Starting 2015 by assisting in emergency surgery…

Vet student in surgery

Today’s Diary entry is sponsored by Spikes Wildlife Foods

It has been 2015 for just over 9 hours, one of which was filled with fireworks, 6 of which were filled with sleep, and 2 which were preparation for another day in clinic. Sometimes I feel old, last night instead of joining the thousands out partying I read a book by my favourite author Lee ChildPersonal the latest in the Jack Reacher series which I had been saving since the summer. I actually finished it in one sitting as it was such an awesome book…

Anyways back to 2015, it’s now a little closer to 9:45am, and we have a patient transferred from the internal medicine service onto surgery that had shown abnormalities on ultrasound. It was believed to be a intussusception caused by a linear foreign body as there were changes in the intestines, so we took the patient to xray to have a look at what we could see. There were some changes on xray to part of the intestine and the rest of the intestine was filled with gas (this is not normal and is a sign of foreign body) however it was non-specific. We then did a second palpation exam of the abdomen and found what felt like a ping pong ball hard round lump.

Finding this the only course was surgery to perform a laparotomy (opening of the abdomen) to examine the intestines, and remove this lump whatever it was. Because of the holiday there were only two of us in the building, so I started prepping the patient whilst the doctor started prepping surgery. I am able to say that it really isn’t as easy doing it alone as with help, even when it’s just holding a leg out of the way it really does make a difference. After I finished prep and got the patient onto the table I sorted out the anaesthesia and got everything connected whilst the doctor scrubbed and then once I was happy the patient’s anaesthesia was stable I went to scrub myself.

After scrubbing and gowning up I moved to assist in surgery whilst keeping an eye on the anaesthesia, this was my first time assisting in an abdominal surgery on a dog so I was really excited. The doctor had found the foreign body, so we removed the loop of intestine from the abdomen before we then opened it to remove the foreign body. It was actually a intact nut that the dog must have eaten a few days, caught up in a bunch of other “stuff” that I could not identify. There were several sites in the intestines where you could see it had got stuck before moving on however here it really had not moved on. It was a case of getting it just in time as the intestines had started to have pathological changes from the blockage here with some change in colour and bruising.

We then had to close the incision we had made into the intestines, and then check the rest of the intestines for any further blockages before flushing them with sterile saline and replacing them back into the abdomen. Now the first time I saw peristalsis (muscular movement to move contents of intestines along) in equine intestines was amazing, and though peristalsis in this dog was decreased I could see all the blood vessels and the pulsing of them which really was amazing.

We closed up the abdomen and I set about recovering the patient, because it is so cold here and the rooms so large maintaining temperature is very difficult. In this case we also did not have anyone to manage it during the surgery so the body temperature had dropped down to around 34 degrees so I set about warming the patient as well. Once I had the patient up to a good temperature, and awake I relaxed a little and actually realised that I had just made a milestone in my education to become a vet.

Barely 11 hours into 2015. I put all my knowledge learnt so far to use to give a dog a chance at sharing another year with its owners. Some people like to party, and I may be old, but there is nothing like the buzz of surgery especially when your patient looks up at you afterwards and tries to wag its tail.

A Vet Students Christmas…

Puppy on oxygen

Today’s DIary is for every single person that has helped me to get here, thank you so much for your support and encouragement!

Merry Christmas everyone, it’s been a while and I have been very bad finishing my diary entries (really difficult to find time at the moment).

For some reason even though the university is not doing emergency cover over the Christmas holiday they are running reduced clinic hours with a single doctor on duty. I’ve been around the past few days as I am going be studying either way so I can sit in my room alone, or sit in clinic and study and be there to help if needed. It’s pretty difficult to do a lot of things alone so even my vet student hands can be useful.

So in the same as in the past few days I’ve gone in, most of our wound management patients are finished by 10, and so I start to study and the doctor gets on with marking exam papers. I’m finding this pretty interesting as seeing the same patients every day over a longer period I can see the daily changes in the wound healing. This is something very useful as a lot of wounds look very scary, and a lot of the time when graduating people do not have the confidence to treat these conservatively so its good experience to get.

Anyways the clocks ticking towards close when at 11:15 there is the sound of the door opening, going to the waiting room we have a collapsed dog being carried in the owners arms with blood dribbling from the mouth. We get this onto the table, and start stabilisation placing a cannula during which we notice the blood is very dark almost heading towards brown in colour.

Less than 3 minutes later there is another knock on the door, I check this whilst the doctor continues with stabilisation. My biggest problem here is still communication as my Slovak language skills are still very poor, however seeing a puppy with obvious respiratory distress I swap patients with the doctor. Now with stabilisation the basics are very important, and being basics are within my capabilities so I am dealing with shock. I get vitals measured, IV fluids running, and then as the temperature is low start warming the patient as well. Performing a clinical exam and with the blood colour in mind we are thinking it is an intoxication of some kind of poison (potentially a rodenticide), so we call internal medicine to send this patient that direction.

There is then another knock on the door with a collapsed rabbit that has had ongoing problems, on a quick exam the first thing I notice is the lack of temperature. It’s winter here and outside temperature has to be around 0-1 degrees, yet the rabbit is in an open basket with just a blanket to sit on. Sometimes I think owners are lucky I cannot speak Slovak (yet), however I set about trying to get the temperature of this rabbit up whilst knowing that being exposed to the cold like this may have killed them. (Please if bringing animals to a vet in WINTER make sure that will be kept WARM!!!)

The doctor on internal medicine duty (who is alone as well) arrives with a cat patient that needs xray for not eating for several days to rule out foreign bodies or neoplasia or torsions etc. My surgery doctor vanishes to do the xray whilst I monitor the 3 patients that have all appeared in the past 15 minutes. After this the internal doctor takes the intoxication patient back to the internal clinic, along with the cat. I take the rabbit which has really bad problems, clean the abscesses and give as much in the way of fluids, antibiotics and pain meds as possible.

This patient then leaves which means we have only the puppy left to deal with. Now this puppy is only 3 months so we are trying to avoid the radiation from x-raying it because it is still growing pretty fast which means we could cause big problems in cell replication from the xray. However we do suspect that it has a pneumothorax from listening to the chest and have it stabilised on oxygen therapy. It needs to be hospitalised in either case so the owners fill the forms and then leave. As it is so small we have a discussion about the management, and decide against the surgical draining of air from the chest with thoracocentesis due to the risks here from the size of the patient (really bad risks here especially on something so small). We choose the conservative treatment route here and reduce the respiration rate using medication, and keep the patient on 100% oxygen and warm.

It’s now 3 hours after we were supposed to close… Merry Christmas