretty standard. When we transfer a patient from the prep room to surgery, we often completely disconnect them from the anesthetic gas if they have sufficient pre-medication and are at a desirable depth of anesthesia. Because of that, time is of the essence. We can't lollygag in the time between disconnecting from anesthesia and reconnecting because we may risk our patient waking up and causing them undue stress. We also can't waste time getting our monitoring equipment up and running in case the patient's condition begins to change. So the first priority once we are in the surgery suite is to get the patient hooked back up to anesthesia and then, quick like bunnies, get all the monitoring probes and lines and what nots hooked up.
The first surgery I monitored today was for the oncology kids. The dog had a large tumor on it's left lung that needed to be removed. As far as awesome factor goes, I think this surgery is in my top 3 of those that I've seen during internship. Various neurosurgeries occupy the other two spots. Ok so, the surgeon opened up the dog's chest to expose the lungs. The tumor on the left lung was so large and had overtaken the lung to the point that basically the entire left lung had to be removed. Meanwhile, from an anesthesia point of view, we had this dog on a ventilator due to obvious concerns with it's ability to self-ventilate. The ventilator was a touch on the finicky side so we were having issues with it delivering consistent breaths to the patient and exceeding the ideal pressure within the circuit (and what is our ideal pressure anesthesia students??? That's right! 15-20cm of H20 and what gauge do we read that pressure on??? The PRESSURE manometer!). Here's another question for you all: Why, when the ventilator caused our pressure manometer to go to 25-30 cm of H2O on our open-chested lung exposed patient, were we not overly concerned? Right again! The vet student is holding the right lung in her hand so it's not contained within the limited space of the thorax where it might burst in to a zillion pieces should the pressure get out of control. (yeah, I did say that the vet student was holding it in her hand...yeah, that is awesome...yeah, that is why this surgery ranks in my top 3 for awesomeness) Eventually, we got the ventilator to behave relatively well. We went from having two onco techs, two anesthesia techs and little old me in the room dealing with the anesthesia situation to just me all by lonesome. Things were peachy keen for a while, the ECG was gorgeous, ETCO2 was ideal, blood pressure had been low but the reading off of the arterial line had leveled out to acceptable levels and we were coasting along. The surgeon asks me how the patient is doing and I responded that she was looking good. I kid you not, less than 30 seconds after that response escapes my mouth, blood pressure PLUMMETS. We went from great numbers to low 40's for both systolic and mean super fast (systolic should be above 80 and mean above 60). Cue Mara freak out. So I hollered (that's one of the southern words I'm picking up down here) for one of the anesthesia techs to please come help me. In the meantime, I have a zillion thoughts going through my head. Why did the BP drop so quickly? Why is everything else still peachy? Should I be bolusing fluids right now? Will that really help at this point? Where the crikey is that anesthesia tech???? So my hand is 3/4 of the way to the fluid pump when the tech comes in and tells me to hold my horses. Tech: Ok let's look at this monitor. Do you see a waveform for our arterial line? Mara(silly pants): Um, crap. No.(waveform, duh, why didn't I think of that???) Tech: So that means that the arterial line isn't reading properly. Of course, of course that's what that means. I know this, I should have looked at that, I should have realized that because the BP went downhill so quickly and everything else was fine that there was a good chance the numbers weren't accurate. Buuuuuut, unfortunately that didn't happen. This is why we do internship and we build confidence through experience and we learn how to think rationally when things aren't perfect. So the tech kind of made fun of my mild freak out (it's not like I was yelling and running around like a crazy person...most of the freaking out was in my head which apparently was conveyed through "some tension" in my voice which was noted by the tech) as did I after the fact, but next time I will not freak out and that, my friends, is what's important.
The. End.
At first, I was helping transition patients from the prep room to the surgery suites and back with some supervision of anesthesia mixed in. The whole transition deal takes some getting used to. The first couple of times I "helped" with it, I was mildly overwhelmed by all of the shenanigans that were going on. Tubes and lines flying and being attached all over the place, fluid rates being set, limbs being taped down, surgery sites being scrubbed etc, etc. Now, I actually am one of those tube placers, line attachers, lead connectors, fluid rate setters, limb taper-downers and surgery site scrubbers. There are at least six different monitoring devices that we connect to every surgery patient (in no particular order): ECG leads, CO2 monitor, temperature probe in the esophagus, BP cuff, fluids/CRI and the pulse ox...there are potentially others, but these are pretty standard. When we transfer a patient from the prep room to surgery, we often completely disconnect them from the anesthetic gas if they have sufficient pre-medication and are at a desirable depth of anesthesia. Because of that, time is of the essence. We can't lollygag in the time between disconnecting from anesthesia and reconnecting because we may risk our patient waking up and causing them undue stress. We also can't waste time getting our monitoring equipment up and running in case the patient's condition begins to change. So the first priority once we are in the surgery suite is to get the patient hooked back up to anesthesia and then, quick like bunnies, get all the monitoring probes and lines and what nots hooked up.
The first surgery I monitored today was for the oncology kids. The dog had a large tumor on it's left lung that needed to be removed. As far as awesome factor goes, I think this surgery is in my top 3 of those that I've seen during internship. Various neurosurgeries occupy the other two spots. Ok so, the surgeon opened up the dog's chest to expose the lungs. The tumor on the left lung was so large and had overtaken the lung to the point that basically the entire left lung had to be removed. Meanwhile, from an anesthesia point of view, we had this dog on a ventilator due to obvious concerns with it's ability to self-ventilate. The ventilator was a touch on the finicky side so we were having issues with it delivering consistent breaths to the patient and exceeding the ideal pressure within the circuit (and what is our ideal pressure anesthesia students??? That's right! 15-20cm of H20 and what gauge do we read that pressure on??? The PRESSURE manometer!). Here's another question for you all: Why, when the ventilator caused our pressure manometer to go to 25-30 cm of H2O on our open-chested lung exposed patient, were we not overly concerned? Right again! The vet student is holding the right lung in her hand so it's not contained within the limited space of the thorax where it might burst in to a zillion pieces should the pressure get out of control. (yeah, I did say that the vet student was holding it in her hand...yeah, that is awesome...yeah, that is why this surgery ranks in my top 3 for awesomeness) Eventually, we got the ventilator to behave relatively well. We went from having two onco techs, two anesthesia techs and little old me in the room dealing with the anesthesia situation to just me all by lonesome. Things were peachy keen for a while, the ECG was gorgeous, ETCO2 was ideal, blood pressure had been low but the reading off of the arterial line had leveled out to acceptable levels and we were coasting along. The surgeon asks me how the patient is doing and I responded that she was looking good. I kid you not, less than 30 seconds after that response escapes my mouth, blood pressure PLUMMETS. We went from great numbers to low 40's for both systolic and mean super fast (systolic should be above 80 and mean above 60). Cue Mara freak out. So I hollered (that's one of the southern words I'm picking up down here) for one of the anesthesia techs to please come help me. In the meantime, I have a zillion thoughts going through my head. Why did the BP drop so quickly? Why is everything else still peachy? Should I be bolusing fluids right now? Will that really help at this point? Where the crikey is that anesthesia tech???? So my hand is 3/4 of the way to the fluid pump when the tech comes in and tells me to hold my horses. Tech: Ok let's look at this monitor. Do you see a waveform for our arterial line? Mara(silly pants): Um, crap. No.(waveform, duh, why didn't I think of that???) Tech: So that means that the arterial line isn't reading properly. Of course, of course that's what that means. I know this, I should have looked at that, I should have realized that because the BP went downhill so quickly and everything else was fine that there was a good chance the numbers weren't accurate. Buuuuuut, unfortunately that didn't happen. This is why we do internship and we build confidence through experience and we learn how to think rationally when things aren't perfect. So the tech kind of made fun of my mild freak out (it's not like I was yelling and running around like a crazy person...most of the freaking out was in my head which apparently was conveyed through "some tension" in my voice which was noted by the tech) as did I after the fact, but next time I will not freak out and that, my friends, is what's important.
The. End.
Friday, May 6, 2011
The duck, day 5!
I just wanted to post a quick duck related update. I have named him Chuck. Chuck, the duck. Here we are together on day 5 of treatment!
We've been putting some stuff called Duoderm in his wound. It creates a layer within the wound to encourage the tissue underneath to stay moist and develop granulation tissue. We have also considered doing a little plastic surgery on him. It would include moving the tissue in front of and underneath his crest forward to cover some, if not all, of the wound. I probably won't see him again since today was my last day of Raptor rotation but I think he's in good hands!
Wednesday, May 4, 2011
QT with the raptors
We were back at the raptor center today and there was a ton of stuff to be done. First, we got a more in depth tour of the facility and we met all of the birds used in the education program as well as the Auburn University mascots (The War Eagles!). There are a bunch of different types of birds used in the education program. They have two barn owls, a turkey vulture, a black vulture, a few types of hawks (some of them are found in the US and some of them are only found outside of the US), the aforementioned eagles, barred owls and the little screech owl (itty bitty and oh so adorable). This is a picture of two bald eagles. I don't know how well you can see from the picture, but one looks like your stereotypical bald eagle with the white head and the one on the ground is still almost entirely dark colored with no white on his head. He is a juvenile bald eagle and won't get the characteristic bald eagle coloring until he is a few years old and officially an adult.
We then got a short lecture on falconry. I, personally, had no sense of what falconry involved so it was interesting to learn more about it from two people who have been falconers for a long time. Basically, falconry is hunting using birds of prey that are trained to some extent. Before the development of firearms, using birds made hunting for small game much easier. Today it's more of a sport but, depending on what their bird catches, the falconer may eat what is caught. Training of these birds builds off of their natural hunting instincts and abilities and mainly focuses on getting the bird to allow a person to accompany them during the hunt. Falconers are required to have government permits in order to legally own wild birds. Veterinarians are also required to have permits to treat wild animals, however, they can treat a bird owned by a falconer without one of these permits because they are essentially working off of the falconers permit. Cool stuff!
Next, we took two of the rehab birds over to the main hospital for neurology exams. One bird was a baby barred owl who, we believe, suffered his injury during the recent tornadoes. This is him:
His neuro exam revealed that he did not have an appropriate deep pain response in his feet and was lacking the ability to grip with his left foot. His left wing was also not functioning properly. Unfortunately, given this result and the evidence from the radiograph, there is nothing that we can do to help this bird. We had to euthanize him. It was a major bummer, but his quality of life would have been poor.
On a lighter note, we were able to take two of the birds out of the critical care ward and place them in outdoor aviaries. This is done when the birds are recovering well from whatever injuries they may have had and are able to coexist with other birds (and ideally, they can fly again). It's basically the next step in what will hopefully lead to re-release in to the wild. We put out a Great Horned Owl and a Barred Owl. We did a physical exam on both birds to ensure that they were ok to go in to the aviaries and we will continue to monitor how they adjust to the new setting. Here is the Great Horned Owl with a ridiculously attractive human just prior to being placed in an aviary (jk, this is a less than stunning pic of me because I'm half smiling and half concerned that he's going to break free from my grasp and tear me into little bite-sized owl treats)
In the afternoon, we had to catch all of the birds in the aviaries in order to weigh them and assess their body condition. The aviaries are large outdoor enclosures that are probably 15-20 feet high. Inside them are perches at various heights that provide a more natural environment for the birds. That's peachy keen for the birds, but makes catching them slightly more challenging. We use the big gloves and our ninja like skills to get the birds. It's important to put one arm up to shield your face (should they decide to fly right at you) and use the other hand to grab one of the bird's legs. You get control of their legs first, holding them both in one hand, then use the other hand to hold around their neck and keep their wings pressed to their body. It's not the easiest thing ever but the staff person that was with us said we did a great job, go us! We weighed all the birds (15 or so maybe??) and assessed their body condition. There is a body condition scale (BCS) that is used for birds and it ranges from 1-5. One being emaciated and five being obese. The anatomical point of reference for this scale is the keel bone. The keel bone is located on the bird's body...here's a diagram:
We then got a short lecture on falconry. I, personally, had no sense of what falconry involved so it was interesting to learn more about it from two people who have been falconers for a long time. Basically, falconry is hunting using birds of prey that are trained to some extent. Before the development of firearms, using birds made hunting for small game much easier. Today it's more of a sport but, depending on what their bird catches, the falconer may eat what is caught. Training of these birds builds off of their natural hunting instincts and abilities and mainly focuses on getting the bird to allow a person to accompany them during the hunt. Falconers are required to have government permits in order to legally own wild birds. Veterinarians are also required to have permits to treat wild animals, however, they can treat a bird owned by a falconer without one of these permits because they are essentially working off of the falconers permit. Cool stuff!
Next, we took two of the rehab birds over to the main hospital for neurology exams. One bird was a baby barred owl who, we believe, suffered his injury during the recent tornadoes. This is him:
He's a cutie pie, right? Earlier this week, we did radiographs on him because he wasn't standing and didn't seem to have the ability to use his legs at all. On the radiograph, we found that he had a compression fracture in the thoracic area of his spine. Here's the radiograph, you can't really see the fracture without blowing up the image, but the rad itself is interesting. The thing on his head is the mask that we use to administer gas to keep the birds unconscious during the procedure. We aren't really concerned with the head so we don't worry about getting textbook perfect radiographs.
On a lighter note, we were able to take two of the birds out of the critical care ward and place them in outdoor aviaries. This is done when the birds are recovering well from whatever injuries they may have had and are able to coexist with other birds (and ideally, they can fly again). It's basically the next step in what will hopefully lead to re-release in to the wild. We put out a Great Horned Owl and a Barred Owl. We did a physical exam on both birds to ensure that they were ok to go in to the aviaries and we will continue to monitor how they adjust to the new setting. Here is the Great Horned Owl with a ridiculously attractive human just prior to being placed in an aviary (jk, this is a less than stunning pic of me because I'm half smiling and half concerned that he's going to break free from my grasp and tear me into little bite-sized owl treats)
See how he's staring me down with his big owl eyes?!?! Seriously though, I'm wearing thick leather gloves to handle him because their beaks and their feet/talons are so strong that they can exert hundreds of psi of pressure and I rather like having ten fingers thank you very much. Those little tufts on his head are what give the Great Horned Owls their name...the tufts look like little horns. You can seem them better in this picture of a different owl in the aviary.
We checked in on our duck friend from Monday and he seems to be doing well! The tissue around his wound is starting to looking healthier and less dried out. It looks like there is some granulation tissue starting to form in the wound which is just ducky! Ha. Ha. Ha.
In the afternoon, we had to catch all of the birds in the aviaries in order to weigh them and assess their body condition. The aviaries are large outdoor enclosures that are probably 15-20 feet high. Inside them are perches at various heights that provide a more natural environment for the birds. That's peachy keen for the birds, but makes catching them slightly more challenging. We use the big gloves and our ninja like skills to get the birds. It's important to put one arm up to shield your face (should they decide to fly right at you) and use the other hand to grab one of the bird's legs. You get control of their legs first, holding them both in one hand, then use the other hand to hold around their neck and keep their wings pressed to their body. It's not the easiest thing ever but the staff person that was with us said we did a great job, go us! We weighed all the birds (15 or so maybe??) and assessed their body condition. There is a body condition scale (BCS) that is used for birds and it ranges from 1-5. One being emaciated and five being obese. The anatomical point of reference for this scale is the keel bone. The keel bone is located on the bird's body...here's a diagram:
The keel is that big, blade shaped bone labeled "keel"...crazy, I know. So we palpate the keel bone and, based on how prominent it is/how fleshy the area around it is, we assign a BCS score. This, coupled with the weight of the bird, is an important way to track potential health changes in the birds. If these values decrease, it can be an indicator of illness in the bird. At the same time, increases in these values can indicate that the bird is thriving and healthy. Most of the kids we worked with today were either at an ideal score of 3 or a bit on the tubby side...that's ok too.
The last event of the day was doing fecal exams on the birds. We use a special solution that is mixed with a fecal sample to help any parasite ova or other bacteria and protozoans to float to the top and be picked up on a slide cover slip which is placed on top of the little container. The cover slip is then placed on a slide and the slide is examined under the microscope. We didn't find anything of note on the slides that we looked at, which is good for the birds. In wild birds, it is fairly common to see some bacteria and coccidia, but no such luck today.
Busy day! Hopefully, you guys are able to see the pictures that I posted in here fairly well. It can be difficult to get good pictures, especially in the aviaries, but I'm doing my best for the betterment of the blog! Good night all!
Tuesday, May 3, 2011
To the zoo!
A note to my blogateers: This blog contains comments about breeding and artificial insemination and the anatomy associated with such events, it also contains a brief description of the dissection of a dead monkey. If you can't handle reading this sort of thing, I give you permission to not read this post...but just this once!
The three vet students on the raptor rotation and I went to spend the day at the Montgomery Zoo today. It's a small to medium sized zoo with about 500 animals. We started out by doing rounds on the animals that had some sort of medical issue going on. The first one was a giraffe who had injured her leg. She had been spooked and fallen in the stall area and as a result had shortening of the tendons in one of her lower legs. When the injury initially happened, she was basically walking on the tippy toe (that's a medical term) of her hoof. But, with some splinting of the area to provide support and encourage flexion of her fetlock joint (kind of like our ankle...large animal people ease up! I know it's not the same), her stance was much closer to normal.
We then went to see a pregnant bison. They aren't sure of her due date because the she and the bull mated several times. We discussed some signs that we see in any bovine (cows included!) when parturition (birth) is approaching. I wish I could say that I remembered all the things that we talked about in my large animal class but aside from terms like "winking vulva" and "waxing"...the whole reproduction thing was a bit fuzzy (sorry Brenda! I'm going to redeem myself in another paragraph just wait!). As we talked about some signs, it definitely came back to me. So, in case you're dying to know here's a few things the zookeepers will look for: about a week out- swollen vulva, mucousy discharge, "bagging up" or lactation then a day or so out: stop eating and separate herself somewhat from the others.
Next we went to do a neonate exam on a 3 day old big horn sheep. A few important things to look for are: mental status (i.e. are they alert, running around, curious, etc.), have they pooped, does the umbilicus look healthy and free from infection/inflammation, is it a male or female, ears/eyes/mouth (it's important to look for a cleft palate, which I guess is common enough to be a problem and can cause issues with feeding), conformation issues (limb deformities, etc.) and cardiovascular issues. So for the cardiovascular part, we use our stethoscope to listen to the heart. Neonates of all species can be born with heart defects that can severely affect their ability to thrive and may be fatal. We listened to this guy's heart and heard a pretty significant murmur (Here it comes Brenda!). After we all listened, the zoo vet asked us what kind of murmur we thought it was and what grade we would give it. The way we categorize murmurs depends on where it occurs in the beat. So the normal heart beat is a "lub dub", the lub represents the "systolic" and the dub is the "diastolic" so if a heart beat sounds like lub sssshhhh dub there is a systolic murmur and if it's lub dub ssssshhhh it's diastolic. I felt that it was a systolic, grade 3 murmur (the grade has to do with how easy it is to hear/it's intensity) and darn if Mr. Zoo Man didn't say the same thing! Kachow! That's about the only time today I felt like I had any idea what I was talking about so I'm going to revel in that for a moment...
Ok, I'm good. Later in the day, we got called over to the enclosure for the Scarlet Ibis birds...they look like this:
The three vet students on the raptor rotation and I went to spend the day at the Montgomery Zoo today. It's a small to medium sized zoo with about 500 animals. We started out by doing rounds on the animals that had some sort of medical issue going on. The first one was a giraffe who had injured her leg. She had been spooked and fallen in the stall area and as a result had shortening of the tendons in one of her lower legs. When the injury initially happened, she was basically walking on the tippy toe (that's a medical term) of her hoof. But, with some splinting of the area to provide support and encourage flexion of her fetlock joint (kind of like our ankle...large animal people ease up! I know it's not the same), her stance was much closer to normal.
We then went to see a pregnant bison. They aren't sure of her due date because the she and the bull mated several times. We discussed some signs that we see in any bovine (cows included!) when parturition (birth) is approaching. I wish I could say that I remembered all the things that we talked about in my large animal class but aside from terms like "winking vulva" and "waxing"...the whole reproduction thing was a bit fuzzy (sorry Brenda! I'm going to redeem myself in another paragraph just wait!). As we talked about some signs, it definitely came back to me. So, in case you're dying to know here's a few things the zookeepers will look for: about a week out- swollen vulva, mucousy discharge, "bagging up" or lactation then a day or so out: stop eating and separate herself somewhat from the others.
Next we went to do a neonate exam on a 3 day old big horn sheep. A few important things to look for are: mental status (i.e. are they alert, running around, curious, etc.), have they pooped, does the umbilicus look healthy and free from infection/inflammation, is it a male or female, ears/eyes/mouth (it's important to look for a cleft palate, which I guess is common enough to be a problem and can cause issues with feeding), conformation issues (limb deformities, etc.) and cardiovascular issues. So for the cardiovascular part, we use our stethoscope to listen to the heart. Neonates of all species can be born with heart defects that can severely affect their ability to thrive and may be fatal. We listened to this guy's heart and heard a pretty significant murmur (Here it comes Brenda!). After we all listened, the zoo vet asked us what kind of murmur we thought it was and what grade we would give it. The way we categorize murmurs depends on where it occurs in the beat. So the normal heart beat is a "lub dub", the lub represents the "systolic" and the dub is the "diastolic" so if a heart beat sounds like lub sssshhhh dub there is a systolic murmur and if it's lub dub ssssshhhh it's diastolic. I felt that it was a systolic, grade 3 murmur (the grade has to do with how easy it is to hear/it's intensity) and darn if Mr. Zoo Man didn't say the same thing! Kachow! That's about the only time today I felt like I had any idea what I was talking about so I'm going to revel in that for a moment...
Ok, I'm good. Later in the day, we got called over to the enclosure for the Scarlet Ibis birds...they look like this:
The enclosure is a huge meshy looking tent-like dealy ( I don't know how else to describe it). Apparently, one of these birds was up towards the top of the enclosure (15+ feet high) when a hawk swooped down towards it from the outside. The hawk obviously couldn't get to the Ibis (we'll call him Jorge) but Jorge was startled and fell from where he was perched down to the concrete ground below. According to the zookeeper, he landed on his head. When we arrived, Jorge was stunned and not able to stand on his own. We did a quick exam to try to assess his condition. Now, if anyone remembers back to one of my neuro posts, I talked about pupil size and response to light as part of a neuro exam. The hard thing with birds, especially wild birds, is that the pupils will most likely be fixed and dilated just due to the stress of being handled by people and secondly, birds have the ability to voluntarily contract and dilate their pupils. As far as I know, no mammal can do this. It's a cool parlor trick but it makes it difficult to assess neurological damage based on the eyes. Since Jorge couldn't stand on his own, we took him back to the clinic, and by "we" I mean that yours truly got to hold the little guy on our short drive back (I felt cool for a brief moment). As you can see in the picture, these birds have quite the beak. That kid was not messing around with it either, he nipped at everyone that came anywhere near him, so I had to be sure to get that beak on lockdown. When we got back, we weighed him (1.09 kg) which is important in determining doses if it's decided to administer medications. We then just put him in a cage and observed him over the next hour. He seemed to show signs of recovery rather quickly. Within an hour, he was upright and sitting kind of on his haunches. Given, this is not exactly normal for a bird, but it was a huge improvement from his initial condition. Since he was showing signs of recovery, he was not given any medications and will continue to be under observation.
We also talked, at great length, about artificial insemination (AI). The staff is preparing to do AI on an Indian Rhinoceros that they have at the zoo. Thus far in the US, no AI procedures on Indian Rhinos have been successful. The rhinos have gotten pregnant but the babies have not survived. The difficult thing about AI is determining when the animal is ovulating, i.e. when is the appropriate time to inseminate. So there are tests done on the animal's urine and heat cycles are tracked and behavior is monitored and so on and so forth. But, when it really comes down to it, it's still a bit of a guessing game. It was at some point during this conversation that I received a fairly odd compliment-like statement. Mr. Zoo Man was describing the process of AI and explaining that he, being a large man (he's apparently a professional power lifter in his spare time) with large yet short trunk-like arms insufficient for plunging into the depths of an animal's reproductive tract, would not be the one physically performing the AI. He then pointed to me and said, "You have the perfect build for doing AI work." My reply? "Ummm, good to know." Now, spending my time palpating the inner workings of a large animal's hind end has never been a dream of mine, but it's good to know that, should it ever become my dream, I have a distinct physical advantage over many other job applicants.
Last event of the day was a monkey necropsy! A necropsy is just the animal form of an autopsy. This little squirrel monkey had been found dead in the enclosure that morning. Apparently, he was an older monkey but there was no outwardly apparent cause of death. One of the vet students had been through a necropsy rotation so she did the procedure under the guidance of the zoo veterinarian (previously referred to as Mr. Zoo Man). Often, no definitive cause of death can be determined from a gross (not microscopic) examination of the tissue that is done during a necropsy. However, we are looking for any obvious abnormalities in the organs such as masses, hemorrhaging, necrosis (dead tissue), various signs of trauma, fluid where it shouldn't be, foreign bodies, etc. The organs that are removed are preserved in formalin and submitted to a lab for closer examination. We found some areas of hemorrhage in the small intestine (looks like bruises kind of), the lungs were slightly hardened and the lung tissue did not look healthy in some areas and the right side of the heart appeared to be thin-walled and flaccid indicating possible heart disease. There was also a fair amount of fluid in the thoracic (chest) cavity that should not have been there. Any abnormalities that are found are noted on the report that is sent to the lab so that they have a better idea of what organs/tissues to pay closer attention to.
That was the end of our zoo adventures. It was definitely interesting to get a glimpse into zoo medicine and how different it is from small animal medicine. I used to think I wanted to do zoo med, but I'm pretty sure that I like small animal med much better. Though there is that whole AI thing...maybe I missed my calling.
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