Inside the dogs spine…

Today’s Diary Entry is sponsored by Eickemeyer

This morning I got to see a very cool surgery. Now the brain and nerves are still one of the big mysteries of medicine, so when we can help it is extremely rewarding. Today’s patient was a german sheperd that had no control over the bowl or bladder and so after the clinical exam it had been decided that surgery was in order.

You see there are different parts of the spinal cord within the spine – the cervical region (neck), thoracic (ribs), lumbar (lower back), sacral (where it joins the pelvis) and the cauda (the tail). Now the spinal cord itself usually ends just before the area where the lumbar spine connects to the sacrum (the iliosacrial junction). However the spinal cord has several nerve branches that arise from the end that are important for the pelvic region.

So there are two main types of problems with nerves, the first is that they are severed (cut), and the second that they are compressed so the signal cannot pass along. Severed nerves are a completely different story and worthy of their own diary entry so I will leave this for now. However looking at compression of nerves this can be from several causes including inflammation, bruising, tumours, or growths. Now the spine has a common problem called spondylosis which is where small bone bridges grow between different vertebra causing both pain and displacement of the disc that sits between them to act as a cushion. This disc is usually pushed upwards compressing  the spinal cord and nerves against the back of the spinal canal.

Going back to today’s surgery the nerves leaving the end of spinal cord were being compressed so the surgery being performed was a spinal decompression via a dorsal laminectomy. Now this basically means removing the back part of the spinal canal (the dorsal lamina) so that the nerves have nothing to be squashed against. During the surgery I assisted on the anaesthesia (I belive its better to learn this properly early on as I can learn surgery anytime) so I only got to see parts however it was really cool being able to see the nerves within the spine.

It’s a pretty weird feeling seeing these little white snake like things that are responsible for the body working the way it does… This surgery is generally an advanced procedure and considered neurosurgery because of the level of skill and specialist equipment required to perform it so I got very lucky to be part of it even in a small way!

Putting a owl back together again…

Today’s Diary Entry is sponsored by Spikes World Wildlife Foods

With the start of week 4, time already seems to be flying away from me. Monday’s are really light for me this semester with just 1 lecture first thing in the morning. This means that I have the option to spend the rest of my time either in surgery or studying extra things that are not normally gone into in detail. Or of course I can spend my time going over stuff again as they repetition is key.

After my lecture today I ended up heading towards clinic, and arrived as they announced an afternoon surgery for a fracture repair by the department director. Enough for me to get interested so I stuck around.

Now somehow I ended up doing anaesthesia, here we don’t really have any monitoring equipment so everything must be monitored manually. With normal animals you can generally see if the chest is moving for breathing, however when it comes to birds because the chest is covered by the wings this is more difficult. Personally I tend to try and keep a finger on the chest to feel for the movement (even this can be tricky when its a surgery which requires movement of the leg which cause more movement).

So this owl had suffered some kind of trauma which resulted in fractures in both of the legs. One of these was pretty easy to fix with the “break” being in a part of the long bone of the femur. This was repaired with a intramedullary pin. The second fracture was a lot more interesting. At the end of the femur there is something called the femoral head which sticks out sideways and connects to the hip joint. The fracture here was between the femoral head and the main part of the femur so on a very small yet important piece of bone. This was wired back together, because the bone here is so soft the wire could be placed simply by using needles to pass it through.

The owl was then recovered from the anaesthetic, and taking down to one of the bird boxes where it will have a chance to heal before being released.

Owl going to nursing box to healIf you notice I am holding the owl through a towel, whilst this prevents struggle it is even more important that human contact is limited so that the owl does not become imprinted (and then tame). There will be very limited human contact now until release.

A pretty weird day at vet school

Todays Diary Entry Is Sponsored by Supreme Petfoods

The best way I think to describe today is weird, it’s given me a lot of food for thought and some positives and negatives. Some things here I am deliberately vague on to protect patient confidentially however I am trying to share as much as I can.

So it all started early this morning with the start of my stomatology (aka diseases of the mouth) training. We started in with lecture shortly after 7am which was pretty interesting, started with diagnosis, then onto treatment and instruments with a little bit on how type of food can also affect dental disease. From this we then went straight into practical prepping and carrying out dentals under supervision.

Somehow here I ended up alone with a large breed dog being told that a tooth needed extraction and asked if I wanted to do it. Off course it was an instant yes (I’ve only ever read about extractions before) however there was periodontitis present with the gap between the roots showing  The biggest challenge here for me was working out just how much force I should use, I ended getting the doctor to demonstrate one whilst I did the second tooth alone. This was complicated by the fact that during this time I was also responsible for the anaesthetic and had to monitor the dog whilst doing the extraction as I was alone in the room.

I then jumped into surgery to observe the plating of a tibia fracture in a cat, this went without any problems and the cat recovered nicely with the ability to bear weight on the leg.

Coming out of this surgery it was lunchtime and I walked into a resus of a cat that had stopped breathing which was where my day really got very interesting. The cat was being manually ventilated and had a strong heart rate (mainly due to drugs), I like basics so asked what the temperature was and it hadn’t been checked as there were not enough people. Trying to check this with my thermometer I just got a “Lo” reading so assumed my battery was flat, however grabbing the thermometer from the consult room I got exactly the same thing and realised that there really was a problem.

Now I faintly remember reading somewhere my thermometer reads between 28 – 50 degrees, so for the temperature to register as “Lo” it would have to be below this with severe hypothermia. This started us warming both with peritoneal fluids, IV fluids and external heat sources to start the raise the temperature. This was actually very interesting to be a part of as temperature change did occur very slowly and being the only student in the building I ended up bagging (breathing for) the cat for the next 3 hours until we could get a ventilator working. Now during this time I was also monitoring the cat, and trying to get spontaneous respiration.

I started to do neurological exams as the temperature started to rise as I really wanted something positive to show me the cat would be ok. I got a strong retraction reflex on both the hindlimb to squeezing the toes and reflex when checking the temperature anally. However there were no other reflexes on front limbs, over thorax, or corneal. The weirdest moment for me came when I checked the pupil light reflex for the first time and got nothing.

Often times on TV medical drama’s you get the line “Pupils fixed and dilated”, this was what came out of my mouth here. I had never before today considered that it’d be something I would say, I had never actually considered the possibility that animals could enter a coma like state (we do not have the machine to test for brain activity so I am not comfortable just calling it a coma). The cat was on life support, if we switched of the ventilator the cat’s heart would stop, and the cat would die.

Ethically how far should we as vets go? It would have been possible (with manpower) to keep the cat on the ventilator indefinitely… Yet even with humans coma’s are not well understood. Personally for me, without having the equipment to monitor brain activity, or the knowledge here I feel that keeping any animal in a coma state is crossing a line. However if the equipment is there, then maybe it is only right we do as much as we can?

I’d welcome your comments and thoughts on this…