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…