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.
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.