Monday, August 10, 2015

Stuff I did when you weren't looking part 1

Hey! I've been very busy and important, so I have not been updating the blog, even though I had weekly journal uploads for school. Honestly, they wouldn't have been interesting to anyone other than my professor and not as humorous as the previous semester. My work practicum 2 prof did not appreciate my sense of humor as much as my work practicum 1 prof. Lame.

Needless to say, the summer semester was crazy busy and I learned and practiced many skills. I have another week before fall semester starts, so I just want to share a few updates. This week is all about work. It's been busy! We are the busiest we've ever been in the history of Bayshore. One day we saw 68 patients. This means we all have to be on our A-game to ensure the best quality care for each patient that walks, crawls, or skitters in the door. It can be overwhelming and stressful, but at the end of the day, I still cannot imagine doing anything else. I've officially been a Bayshore employee for a little over a year and have received my first raise!

I went through my weekly journals to find some highlights of the semester to share with you, and I found one story in particular that warms the heart with feels. So here it is!

Our clinic works with the local shelter to treat and care for impounded and surrendered animals in order to prepare them for adoption. A few days ago, I cat came in that was possibly pregnant. The doctor confirmed, and a spay was scheduled for Monday. It sounds grim to think of performing an abortion, but unfortunately the number of unwanted pets is so high that population control is often necessary. It also prevents overcrowding at the shelter. On Saturday, the cat was extremely vocal and destroying her cage. At the end of the day, the technician feeding her noticed a discharge coming from her vulva. We suspected that labor was imminent, so I volunteered to take her home to monitor her. Before I left for the evening, we took an x­ray to determine approximately how many kittens she had. 

We counted skulls and spines and guessed there were five at the most. I took her home and set up a quiet place with a blanket and box plus food, water, and litter. Then I left her alone and periodically checked on her throughout the night. At 10pm, I noticed she was restless, licking her vulva, and possibly having contractions. Thankfully, the queen was comfortable enough to allow me to be present in case she needed assistance. The first kitten was born at 10:12pm and did not appear to be moving. I took the kitten and wiped its face, carefully tore the umbilical cord and ensured the whole placenta was present, and commenced resuscitation. I rubbed the kitten gently yet vigorously, blew gently in its face, and turned it upside down in an arc to try and clear the fluid from its mouth and lungs. Unfortunately, my efforts were in vain. At 10:50 the second kitten was born alive and so I did not interfere. The third kitten was also healthy, but the 4th and 5th were stillborn. Interestingly, they did not appear to be fully developed, possibly due to the malnutrition of the mother? After the 5th kitten was born, mom relaxed and was nursing the healthy two. Suddenly, she cried out and appeared to be birthing another. Simultaneously, her kittens cried out. She appeared quite stressed by the time the 6th kitten was born, but she cleaned it and it moved and cried out. I thought all was well until I looked closer a few minutes later and noticed something off. I picked up the last kitten and saw that it was eviscerated either due to the mother or a hernia. I contacted our on­-call doctor and brought the little family in on emergency. The 6th kitten was humanely euthanized and a radiograph was taken of the mother to make sure she was finished giving birth. She was thankfully, and I took her home to relax. It was an exhausting experience, but one I will learn from the next time I bring a whelping animal home! Mom is doing great and is attentive to her kittens, who are nursing well and seem to be stable.

Two healthy kittens!

Happy family. I called mom, "Tess," while she was with me. She was very sweet and I was sad to see her go back to the shelter to be placed in a foster home. 

Update: We recently saw both mom and the orange kitten at the shelter to be spayed in preparation for their adoptive home! It was wonderful to see them and to know they were being placed together. I hope to see the other kitten going to a new home soon!

Sunday, May 24, 2015

This week I was pooped on twice but that isn't covered in this post

The summer semester is here and that means more weekly journal updates of life as a veterinary assistant! Who's excited to hear more about poop?!

Also, just want to put a plug in for a new (to me) artist I've been listening to lately. Thank you, YouTube, for finally suggesting something good to listen to after months of poop:

Week 1: May 18-­24, 2015
The clinic I work in is Bayshore Animal Hospital, a small animal clinic offering general exams, surgery, and diagnostics including in house blood work, digital x­ray, and ultrasound. I am an assistant who does everything from checking client to running lab work. In order to gain as much experience as possible, I put my nose into everything, learning as much as I can through asking questions, observation, and by hands­on practice. Sometimes I fail. I get frustrated, I feel like I’m not cut out for this job, I fear I will never become a technician. Then I try again, and when I succeed, it gives me the confidence to move forward. Everyone has a bad day, and I’m learning that I can’t allow the failures to make me give up. 

This week I’ve been jumping whenever possible to practice my blood draws, especially for cephalic venipuncture. I feel fairly confident drawing from the jugular, but for some reason I have trouble with the front leg. The technicians are really helpful at guiding me with proper placement and don’t judge when I have to step away. I generally only give myself two tries with a dog and one with a cat because I don’t want to hurt the animals with too many failed attempts. One technician suggested I ask to practice on sedated patients so I can concentrate on technique without worrying about the animal struggling. I am also practicing my catheter placement. The other day, I was getting very frustrated because I could not place a catheter in a cephalic vein. I tried on two different dogs and I was getting frustrated. We had a patient that was having a vulvoplasty (a Great Dane), and even though the veins were large, I was having trouble positioning the catheter. The doctor showed me that I needed to enter the skin at a 30 degree angle and then level out into the vein. She said once I have a flash of blood, advance a little more and then push in the catheter while withdrawing the needle. She had watched me struggle and advised me to trust that I’m in the vein and not to second guess myself. With this in mind, I chose a vein and placed the catheter on the first try. It felt great to finally get it right and also to hear all the support and encouragement from my colleagues. I was a non­-scrubbed in assistant for the procedure in addition to the certified technician, which was exciting not only because I wanted the experience but also because I had not observed this surgery before. I try to observe any procedure I’m not familiar with so that I know how to assist the doctor in the future. After she was sedated, I placed the ET tube and hooked her up to the anesthesia machine. For the vulvoplasty, the patient was placed in sternal with her legs almost off the end of the table. Her tail was taped up out of the surgical field while I attached the leads, BP cuff, fluids, SpO2 monitor, and esophageal thermometer. A surgical laser was used and I was in charge of suctioning the smoke without contaminating the sterile field. I also retrieved anything the doctor needed while also monitoring the patient. It was a great experience and I look forward to assisting more surgeries! 

One of the things I love most about the clinic I work at is the staff’s devotion to patients, especially those that have been valued clients for years. Many of the staff members will go out of their way to deliver meds and pick up or drop off patients. One of our clients have taken their pets to us for years. As an elderly couple with a large dog, they pick him up and carry him if he were to have a seizure. On Friday morning, he collapsed seizuring and the owners called us for help. Without hesitation, a coworker and I climbed into my car and went to pick the old dog up. Later that day, a client called about his sick cat. He was advised to bring the cat in, but mentioned he would have to scrounge up enough money for a cab before he could. The doctor, wanting to help both the cat and the owner, asked the manager if someone could pick the cat up. So, my car became an ambulance again that day, and at the end of my shift, I brought the cat back home. Going the extra mile for an animal and owner in need reflects the best positive image on a clinic and its staff because it shows that our first priority are the patients regardless of the owner’s financial circumstances.

Tuesday, May 12, 2015

Adventures in Cooking: Chicken Hearts

Today Roman and I were at the store debating on what to cook for dinner. As a joke, I started grabbing weird items off the shelves and asking his opinion. In the meats section, I held up a package of chicken hearts and smilingly asked, "What do you think, bud? Chicken hearts?" After getting over the initial disbelief that yes, there in fact were real chicken hearts in the package, he emphatically affirmed that yes, he wanted to eat them for dinner. Thinking that he was playing along, I put them back. A few seconds later he looked in the cart, and seeing that they weren't there, asked where they were.
"I thought we were playing, Roman. I'm not really making chicken hearts tonight."
Tears. No bullshit. He was so upset that he cried.
What could I do? As a mother I want my children to try new things, especially foods, and here was my 4 1/2 year old son begging me for chicken hearts. I couldn't quash his adventurous spirit.

So, I bought a package.

And the adventure began.

I've never cooked chicken hearts before (shocking, I know), so I had no idea how to proceed. Thank goodness for Google. I browsed different cooking sights for suggestions, filing good tips away while disregarding those that would not apply today (namely, those that involved grilling. Not possible on a wet, May day at the beach). All the while I tried not to allow visions of giant chicken hearts beating ever closer, growing to enormous sizes, and waiting to devour us all, to invade my subconscious. Honestly, I feared Bill Cosby had ruined the tiny organs for me indefinitely. Had I endangered my children? Was I adequately armed in case of attack? Thankfully, I remained calm enough to decide on a game plan for cooking the tiny, seemingly harmless, ex-blood-pumpers.

Since I had time, I decided to marinate the hearts in olive oil and chopped garlic. 

This was a new food for the kiddos, and new foods are met with suspicion and fear, so I had to have a few back-up side dishes that I knew the kids would eat so they wouldn't starve. 

The plan: sauteed chicken hearts with diced potatoes in bacon and couscous. And of course, wine for me!

I started with cooking the bacon and potato together since they would take the longest. Since I only had two slices of bacon, I also added a little butter to help the potatoes cook. And because you can never have enough fat. I seasoned with pepper and a little bit of salt.

The different colored potatoes looked and smelled delicious!

Then, I prepared the couscous as directed. It would only take 8 minutes total. After the potatoes and bacon were cooked, I used the leftover butter and grease to cook the hearts in. 

Mmmm...I love mixing dinner with science. 

The only extra seasoning I used was fresh ground salt and pepper. They might look a little intimidating, but it actually smelled pretty good!

The big moment: tasting. Evie was pretty unprepared since she wasn't at the store with us, so she met the plate with a mixture of disgust and disbelief. 

Roman was very excited to try, but Evie was less convinced. Still, she gave it a good bite, and declared, "YUCK!" Roman on the other hand...


I was very proud of my little minions for trying something new and weird. Honestly, they mostly tasted like dark meat chicken. 

Next time on adventures in cooking with the Metzgers: gizzards?


Wednesday, April 29, 2015

Here's the gross you've been missing

Hey, all! I've been crazy busy with work and school and life, so I haven't had a chance to update the weekly journal blogs. This is one from a few weeks ago that I thought was most interesting and not too depressing. Finals are here, so I'm burying myself in studying and homework until the semester is over. Then I get a couple weeks off before summer session. Yeah, step back because my life is CAH-RAY-ZEE interesting!

Week 12: April 13­-19, 2015 

This was the week of the largest tumor ever. We had a dog come in for an exploratory surgery for a suspected splenic mass. My job was to assist the technician and doctor during surgery, retrieving anything they needed and setting up the room. It was the first time I set up for an exploratory, so I had to learn which instruments were needed. I knew to grab a spay pack (which we use for most surgeries as it contains the basic instruments), a large drape, a bowl and handle, and a laser tip. The technician instructed me to also grab lap sponges, retractors, a suction tip, and the suction machine, which I had never used. Once the surgery started, everything seemed routine, and then the doctor opened the abdominal cavity. There was a lot of fluid and the technician had to apply suction and I had to run for towels so the doctor wouldn’t slip on the floor. My job was to watch the bucket on the suction machine and to switch it out when it became full. I really had to hustle because there was a lot of fluid and blood and the buckets filled fast. If they became over full, there was a risk the fluid would back up into the filter. The technician told me I did a great job making sure the buckets didn’t get too full, dumping the fluid, and then running back to switch them out again. Once the fluid was clear, the doctor was shocked to see how large the tumor was in the abdomen. Oddly, the spleen looked normal, but the liver and pancreas were enormous masses. There didn’t appear to be any tissue that was not infiltrated by cancer. The owner was called and decided to euthanize the dog on the table. It was a sad end to the case, but the instruction was not over. The technician instructed me to watch the ECG while listening to the dog’s heart. Even after the heart had stopped, the machine continued to register a heartbeat for several minutes. It was a lesson in never fully trusting the machine, and to always listen to the heart and lung sounds manually. 

The newest skill I learned was how to perform the Schirmer Tear Test. The patient was a cocker spaniel that had bilateral eye discharge. The eyes were also quite red. We brought the animal back in treatment and I retrieved two test strips, one for each eye. While the strips were still in the sterile packaging, I folded one end, carefully opened the package, and placed the folded end between the lower eyelid and eye. The animal was restrained while the strip remained in place for 60 seconds, then it was removed and the point where the wetness stopped was noted as the basal and reflex tear production. The normal rate in dogs is 13­-25 mm per min. The left eye was in the normal range, but the right eye produced less tears than normal. The doctor theorized that the dog’s ablation surgery of the ear canals restricted the dog’s ability to blink, a fact confirmed by the owner. The dog was prescribed an opthalmic solution to treat the dry eyes. Learning new tasks such as the Schirmer Tear Test is not only satisfying in regards to new experiences, but also in allowing the doctor to concentrate on other things. Freeing up time for the doctor is one of the main aspects of my job, I’ve discovered, so anything I can do to help can be very rewarding. 

The Schirmer Tear Test. The strip is placed between the eyelid and cornea and the dog is held still with eyes closed for 1 minute. 

After 1 minute, the strip is read. Inadequate tear production indicates dry eye. 

An interesting thing I witnessed this week involved a feral cat that was scheduled to be neutered. We participate in a feral cat program that allows people to catch feral cats in their area and bring them in to be spayed/neutered and vaccinated before being returned back into the wild. The program helps reduce pet overpopulation, the spread of disease, and by putting the cat back, prevents more feral cats from taking the cat’s place. The cat was brought in a trap and sedated. Thankfully, it was a male, which meant a quick easy neuter. Or so we thought. Once the cat was safely removed, it was discovered to be polydactyl. A few of the claws on the front paws could not be worn down, and as a result, they had grown into the pads of the feet. The doctor decided it would be best to declaw those toes to prevent further injury as the cat obviously had no owner who could trim the nails. We were shocked to discover the claw in between the two “feet” on the front left paw was so long, it had curled over and over into the foot. Uncurled, it appeared to be at least an inch long! The cat was declawed, neutered, and given injections for pain and antibiotics. It was gross and amazing!

This is a great photo indicating the problem often seen with polydactyl cats. The toe between the two "feet" (circled) cannot be worn down by the cat scratching posts, so it must be trimmed to prevent overgrowth. 

Monday, April 13, 2015

You know you love your job when...

You get excited over fecal samples. Read about it in this week's journal entry!

Week 11: April 6-­12, 2015

 The highlight of this week is that I intubated my first patient! We were preparing a dog for spay and the technician handed me the ET tube and said, “You place it.” I was so excited because I have never done this before even though I had observed and assisted in the procedure hundreds of times. The technician told me that I should learn how to do the one ­handed technique because there might come a time when I either don’t have help or it’s an emergency and I won’t have time to wait. She showed me how to pull the tongue out, “like you’re going to rip it out of the dog’s head.” (Not really; it was a strong pull, but not enough to injure the dog). I held the dog’s tongue in the last three fingers of my left hand and then placed my index finger behind the canine tooth and used my hand as an elevator to pry open the mouth. She showed me the epiglottis at the back of the throat and used the end of the trach tube to gently lower it to reveal the larynx. She said, “ You see that V? You want to hold the tube slightly on its side and place it between the V into the trachea.” I placed it on the first try! She showed me the dog’s breath coming through the end of the ET tube and explained that if I felt the throat, I should only feel one hard tube. If I felt two, the ET tube was most likely in the esophagus. Since we determined the tube was placed correctly, I inflated the cuff and tied the strings behind the dog’s head in a bow to help keep it in place before hooking up the anesthesia machine. A technician told me never to hook an animal up to a dead machine, so I turned on the oxygen first, hooked up the rebreather, and then turned on the iso anesthesia. She later explained that cats sometimes are more difficult than dogs because their larynx is easily reactive, so you oftentimes have to “spear” the larynx really quickly or use a tiny drop of lidocaine to relax the throat. It was really exciting to learn a new technique that I can use to assist the doctors and technicians on future procedures. 

This has been another week in trying to work out the kinks of going paperless. One of the doctor’s in particular is having trouble adjusting because she relies so much on writing things down. She also admitted she’s not computer friendly in general, so having to work with the computer system at work was frustrating. She dreaded seeing appointments because of the stress, so my job became to hold her hand and make the process as easy as possible. The hospital manager instructed the receptionist to schedule all her Saturday appointments for 30 min instead of her usual 15 so she wouldn’t fall so far behind trying to figure out a system that worked for her. I had to channel my mom patience, but we made it through Saturday, and at the end of the day, she was excited and on board with going paperless! There are a lot of aspects I like about going paperless, namely that everything is recorded where anyone can look up information without having to find a file. Every communication with the client is at hand, every test, drug administered, and prescription can easily be accessed. The next step is to get scanners for things that have to stay papered, such as consent forms. I hear there’s talk of a new x­ray machine that will allows us to transfer radiographs into AviMark. I’m just excited about the prospect of having an x­ray machine/program that won’t randomly decide to die on us. 

Thursday I had the most exciting fecal sample of my life. And I think its awesome I get to say that in my line of work. We had a client drop off a fecal sample for a patient that kept having horrible bloody diarrhea and they couldn’t find out the answer. The dog was on metronidazole and the doctor suspected the food might be the culprit. I set up the fecal sample as usual, took a sample and mixed it with Fecasol, spun it in the centrifuge for 5 minutes, then allowed it to sit with a microscope cover slip over the top for 3 minutes. I placed the cover slip on a slide and placed it under the microscope. I usually start on the lowest objective, but in the interest of time I went straight for the 10x. Immediately I saw hookworm eggs, a heavy load of hookworms, up to 15 in a field at least! Then I saw this strange critter that looked like a mite. I pointed it out to the technician and she thought perhaps it was something that had crawled on the pooped when it was on the ground. But there were several! I excitedly showed the doctor and he theorized they were grain storage mites. We decided to send the rest of the fecal sample to an outside lab to find out exactly what they are. I can’t wait for the results!

The oval shape is a hookworm egg. The eight legged creepy thing? STAY TUNED!

Monday, March 30, 2015

And then puppies happened.

Hey! Been a crazy few weeks since I posted last. I had a "Spring Break" (in quotations since technically I didn't get a vacation and had one professor still assign homework *grumble*). Work and school have been busy. The kids are getting involved in activities, including karate and archery, so my schedule is full and the coffee is constantly flowing! Somewhere in there I have a date night with Rick so I don't forget what his face looks like. I periodically message him pictures of mine so when some random girl walks up and hugs him, he'll remember it's his girlfriend and not to be frightened.
Anywho, here's what I was up to at work this week!

Week 9: March 23-29, 2015 

Recently I’ve been preoccupied with learning as many new skills as possible that I didn’t stop to make sure I was proficient at the ones I know. I decided to make an effort to slow down and practice acquired skills and to allow the new ones to present themselves without stressing about it. My main goal was to become better at venipuncture. There are certain veins I feel less confident in, so when we had anesthetized patients, I would practice cephalic and lateral saphenous venipuncture. In addition, I didn’t hesitate to jump in and do blood draws myself instead of handing them off to someone with more experience because I was nervous. I figured if I don’t hit the vein by the second poke, I can hand it off and still get the practice. I had many opportunities to practice jugular and medial saphenous and hit the vein on the first try each time, which has given me confidence to move forward with blood draws and eventually other skills as well. I would really like to learn how to perform cystocentesis since it’s a procedure we do very often. 

Cystocentesis is the introduction of a needle into the urinary bladder for the purpose of extracting urine. It's the best way to collect urine for sterile lab send outs. 

The best part about this week was puppies. Puppies make all the stress, anger, and heartache just fade away into warm, cuddly fluff. We work closely with the local shelter and they had a stray mother with four puppies they were trying to catch. They were able to retrieve the pups, but the mother remained elusive. The four puppies estimated to be about 35 days old were brought into the hospital and put under my charge. I weighed, took TPR, assessed mucous membrane color, and performed a PE to check for any obvious injuries or abnormalities. I also obtained fecal samples from all four for microscopic examination. They had fleas, but were otherwise in great condition: active, vocal, and chubby! They were given names and numbers for the shelter and placed in a kennel with plenty of blankets. A fecal flotation resulted in roundworms, which wasn’t a big surprise, so they were given 0.5ml Strongid each with instructions to follow­-up with 1ml each in 10 days. There was no way of knowing when the puppies had last eaten, so I then prepared to feed them both with replacement formula and canned food mixed with formula in a bowl since they were over 4 weeks old and able to begin solids. I offered each puppy a bottle with formula and when I had them excitedly eating, I offered the canned/­formula mixture. They were all eager to eat off my fingers, so I then directed them into the bowl. Most of them ate great this way and settled in well together for a nap. Later, we received a phone call that the mother had been trapped and the shelter manager was bringing her over to reunite with her pups. She was scared and a collar that she was wearing had slipped under her arm on one side had been digging into her skin causing a wound. The puppies were very excited to see her and she seemed content to have them back. They were set up in a run with plenty of soft bedding. Mom was given water and plenty of food. Lactating mothers require a lot of calories and it was clear she wasn’t receiving enough to maintain her own body weight though her pups were in great condition. Puppy food is the best for lactating moms, so we gave her both dry and canned free feed. It was really heartwarming to see the family reunited, happy, and on the road to healthy. The next step is to see them go to forever homes!

The feels! 

Monday, February 23, 2015

It's a dog. Feed it like one.

Disclaimer: The views expressed in this post reflect my opinion based on research. You do not necessarily need to agree with my opinion to read this post, however, I will judge you heavily if you do not. 

Week 6: February 16-22, 2015

It happens quite a bit that the topic I happen to be studying applies itself to real life inexplicably. Or perhaps I’m more aware of the issue and can recognize it? Regardless, nutrition was the topic of study this week, and two cases presented itself that gave me an opportunity to educate clients as well as learn first hand the importance of a balanced diet in a pet’s life.

The first case was Hazel, an 8-week old German Shepherd puppy much beloved by her worried owner. She had done her research before purchasing Hazel, and had purchased her a week earlier from a reputable breeder, who recommended a feeding schedule that included a raw diet. Unfortunately, the owner was unable to find the particular raw food product the breeder was feedings, so she attempted to make her own supplemented with dry puppy food. Her owner had no interest in continuing the raw diet, but when her puppy wouldn’t eat anything else, what could she do? The problem with raw diets is often a lack of balanced nutrition and the risk of pathogens in undercooked, raw, or contaminated meat. Hazel continually snubbed her nose at the puppy food and would eat the meat, resulting in a BCS of 2/5 and bloody diarrhea. A fecal sample was run, and the vet and technician suspected Giardia present, so we kept Hazel in order to collect enough of a sample to send to Idexx for a diarrhea panel. We theorized that the owner unintentionally fed Hazel improperly prepared meat. Upon discharge, we sent Hazel home on a prescription i/d diet for gastrointestinal problems, panacur, and amoxicillin. It will be interesting to see what the results of the send out reveal next week!

Symptoms of giardia infection include vomiting, diarrhea, failure to gain weight, dehydration, and poor hair coat.

Another case involving improper nutrition involved Wiley, a black lab who couldn’t poop. He had a history of anal gland resections and constipation, but this time was worse. Poor Wiley had not had a proper BM in weeks, though he tried valiantly. His owner worried he was in pain, and tried to help him by feeding him coconut oil, which he immediately vomited up. She also fed him pumpkin and tried giving him a prescription laxative, with no relief. His usual diet consisted of pumpkin and limited ingredient, grain-free dry dog food. The doctor who saw Wiley that day felt his diet should have been evaluated when he started having the issues with his anal glands. Wiley clearly needed a balanced diet that would not cause digestive upset and constipation. For the immediate instance, Wiley’s suffering had to be relieved. The doctor performed a rectal exam to check for tumors and to examine Wiley’s prostate. No abnormalities were found, though we all agreed Wiley’s feces and gas smelled oddly like livestock. He did appear to be eating quite a bit of grass…The next step was an enema, much to Wiley’s shock, which yielded some success. He later went home on the i/d diet and instructions to take him for a long walk!

This week highlighted the importance of feeding pets a balanced, nutritionally and medically appropriate diet. I’ve listened to many owners spout the importance of “organic,” “limited ingredient,” “raw,” “vegetarian,” and any number of fad diets. Applying human diets and requirements can be detrimental to our pets’ health as they require specific dietary requirements. In addition, animals with medical needs, such as kidney disease, have different needs than an animal in maintenance. As a veterinary professional, I learned that part of my job is educating clients and how to read food labels and feed their pets appropriate diets. Even if an owner is insistent in their beliefs and will not change, at least they can make the decision as a well informed owner.