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!

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