The story of the dancing eyes….

snow-in-slovakia-vet-school-nystagmus

Today’s Diary Entry is sponsored by Supreme Rabbit Food

I’ve been spending as much time as I can in surgery, this leaves me for very little else at the moment so apologies for the lack of updates. I’ve started quite a few posts but not quite finished them… It’s all a matter of time as I need to sleep at least a little now so that I can focus on what I am doing, and more importantly so if I am assisting my hands don’t shake.

What I really love about what I do is the unexpected. How your heart goes from 0 to 1000 in a split second…

It was lunchtime; I was the only person in clinic monitoring a patient after anaesthesia, whilst an owner was sitting with another dog after its anaesthetic which was a bit more alert and stable than my patient.

Suddenly the eyes of the other dog started flicking side to side crazily fast. Owner has gone pale. My brain has gone into auto drive.

My mind goes back to my reading, nystagmus jumps to my brain… The involuntary movement of eyes side to side otherwise known as dancing eyes…

Dog is breathing? Yes…

Dog has heart beat? Yes…

Are there muscle tremors? No…

Are pupils normal? Yes…

Was the patient here for neurosurgery? No….

Is it life threatening? No…

Does the owner talk English? No…

Is it positional nystagmus? Maybe…

Is it toxicological? Maybe…

Pharmacological? Potentially…

10 seconds have passed, I have a plan, and I breathe. I have time… I smile for the owner and say moment. My favourite word… When said calmly and confidently it has a big effect on an owner, it calms them to have someone in control. Even though I know nothing it is all about the appearance I’ve found. I wear a stethoscope, I am smiling, and I am not panicking. The owner does not panic either.

So I head to the staff room to grab the doctor that did the anaesthesia, and we find that moving the head from its side to straight decreases the nystagmus. It’s positional. Basically with the ear inside the skull are 3 little semicircular canals at right angles to each other, one is horizontal, one is vertical and one is at an 90 degree angle to this. These are the heads motion detectors, they know when the head is moving. If you focus on something and turn your head whilst still focusing on the same object these will keep your eyes looking at the object for as long as possible. It is why when you reach a certain point your eyes will seem to snap to the image in front of you.

Now these can be affected by the drugs we use, so in addition to changing the head position we gave a sedative to calm down the body whilst we waited for the dog to calm down again. With a little more time the body reached a state of balance again and the dog recovered uneventfully.

My biggest regret though is that I did not think to get a video of this, it really is one of the strangest things I have ever seen. Going by what the doctors said it is also pretty uncommon as well.

A vets gift of euthanasia and great sadness…

Drugs for stopping the heart

Today’s Diary Entry is sponsored by Pet Webinars

As vets we are given a great gift to be used with great responsibility. We are given the right to euthanise animals in order to alleviate pain and suffering. Translated to English the word euthanasia means good death, and when used by a vet it generally is. It is painless, and for the animal just like going to sleep. For some animals that are sick and suffering it cannot be done fast enough – and though the vet may wish there was more that they could do to make the animal better it can be justified.

Now what I have noticed is that the techniques and methods for euthanasia are not covered in most of my textbooks. Instead my textbooks even with chapters on euthanasia tend to focus this towards dealing with the owner and how to prepare them for this instead of how to make this good death happen. Generally though for euthanasia an animal is sedated or given an anaesthetic drug to make them sleep, and then a different drug is injected into the animal to stop the heartbeat.

So there were two dog euthanasia’s today but they couldn’t be more different in how they made me feel.

I arrived this morning to a road traffic accident with a large dog, once we got this patient stabilised and completed the initial exam we rushed them into xray to get a better assessment. Waiting for the images to come up on screen I was slightly excited about the surgery to repair the damage, however when the images came up a deathly silence feel among us. It was not good. It was very very bad. Now you see with a large dog there is a lot of weight that needs to be supported, this is a lot of force on the legs, and so even one leg compromised can be disastrous. However this dog had 3 legs that had been damaged. We anaesthetised at this point so that a full physical exam of the injuries could be performed, after assessment and after discussion with the owner elected that it was kinder not to allow this dog to wake up. This dog was in great pain and suffering, and so the ability to deliver the gift of a painless death was a privilege.

Throughout the day there was an 8 week old puppy in for assessment of a congenital deformity to one of the front legs. Being a puppy this was a very cute dog, bouncing around wagging its tail and being very happy whilst receiving a lot of attention from everyone passing. Now after xrays and exam at the end of the day a discussion with the owner took place. The owner left without the puppy, and it was here that I realised something was up. The puppy was to be euthanized. Not because it was in pain or suffering. But because of a choice. There were surgical options available. The puppy could be fixed. However for whatever reason the owner elected not to. So it was us with this great responsibility that cuddled the puppy as it fell asleep. It was me that listened to the chest to make sure the heart had stopped. This puppy that had tried to soak me with water from its water bowl just hours before was gone. The tail wasn’t wagging.

Now you can probably guess the one that kept me awake that night… Not that I didn’t wish that there were surgical options for the big dog and was frustrated with our lack of ability to do anything… The one that kept me awake was the puppy that was happy and had good surgical options for a good life. Sure we shouldn’t get attached to patients, but there is just something about animals that makes you love them.

Sometimes euthanasia is necessary, however I believe it is a gift to be used to relieve pain or suffering. I realise that the world is largely based around consumerism now, and I hate the thought that by setting out on my quest to help animals that I may become a way to “return” a dog or other animal… As vets we are there to save as many as we can, I hate that sometimes money gets in the way, but until we have a better system I will advocate for every single pet out there being insured to remove this money factor from what is often the hardest decision pet owners have to make. Euthanasia is and should be about the animal.

Some thoughts on removing limbs and body parts…

Thoughts on amputation of a dogs leg by a vet student

There are times when I find myself wondering just what we actually do and found myself there again today. I’ve always had the image of surgery being a beautiful act of fixing things, making animals better. Yet today I kept a dog sleeping comfortably under anaesthesia whilst I watched a surgeon remove its leg. The other week I watched a surgeon remove part of a bone, the sound of the saw making it definite.

For some reason when I imagined surgery this isn’t what came to my mind. Surgeons putting things back together, suturing vessels, intestines or constructing metal frames around limbs. This happens a lot of the time, however there are times like today when I just start to wonder.

When I actually think about it, we often remove parts of an animal’s body during surgery, whether that is the uterus and ovaries or even a tumour. All of these are routine and I have never considered it fully before. I guess here I think it is that the animal will not miss these parts though, with good pain management the animal may not realise even that there had been surgery.

Now when it becomes a leg I guess it just takes a different perspective as I am pretty sure an animal may miss it… And worse that the animal has come walking in with 4 legs, yet will be waking up with a leg missing. Sure there won’t be pain, I gave the morphine that ensures that, but when the dog tries to stand it stumbles and falls. Unlike ovaries or a tumour, it actually notices that a leg is missing… That is before you consider things in humans such as phantom limb syndrome and then wonder if animals can also suffer from this… If they do then they can’t say…

This is where for me a beautiful art really does become a little less beautiful…