Sunday, January 25, 2015

Everybody poops. And pees.

It's the end of another exciting week! Here's the exciting highlights! They're exciting! And gross!

Week 2 Journal Entry: January 19-25, 2015

This week at my clinic was all about bodily fluids. I have long since accepted that my job will never make me rich or famous, it isn’t glamorous, and I often go home and my dog plays the, “what’s that smell?” game. In my last entry, I talked about discussing parasites with clients, namely heartworms. This week, I had ample opportunity to perfect my fecal flotation technique.
Sometimes it’s easy: a client suspects they see worms so they bring in a sample. Other times, it’s not so straightforward. A patient comes in with diarrhea and the doctors of course want a fecal sample to analyze. Of course, no one has advised the client to bring one in, so we have to get it ourselves. Enter the fecal loop. 

Bend over!

I enter the exam room or take the dog (or cat) back into treatment with the fecal loop, a tool about twelve inches long with a tapered end with keyholes in them, apply sterile lube, and insert it into the rectum. I twist the loop gently and pull it out hoping to have enough sample to run a test. If I do, I then take the sample to the lab and retrieve a Stat OvaTube. I put the sample in the tube and fill it halfway with Fecasol, stir it, add the topper, and fill all the way with the Fecasol. I then place the tube in the centrifuge for 5 minutes, twist down the topper, place a microscope coverslip on top, and set a timer for 3 minutes. I then examine the sample under the microscope for parasite eggs. When I first started working, I had to consult the staff or books to identify anything unusual, but now I can quickly identify roundworms, hookworms, and coccidia under the microscope and tapeworms in fecal samples.

You can't imagine how sad it is to examine unexciting poop.

I’m also learning what to look for in urinalysis. We collect urine in several ways: free catch, cystocentesis, or urinary catheter. I then take the urine to the lab area and grab the refractometer, a Stat Spin tube, and a urine dipstick. I put one drop onto the refractometer to find the specific gravity and a drop on each square of the test strip. I then put the rest in a tube and spin it in the centrifuge. I record the findings on a sticker noting the specific gravity, pH, and the presence of bilirubin, urobilinogen, nitrates, ketones, blood, glucose, leukocytes, and protein. After the urine is spun, I pour off the urine and put a drop of stain into the tube and mix it with the sediment before putting it on a microscope slide. The staff are teaching me what to look for in the urine, such as WBCs, rods, bacteria, and the other day I found crystals! 

Refractometer and dipsticks: if not for a physician in 1797 saying, "I need an easier, faster way to test urine," we might not have these tools today.

I’m very fortunate to work with doctors and staff that challenge me. The other day, the veterinarian gave me a pop quiz, which she often does.
“Hey, Mandy. I have a 25lb dog that comes in having trouble breathing. It’s turning blue, but it still has a pulse. What would you get for me?”
It’s a little scary being put on the spot, but I know she’s testing me not only to see what I know, but to educate me on what I don’t. My first response was that I would get her an ET tube and the oxygen machine. She agreed and then asked what drugs I would give her and where they were. I said I didn’t know. She didn’t either! (Note: she’s a newer doctor at the clinic). The technician showed us the Crash Kit in the surgery room and the doctor explained the drugs inside and when and how I should give them. It was a great learning experience and it gave me confidence if I was ever in a situation where the doctor had an emergency and I was the only one available to help. It was applicable because we had a patient in the hospital having trouble breathing, and I just learned about a medication I had never filled before that was a bronchodilator.

As always, I was reminded this week that no matter what happens, don’t forget to have fun. A dog that was very dear to a staff member was brought in to be euthanized and the mood was somewhat bleak. Then a shaggy border collie came in that had some mats that needed to be brushed out and shaved. The technician shaved off a big mat off the dog’s tail, and she observed that it looked like a troll doll. She ended up dressing it up and turning it into the clinic mascot. If I can end every day at my job with a good laugh, I believe I can do this job forever!

I think we ended up naming it Troll Michaels. 

Sunday, January 18, 2015

It's gross and it's wonderful.

My life, that is! Oh, man, I'm not even sure where to start. I'm entering my second semester of the Veterinary Technology program at St. Petersburg College and it's exciting and stressful while also amazing. I ended last semester with straight A's! Woot! No pressure...I'm so thankful for this period in my life. My kids are healthy and happy, and so am I. While I have seen sadness and had heartaches, every step of this journey has been worth it. I know this blog has been sadly neglected, but I am sure whoever is out there reading will forgive me the life I am living.
Have I mentioned recently how much I love my job? It feels so wonderful to say that after so many years of dreading going to work. I love being a veterinary assistant at Bayshore Animal Hospital. The people and animals are awesome and I'm learning so much being there. It's really helpful working in an environment you're studying. Applying real life to my studies and vice versa has made an incredible difference in the ability to retain information and do well on exams in addition to allowing me to succeed in my job. Every day when I get up for work I go:

One of my classes is a work practicum class where I have to journal my work experience for that week. I thought, how awesome would that be for the blog? Two birds, one stone, boom! So, here is week 1, with illustrations for your visual pleasure and because I like to be as gross as possible. My job is so awesome :)

Journal Entry #1: January 12-January 18, 2015

My time at work is busy, often stressful, and sometimes events jumble so much I can’t remember what happened when. I am a veterinary assistant at Bayshore Animal Hospital in NW Oregon. Our practice has three veterinarians, four technicians, and three assistants as well as three receptionists and a kennel technician working with an average of 30 clients daily, and this doesn’t include the work we do for the local animal shelter. We mainly see cats and dogs with the occasional pocket pet. Our days begin with checking in the drop offs, which are animals scheduled for surgical procedures, sedation, or sick patients needing in hospital exams and care. During rounds, we explain and plan the day's cases and establish teams, which consists of a doctor, a technician, and an assistant. As an assistant, my job is to check in rooms, fill prescriptions, restrain for procedures, and the list goes on!

Our practice is currently working to go paperless, so even though we still have files, much of what we do is centered around the computer system, Avimark. It took some time for me to navigate this system having never worked with medical charts or programs before. We can schedule, put in charges, make estimates and drug labels, follow-up with patients, see lab work, clock in, and I’m still learning all this program can do. The first thing I do when I walk into an appointment is to login to Avimark and open up the patient file. I then put in charges that I know will occur before the doctor even walks into the room. Some things were easy, such as exams and scheduled vaccinations, but it took time and intuition before I was able to predict what else I knew would be charged. For example, if an animal was coming in to check the ears, I know the doctor will do an ear swab and slide and will charge for that. I also know to take an ear swab and prepare a slide, which makes less work for the doctor and saves time. After I enter charges, I go into the lobby and call the client in. I like to introduce myself as the assistant and explain that I’ll be taking vitals and a brief history because then the client doesn’t get confused as to why I’m not performing a full exam. I’ve had clients think I’m the vet and then wonder why I’m not going more in depth with the patient! I weigh the pet then TPR them, that is I take the heart rate, respiration rate, and temperature. I then take a brief history of the complaint if there is one and ask general health questions such as if the pet is eating/drinking, any vomiting/diarrhea, are they on any medications, and so on. I then inform the vet of who is there, what room they are in, why they are here, and if I have prepared any slides whether it’s an ear/skin swab, fecal, or urinalysis. I also draw up vaccinations and place them in the room for the vet.

As an assistant I am not authorized to dispense medical advice, but I can educate clients on products and services we offer, vaccination protocols, and preventative care. One of the main issues I educate clients about is flea and worming. We had a client bring her dog in for an exam that she had adopted from the local shelter. We had previously treated the dog for heartworms and it was having a recheck appointment. The owner had many questions about heartworms, what to do if the test was again positive, and what she should do to prevent her dog from getting heartworms again. I explained that heartworms are transmitted by mosquitoes, which inject the larva into the host and the worms mature in the heart and lungs. I explained that we recommend Heartgard as a preventative against heartworms as well as roundworms and hookworms. I later explained to another client that we often recommend worming cats and dogs who have fleas because they often ingest the fleas while scratching and then develop tapeworms.

Just be thankful I didn't post a picture of worms bursting out of an overloaded heart. This shiz is nasty, folks. 

One of the biggest challenges I face is venipuncture. I think I stress unnecessarily because I want very much to excel. I feel I'm improving when drawing from a jugular, but I struggle when drawing from the cephalic vein. We brought the above mentioned dog back to treatment for her heartworm SNAP test, and the technician handed me the needle. I have been lucky to work with people who have been really supportive in helping me practice procedures and helping me learn, but I was nervous! I told her I had trouble drawing from the leg, and she gave me a few pointers as far as needle position, and I hit the vein on the first try! I got my sample, prepared the test, and set it in our lab machine that runs CBCs, chemistries, and SNAP tests. Thankfully, the test was negative!

This sight terrifies me. Hit that vein, Mandy! No pressure!

One thing I do a lot of as an assistant is clean and treat ears. We use a product called EpiOtic to wash the ears and then use cotton to clean away any debris. We are careful not to use cotton swabs except around the pinna so we don’t ulcerate the inner ear and potentially puncture the eardrum. A medication we use often is the EKT ointment, which is a thick ointment when warm and then solidifies in the ear. It releases medication over a period of two weeks and treats a variety of ear infections. We use it quite frequently and the clients like that they don’t have to do daily medications and weekly cleanings.

I love that my job challenges me and that every day I learn and see something new. The other day, the receptionist said we had a drop off coming in that was a cat with rapid, shallow breathing. The other assistant, who is also going to school to be a technician, and I decided to bet on the diagnosis. She quickly theorized a heart condition and I said it was fluid in the thoracic cavity. The cat came in and it was clearly having difficulty breathing. An x-ray was taken, and sure enough, there was so much fluid in the chest you couldn’t see the heart! I felt bad for the poor cat, but excited to have guessed the correct diagnosis! I have learned that in working in a field that can oftentimes be incredibly depressing, one has to find humor and joy anywhere you can, even if it seems callous. 

Normal cat chest x-ray. Notice you can see the organ structures.

X-ray of the cat with pleural effusion (fluid in the chest cavity). 

helped the technician prep the cat for a thoracocentesis, which involved shaving a 4x4 square on each side of the chest over the last few ribs. We then sterilized the area as if preparing for surgery, and the doctor put a needle between the ribs and started drawing off fluid with a 20cc syringe. 

This is how we do.

The fluid was purulent, and the doctor said that was the best scenario for treatment. If it was red or yellow, it could have signaled a big problem. After drawing off more than 320ml of fluid, the cat was breathing much better. It was incredible! The cat came in weighing 12lb 5oz and left weighing 11lb 5oz. It lost a pound of fluid! The doctor had me take some of the fluid for analysis on our CBC machine, which was fun because I had only run blood on the machine before. In fact, no one else had run anything other than blood either, so I demonstrated in front of the other assistants what settings to change and then we looked at the printed results together. Later, the doctor wanted me to prepare fluid for a send out to an outside lab, and the other assistant and never prepared pleural fluid before either or requested the specific tests, so we learned together how to fill out the paperwork and she taught me how to put charges in the computer for labs that weren’t listed. It was a very informative day!

One of my favorite aspects of my job is being held solely responsible for the care and treatment of cases. It makes me feel good that I am trusted enough not only to carry out the tasks, but to ask questions and communicate concerns to the certified staff. This is especially rewarding when I perform the discharge for that patient later as I know every aspect of the care they received, can explain the medications they are going home with, answer questions, and feel that I have established a personal relationship with the client through their pet. It’s very rewarding when a client sees me and remembers my name and smiles because of the care I gave to their pet and the help I gave them. I always said I wanted to work with animals because I’m not very good with people, but I’ve learned that the people skills are just as important because they own the pets and their pets are their family. Building a trusting relationship with the owners means a great deal to me, and I’m trying to do that through respect, care, and attentiveness. Every day I go home and no matter what happened that day, I love my job!