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. 

Sunday, February 15, 2015


*SIGH* Just read and you'll understand.

Week 5: February 9-15, 2014

My animals are falling apart.

I pulled up to my house after work Thursday night, and in the headlights I saw my dog in the backyard. When I saw the way he was holding his leg, I yelled, “Noooooo!” in very dramatic fashion. After many months of working at Bayshore and seeing dogs in a similar condition, I knew immediately what was wrong. But of course, I chose to be in denial until one of the vets could look at him. I took him to work with me the next day and explained that he was let outside to potty, and ten minutes later when I pulled up, he was limping on his left hind leg. No one saw what happened, but he does like to run back and forth across the fence barking at the trees. The veterinarian examined each joint starting at the digits, working up to the stifle. He did the “drawer test” by holding the femur and moving the tibia to see if it protruded forward. 

You just had to open the drawer!

He gave me a look, and I knew: my dog had ruptured his CCL. The overall theme lately is the care for aging pets. My dog and two of my cats are approaching 9, and though I still consider that fairly young, I have to remember that their bodies are aging rapidly, and that I must prepare myself for age related illness. My dog has never had blood work run, so I decided to prepare a Senior send-out to an outside lab for 25 chemistries, T4, UA, and CBC to make sure he’s healthy enough for the next step: surgery. I also have a lateral ear resection for my cat’s left ear to schedule. It’s been a week.

My patient of the week was Olive, a 6yr old Pug that came in for hacking. She displayed the typical pug snort and raspy breathing, and her owner mentioned that she occasionally had respiratory attacks that she had a prescription of Valium for to use as needed. Olive was adorable, with a brachycephalic face that was so smashed in that she resembled a Persian. She was calm, unlike other pugs I’ve seen that are constantly panting and snorting. The veterinarian recommended an x-ray to see if there was anything in her throat. We took lateral and VD thoracic radiographs that included the trachea, and the doctor felt that she should be sedated for a closer look. Once Olive was asleep with doggy magic, a throat exam was performed, and it was discovered that not only did Olive have an elongated soft palate, but that she also had larygneal paralysis. She was reversed with Antisedan and given Dexamethasone for inflammation. As she began to wake up, I noticed she was acting strange and making an odd gurgling noise. I alerted the doctor and she took her heart rate and felt that she was reacting to the Ketamine. She had me hold her in sternal recumbancy while she recovered. I became concerned as the strange sounds continued, so I checked to see what color her mucous membranes were, and saw her tongue was turning blue. I grabbed my technician and we masked Olive with oxygen, feeling that the procedure and her panic had resulted in her throat swelling and cyanotic state. Thankfully, her color began to return to pink, and I was instructed to keep the oxygen on her for a while.

Fifteen minutes later, she had a seizure. I was alone in treatment, so I had to yell for help, and staff came running. It was amazing how they jumped right into action. One technician shaved a forearm while another started gathering catheter supplies and an ET tube and another veterinarian drew up Valium while I held off the cephalic vein. When Olive was settled enough, my technician intubated her so she would have an open airway and we continued the oxygen. The hustle and teamwork was very impressive! A catheter was placed and Olive was hooked up to EKG with me monitoring her for the next 2 hours until her owner was able to take her to an emergency 24 hour hospital for monitoring. Happily, Olive was starting to become more alert and was breathing comfortably without the ET tube when she left, and her doctor felt that she would be okay.

Dogs with smashed in faces are super cute, but unfortunately, the abnormal shape of their skull leads to many health issues related to respiration, skin, and eyes.

Experiencing how well my team worked when a crisis happened made me very proud to be a part of this hospital. Because everyone was on their A-game, Olive was well on her way to recovery even though surgery is likely in her future to correct her anatomical abnormalities. What made the situation more stressful was that the owner was a new client, Olive was a new patient, and this was the first time we’d seen both. The impression we made must have been favorable because the owner said she would definitely be coming back!

Sunday, February 8, 2015

What would Jane do?

I had to channel some serious Jane Austen poise this week. Read about it in this week's journal entry.

Week 4: February 2-8, 2015

In my former life, I owned a coffee roasters and was a barista, so I am no stranger to angry customers. That experience didn’t make this week any easier. This seemed to be the week of angry clients, whether they were unhappy with their service or the price of said service. Luckily, I’ve been able to avoid any serious encounters that ended in yelling and tears, but even quiet anger can be tough to deal with. We had clients with a 16 week old Bulldog puppy with a tear in the tibial growth cartilage that left her unable to use her leg properly. The doctor sent xrays to a specialist, but that apparently took too long for the owners because they took their dog to another doctor and ended up making ours look bad by insinuating that she didn’t know what she was looking at. They insisted at this other doctor’s suggestion that a Robert Jones wrap be placed on the puppy despite warnings that it may not work. So, the leg was cast, and I brought the puppy out to the owner. She was not pleased because the wrap was large and the puppy was wearing a cone. I informed her of the doctor’s instructions to keep the cone on to stop the puppy from bothering it, but she could have it off to eat with supervision. I also told her the doctor wanted the puppy back for a bandage change in a week unless it slipped or became very dirty. Here are a couple highlights of her response:
“Well, of course it will get dirty. It’s horrible outside,” said with great condescension.
“Does she HAVE to wear that cone?” very distressed.
“I just don’t know if this will work. It’s awfully big. Can she even lay down?”
“So, she has to have it changed once a week for three weeks? You mean you don’t know?”
Me, with as much patience as I can muster, “I’m just telling you what the doctor said. Please bring her back if she slips her bandage.”

This dog is wearing a Robert Jones bandage. Now imagine this on a 16 wk old wiggly Bulldog puppy. 

Big surprise, she slipped her bandage. And mom wasn’t happy. We just wanted to yell, “You’re the one who insisted she wear this thing! What did you think was going to happen?!” Dad is a human doctor, which also added to the frustration because he tried to tell the tech how HE would do it.
Later, I had to work with a client who insisted on telling me her life woes and why she was on such a tight budget. I don’t have a problem with people setting a budget, but I don’t need to know it’s because your husband of 30 years left you for a younger woman. While reviewing the price of the procedures we wanted to perform on her dog, she cussed out the price, told us how expensive we were and that she was going somewhere else next time, and that she would pay for everything but we were taking out of her grocery money. I honestly didn’t know how to respond, except to say we were willing to work with her and that our doctor’s were excellent. Above all, I tried to stay patient and understanding. A glass of wine was warranted that evening. Dealing with angry clients reminded me that it’s not just about the animals, but also the people that bring them in. If you don’t have the trust of the client, you can’t treat their animal, so no matter how frustrated or angry they make you, it’s best to remain calm and noncombative. Otherwise, you might risk the health of a pet who needs your help.

The biggest part of the week was assisting in the surgery of my own cat, Brautigan. Braut had horribly itchy ears, and it turned out they were full of bacteria, yeast, polyps, and inflammation. My poor guy was miserable! The doctor recommended a lateral ear resection for both ears. We did the right ear Thursday. I helped the technician place an IV catheter, intubate, and then I shaved and cleaned around the ear for surgery. After we moved him into the surgery suite, the tech showed me how to hook him up to the anesthesia machine and I placed the leads, BP cuff, and esophageal thermometer. I then monitored his vitals throughout the surgery and helped the tech assist the doctor. After the surgery was complete, I moved him into treatment, performed therapeutic laser on the site, applied eye ointment, and monitored his recovery. When I observed the swallow reflex, I removed the ET tube and placed him a cage with blankets and hot water bottles to keep him warm. I checked on his progress to make sure he was breathing well and waking up without difficulty. 


I’m happy to report that he did great and is recovering well, though he doesn’t appreciate the comfy cone!

"I believe you can go fuck yourself."

Sunday, February 1, 2015

What if it really is all about the bass?

In writing these journals, I've noticed a startling trend: I spend way too much time in animals' rectal area...

Week 3: January 26-February 2, 2015

This week was a mixture of the routine, excitement, and disappointment. Basically, your average week working in an animal hospital. The main skill I had opportunity to practice was anal gland expression. From taking anatomy, I know the location of these malodorous glands, but I’ve mainly been observing or restraining for the procedure. This week, I felt confident enough to step up and try the technique myself. I started by expressing glands on anesthetized patients so I would get the feel of where the glands are and what they feel like full on an animal that wasn’t struggling. I then was able to practice applying the correct amount of pressure and squeezing technique and feel the glands emptying and observing the discharge, again at my leisure since the animal was asleep. I then moved on to patients that were awake. I found I like to equate the procedure to milking a cow in that I start at the bottom of the gland and “milk” the discharge out by applying pressure with my thumb against my index finger on the inside of the rectum. I try to exert the least amount of pressure as possible to prevent injury to the animal, but I’ve encountered a few glands that were “plugged” and needed a little extra work. After those expressions, I like to wash the perianal region with cool chlorhexidine to ease any discomfort. This procedure is the epitome of, “it’s a tough job, but somebody has to do it.”

Hey, ya'll, you're lucky I didn't post a picture of a dog getting it's anal glands expressed. That's how much I care about you keeping down your lunch. For the rest of your life. Instead, here's a picture of a dog scooting, a common indication that it needs it's anal glands expressed. Should I say anal glands again? Anal. 

We perform quite a bit of blood work, and we’ve recently started using new machines for CBCs and chemistries. Generally, we aren’t running more than one animal’s blood at a time, but one day this week I was handed tubes for three animals that were ASAP. I got to work putting the tests into the Avimark system, which then put an order into the lab machines. The green tops were spinning and the lavender tops were rocking when an error message pops up on the Catalyst screen. It was time for a crash course in troubleshooting the new machine. Knowing similar problems have occurred in the past, my first step was to empty the waste tray. It was full, which often results in the slides not being able to load into the machine properly. The error message still appeared, so I then opened the front of the machine and took all the slides out. It was terrible to waste them, but the number one priority was getting the machine to run! After running an initializing process, I set the machine to run the blood work again and crossed my fingers it would work. It did! I then worked efficiently to systematically load the plasma and slides into the machine to run in succession. Even though most of my job is working with animals, I learned it was also important to understand how the equipment we use works so that we can fix it when it doesn’t. After all, without our lab equipment, we can’t diagnose illnesses and maintain patient wellness. 

I love our lab equipment...when it works.

The hardest lesson I learned this week was that no matter how much you want to save the world, oftentimes the world has other plans. One of our vets was in an extremely optimistic mood when it came to two unanticipated exploratory surgeries. I had checked both patients in as appointments, and the doctor determined both required immediate surgeries. One had a hard mass on the right side of his abdomen, and we were hoping it was his spleen or something equally operable. The doctor went into surgery with hope, and unfortunately discovered that the dog’s entire right kidney was enveloped in a large, football shaped mass that grew against the spine. His disappointment was furthered by the next patient that hadn’t been eating and was vomiting. They were hoping for an obstruction, but what they found was an abscessed mass which necessitated the dog be euthanized on the table. My heart goes out to the owners when things like this happen, but I try to help them take comfort in the knowledge that they did everything they could to make their animals well, and so did our dedicated doctors. When sad outcomes occur in quick succession, it’s difficult to find the silver lining and the mood in the hospital can become sour, and we have to remind ourselves why we’re in this field. Our deep love for animals pulls us through and helps us come to work everyday.

Puppies help, too.