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!