Thursday, May 31, 2012

Day 8: Ruptured Cyst, Kitten Caring, Lump Removals, Declaws, and Heartworm, Feline Immunodeficiency Virus, and Feline Leukemia Virus Testing

                When I first came today, there was a pekinese named Bailey who had a cyst on side that had ruptured inside her skin.  Dr. Mark cleaned her off and gave her owner some ointment to apply on the wound.  After Bailey, we had a lab mix named Coffee who had a strange lump on her elbow. Dr. Roberta drew some blood and drew some of the fluid from the lump, but it came back non-cancerous so luckily it’s harmless.  We didn’t really have any appointments for a bit after that (just small things like nail trimmings), so I fed and stimulated (made them go to the bathroom) the kittens again and walked around to see how the animals were doing.  I found out that Jetta (the diabetic cat) had been euthanized the night before, which, as sad as it was, was overall was good to hear because she had been in a lot of pain, and just overall not doing well the past couple of days.  I also saw that the police department had brought in a ferret during the previous night, but we don’t know if the ferret has an owner or not so we’re housing him for now.
The cyst on Bailey's side.
A closer veiw of the cyst.
 The lump on Coffee's elbow.
The four kittens we received yesterday.
The ferret.

                Technician appointments (ear cleanings, nail clippings, etc.) and walk-ins were sort of slow again today, except for Dr. Lou, who was swamped with surgeries.  In addition to having a few regular checkup appointments (blood draws, ear cleanings, etc.), she also had four spays, two neuters, two cat declaw dewclaws, two lump removals, and a dental surgery to complete throughout the day.  Dr. Todd and Dr. Amanda both also had surgeries, so even though there weren’t too many appointments going on, there was always something going on in the surgery room today.

                The surgeries I watched today were lump removals and declaws.  The first lump removal surgery was a mass cell on a dog.  Dr. Todd removed it, making a wide, diamond-shaped cut in the skin with the laser, cut a little bit into the fatty tissue, and removed that diamond-shaped area with the lump.  He was pretty sure that it wasn’t cancerous, but he was sending it in for tests just to make sure.  The other lump removal was on Jenny, the dog who came in yesterday with the mysterious lump in the armpit area her front left leg.  The owners had said that the lump kept bleeding since she had come in yesterday, so Dr. Amanda took her into surgery to remove it.   Since the lump wasn’t inside the skin, and since we knew it was only filled with blood, Dr. Amanda simply made an incision and carefully poked around the area of the lump while she was removing it so she wouldn’t accidently hit any major blood vessels.  Because it was outside the skin and only filled with blood, it really wasn’t a harmful lump, so it wasn’t sent in for tests or anything.  The last lump removal was on a cat named Kabu that was receiving a dental treatment.  Dr. Karen noticed the lump while performing the dental procedure. Since he was sill unconsious from the dental, she was able to just grab the laser and start working on getting rid of it. It was a tiny lump (like a cyst) by the cat’s eye, so Dr. Karen took the laser and removed the lump by killing off the cells with the laser.
Dr. Todd cutting through the fat around the diamond-shaped area he lasered.
The removed lump.
 Dr. Todd stitching up the tissues and skin.
The finished stitching and stapling.
The lump under Jenny's arm (after Dr. Karen drained it of most of it's blood filling yesterday)
 Dr. Amanda removing Jenny's lump.
Stitching up the incision.
The finished stitching.
Dr. Karen lasering off the tiny lump/cyst by Kabu's eye.
After the lasering.  The small brown spot was where the lump/cyst used to be.

                The declaw procedures were simpler than I thought they’d be, but then again I wasn’t sure how these procedures were done in the first place.  After putting the cats (Ozzie and Harriet) under anesthesia, Dr. Lou showed me how to properly cut the claw below the joint (where the claw would start to bleed; animals get very nervous when their claws/nails get trimmed because a vessel runs into each claw/nail, and if they are cut down too low, they start to bleed.  Just like if a human nail gets cut down too far).  After cutting the claw down about as far as it can be cut, Dr. Lou pulled out the last bit of claw that was left in the toe and showed me how a smooth bone should be clearly seen.  Once she finished that, she tissue-glued the toe shut and moved on to the next claw.
Dr. Lou jutting out the claw so she could cut it.
Dr. Lou cutting the claw.
 Pulling out the last bit of claw.
Showing me the smooth bone that should be seen.
Gluing the claw hole shut.
The removed claws.

                The last thing I was shown today was a blood test for a cat that tested for heartworm disease, FIV antibody (Feline Immunodeficiency Virus), and FeLV antigen (Feline Leukemia Virus).  The test is called the ELISA Test, and it detects the presence of the tested disease(s) in the blood.  An enzyme that is on the test attaches to detected antibodies, so if the antibody for the disease is detected, it causes a color change on the test.  After waiting for ten minutes and seeing the results, the cat luckily didn’t have anything wrong with her, but she of course still received some prevention medicine so she could continue being healthy.
This is an ELISA Test.

This picture labels what each mark tests for.  The red dot is where the drop of blood is placed, and if any of the blue dots are seen after ten minutes than that detects that the cat has that disease (the positive control dot basically means you performed the test correctly, so it always shows up to let you know that even if no diseases are detected).

Tuesday, May 29, 2012

Day 7: Lots of Patient Check-ups and Small Issues

              Today was an extremely slow day.  For the first six hours that I was there, we only had a few patients, and they were all there for basic checkup appointments, blood work, and nail clippings.  I held animals for the Veterinarians and assisted them whenever they needed help with these appointments, but because we didn’t have very many patients, I spent a lot of time keeping myself busy by cleaning cages and feeding the animals. Some of the patients that we had go home today were Reagan (the bulldog who had the twisted stomach), Mr. Knightly (the cocker spaniel who had anemia), and JoJo (the beagle whose body went into shock).  All of them were healing and doing nicely, so they were able to go home today.  Monstarr (the dog with parvovirus) wasn’t much better since yesterday, though that’s expected since it can take a dog up to four weeks to start recovering from the virus.  She was receiving fluids and antibiotics, and for the most part she seemed fine; by fine, I mean she wasn’t throwing up or having diarrhea like she did a couple of times yesterday, so that of course was good news.

JoJo, feeling much better and much more entergetic.

                Once mid-afternoon (2:00ish) came around, though, we had a rush of patients for about 1/1.5 hours.  There was a dog named Jenny that came in who had a red lump in the armpit area of her front left leg that was filled with a mysterious fluid.  Dr. Karen poked the lump with a needle and drew out some of the fluid for testing, and then Tracey squeezed the lump to get the rest of the fluid out.  It was thick, like clotting blood.  This had Tracey and Dr. Karen baffled, and after testing it they said it seemed like just a harmless mass cell, but it was a strange sight for me to see because of its coloring and placing.  But since it appears to be harmless, that is a of course a good sign.  Dr. Karen also showed me that Jenny had a growth in her mouth (and she’s had it for a while).  From what they told me that seemed to be just a harmless mass cell also, but they weren’t able to remove it when they discovered it because of its placing on the roof of her mouth.  The growth started growing again recently, and it was growing up into her sinuses and giving her trouble breathing.  She sounded like she was having a difficult time breathing through her nose, but because the placing of the growth prevented them from removing it when they discovered it, the outcome is to be determined. 
Jenny, the dog who had the unusual growths in her mouth and armpit.
Dr. Karen trying to get a sample of the lump's fluids.
The lump after Dr. Karen and Tracey squeezed the majority of the unusual fluids out.
The growth inside Jenny's mouth.
After Jenny, an extremely sweet cocker spaniel named Lilly came in who had hurt her bottom, and she was hurting it even worse because she kept scooting around on rough surfaces.  Dr. Lou gave her owner some medication and ointment to help her bottom stop hurting.  After Lilly, we had a malamute mix getting bandages removed, a cocker spaniel-mix puppy named Gracie who had gnats by her eyes, and a stray shih tzu-mix who had some sort of reaction (probably scratches that got infected) on her eyes.  The malamute-mix had gotten her tail slammed in a door a couple of weeks ago, and was getting the bandages removed today.  She didn’t fuss a bit when the bandage and tape came off, and her tail was healing fine; though it wasn’t healed enough for the bandages to remain off, so Dr. Mark took some new bandages and rewrapped it for her.  We of course felt bad for the poor girl since she lost most of her tail due to the door slamming, but her tail looks funny since she has lots of fur where her tail starts, and then it turns into a thin vertebrae (since it had to be shaved down for her surgery).   But anyway she is healing just fine, so she was re-bandaged and able to go home.  Gracie just needed to have the mats cut out of the fur around her eyes, so she was able to go back home pretty quickly as well. The shih tzu stray had extremely red and blotchy eyes, and she tried to bite anyone to even got close to touching her head and/or eyes.  Dr. Mark said the best thing to do would be to give her prescription  eye drops three times a day,  but she was being so aggressive he wasn’t sure how that was going to work.  Stephanie placed her back in her cage while Dr. Mark thought over what the best solution would be.  I’m going to have to see what that decision was and how she is doing tomorrow.
The sweet cocker spaniel, Lilly.

The malamute mix, still wearing her cone (to prevent her from fussing with her tail), and her bandages. 

The tail of the malamute mix.

Gracie. The mats can't be seen as clearly in this picture as I thought they could be, but she has a few hair clumps around her eyes, which are the mats of hair).

The stray shih tzu.  As the picture shows, her eyes are extremely red and blotchy and they look like they are in a lot of pain.  Hopefully either she will allow us to give her the eyedrops, or we find another solution so her eyes can feel better.
Two more so uncommon cases we had today were we received an iguana and a box of kittens.  The owner of the iguana was moving to a new apartment and wasn’t allowed to have any pets.  She tried to find someone to take the iguana, but unfortunately no one would so she brought him to have him euthanized.  About an hour before I left for the evening, a police officer brought in a box of four stray kittens she had found (two boys and two girls).  The kittens were only a few weeks old, and were starving.  We weighed them and took their temperature before feeding them to make sure they were healthy enough to have food (if they aren’t warm enough [around 98oF], their stomachs can act up and cause them to get sick).  Three of them were fine, and so we began to bottle-feed them with warm kitten formula right after checking them.  One of the boys wasn’t warm enough, however, so we gave him some warm fluids, wrapped him in a blanket, and placed him on a heating pad for about ten minutes and then he was able to have some food, too.  After feeding kittens, they have to be stimulated to go to the backroom, meaning that their bottoms and undersides have to be gently rubbed with a warm cloth or piece of gauze. After we stimulated them and they went to the bathroom, we placed them in a cage with a heating pad and lots of blankets so they could get some rest.
                                          The iguana right before he was euthanized.

                                     Three of the kittens that were found and brought in.

Monday, May 28, 2012

Day 6: Description of Parvovirus, Diabetes, Anemia, Description of Gastric Dilatation Volvulus, Liver Tumor, Drain Rinsings, Description of Heat Shock

Today was strictly emergency hours because of the holiday, but it was still fairly busy; we had at least one patient at a time throughout most of the day.  When I first came in today, Lauren was moving a dog named Monstarr, who has parvovirus, into the isolated room (which is the room there we house any stray cats we receive).  Lauren was placing Monstarr into the stray cat room because parvovirus is extremely contagious to other dogs, but it doesn’t affect cats; so that was really the only safe room for Monstarr to be in.  Parvovirus is passed through the feces, so direct or indirect contact with an infected dog’s feces will cause other dogs to pick up the virus.  Symptoms of this virus are lethargy, vomiting, and diarrhea.  Also, the feces of an infected dog have a very distinct smell, which is an automatic, easy-to-recognize alarm if a dog has the virus.  Unfortunately, Monstarr had the virus, so she has to stay isolated from other dogs and her family for a few days while we observe her, give her antibiotics, and allow her to rest.
           Monstarr resting right after being moved to her cage in the stray cat ward.
A second patient I was able to see today was Jetta, a tabby cat who had been at the hospital since yesterday.   Jetta has diabetes, and unfortunately for her, her owners never really seemed to take that fact into consideration when it came to what they fed her, the amount they fed her, and when they fed her.  Nancy told me that a normal, healthy range for a cat’s glucose is 110-220, but Jetta’s glucose was at a mere 41 today.   Yesterday, however, her glucose had been extremely high; so it’s strange that her glucose levels took such a dive, and really strange that her levels were so drastically above or below the healthy range.  Dr. Christy told me that since her owners never really paid attention to her diabetes, her body was all out of whack and not metabolizing sugar properly.  Since she had so little insulin being produced, the body was breaking down fat instead of glucose, which created acid groups called ketones.  These are extremely harmful to the body, and if they build up they can lead to diabetic ketoacidosis, which in turn can cause death.  This poor cat was so weak she wouldn’t move, eat, or drink.  She was being given fluids, antibiotics, and some insulin, but she still seemed to be in a really bad state.  Lauren tried to get her to eat and drink, but she wouldn’t.  The Vets and technicians kept checking blood and urine, but she didn’t seem much better when I left for the evening.  I’ll have to check on her tomorrow and see how she’s doing.
Jetta after we triedn to feed her. She didn't chew or swallow and doesn't move or change positions unless we do it for her.

A new patient we had today was a cocker spaniel named Mr. Knightley.  He had anemia and liver problems, so he was receiving a blood transfusion and receiving the antibiotics of Flagyl (aka Metronidazole, helps with intestinal infections), Ampicillin (helps clean the urinary tract), and Cerenia (helps with nausea). Anemia is the deficiency of red blood cells and/or hemoglobin, which is why he was receiving the blood transfusion.  He was quite pale and weak this morning when he came in, even his gums were nearly white; but thankfully he got better and better and perked up as the day went on.
                                                                       Mr. Knightly
Mr. Knightley's gums.  As the picture shows, his gums are pretty pale.  This is improved color from what they were when he first came in; his gums were pretty much white at that time.

We had two cases within the past two day which either involved CPR, or almost involved CPR.  The first case was with a bulldog named Reagan.  He came in yesterday (when I wasn’t there), so I didn’t actually see what had happened but the Veterinarians and technicians told me what had happened: his stomach had bloated and twisted 180-degrees sometime while he was at home; since the stomachs of dogs hang down, this can happen quite easily, especially with medium-sized and larger dogs.  It is really harmful to the dog because it releases toxins and doesn’t allow anything to enter or leave the stomach, which prevents the dog from getting nutrition and from releasing digested food, and causes the stomach to bloat even further.  Because the blood supply is being cut off to and from the stomach, the stomach tissue begins to die.  This can result in death, so the dog needs to be taken to the hospital right away when this happens so that he/she can receive the surgical procedure that will fix his/her stomach.  Reagan’s family rushed him into the vet hospital as soon as they discovered his stomach had twisted, but right after he had gotten to the hospital his body had arrested (stopped breathing) and he passed away.  Dr. Amanda and Dr. Karen performed CPR on him, and thankfully they were able to bring him back to life.  They rushed him into surgery and they untwisted his stomach, and he has been in recovery since that time yesterday.  From what I saw of him today, he seemed pretty healthy!  He was energetic and eating, which of course were very good signs, and he was able to go home during the afternoon today.
Side view of Reagan.  His stomach is still a little bloated, though it isn't nearly as bloated as it was yesterday.

The second case that almost involved CPR was with a cat.  A family brought in an orange tabby cat named Pumpkin whom had hyperthyroid issues.  He had been having trouble breathing and was very lethargic over the course of the past few days, but the family didn’t bring him in to get him checked out (which I don’t understand) until today.  However, he had died on the way over to the hospital, and by the time we had him in our hands it was too late to try and save him; Dr. Christy was going to attempt CPR but then realized from quickly checking the cat that it was too late.  It was really unfortunate.   While we were trying to find out what exact cause of Pumpkin’s death was, Dr. Christy found a huge tumor in his liver.  She let me feel it through his skin, and it was huge and as hard as a rock.  If that had anything to do with his death, I’m not sure; we didn’t really find what the exact cause of his death was, but I‘m sure the tumor and hyperthyroid all contributed to it.  We made a remembrance paw print for his family, bagged him with a tag including his name and information, and placed him in the freezer outside for All Paws.
Pumpkin after he was taken out of his carrying crate; Dr. Christy had just felt his pulse and breathing and discovered he was dead (and had been for a little bit), and she is feeling the liver tumor right now.

Some miscellaneous and/or smaller cases we had today were a pug with cornea issues, a stray snake, a checkup for Buddy, and a Pomeranian-Keeshond mix that had a fractured pelvis.  Pugs are a breed of dog that genetically don’t produce a lot of tears, and because of this they can have cornea issues.  Dr. Christy checked his eyes and gave him some eye drops to keep his eyes moist, and he was placed in the dog ward for some observation.  The snake had been found by someone along a road near where he lived, so the snake was caught and brought in.  Buddy was a dog that had gotten into a car accident around Tuesday night of last week (he came in after I had left for the evening that day), and he was just getting a checkup to make sure he was healing properly and that his drains had been working properly.  He was healing up fine and his drains were working wonderfully, so Dr. Christy cleaned off dried blood (his family never wiped the blood or dried blood off of him), took the drains out, and he was able to go home again for the time being.  The Pomeranian-Keeshond mix was named Lou, and he had a fracture pelvis.  He was given a morphine shot to lessen the pain, and was given painkillers to take home.  He too was able to go home after he was checked out.  The remaining Chihuahuas who had eaten the castor beans, Ninja and Oreo, were able to leave and go home over the weekend as well.
The pug and his dry eyes
Dr. Christy testing and flushing the drains in Buddy.
Buddy after being all cleaned up and having his drains removed.
The stray snake.  I'm not sure what is going to happen with him.
Lou.  He didn't seem to be in much pain when I saw and held him, so hopefully his pelvis wasn't completely broken and/or the morphine was starting to work.

The last major case of the day before I left was a beagle named JoJo whose body was going into shock, and he was having bloody diarrhea.  His family had been playing and exercising with him outside in the sunny, hot, 95-degree weather for over an hour, and JoJo had heat stroke.  To cool him off, his family hosed him down with cold water, which sent his body into shock and he started throwing up and having explosive and bloody diarrhea.  The poor guy looked so sad in like he was in such pain when he arrived.  He was cooled off too quickly with water that was too cold, which was causing his hypothalamus (a gland in the forebrain that coordinates autonomic nerve and the pituitary gland) to act up and think he was still warm because he had been cooled off so quickly.  His body temperature was low (around 98-degrees) so we gave him fluids, and worked on warming him up.  We wrapped him in about five thick blankets, placed him on a heating pad, placed another heating pad on top of him because his temperature continued to drop, and a bunch of us were half hugging, half laying across him so he could absorb our body heat.  His body heat dropped from 98.9oF to 98 oF, then 96.7 oF, then97.6 oF, then 97.3 oF, then to 96.5 oF,  and after about a half hour of warming him his body temperature finally started going back up towards 97 oF.  We were really worried for a while because if his body temperature continued to drop, it could have gotten to the point where the odds of us being able to save him would have been pretty slim; but luckily, we didn’t reach that point because he began to slowly warm up. Throughout this warming period, the only real obstacle we faced was that he tried to get up and off the heating pad a few times, and the bloody diarrhea kept coming and getting all over his blankets and towels. We continuously had to change the cloths and clean up the messes so he wouldn’t be covered in his own blood and fecal matter.  As I had said before all we wanted to do was make him better because we could tell he was upset about it and didn’t feel good, so the fact that we were able to get his temperature to start rising was a really good sign.  We moved him to the dog ward, and when I left he was still warming up but also still having the bloody diarrhea, so I will check on him again tomorrow to see how he is recovering and feeling.
Poor JoJo.. This was his facial expression throughout the majority of the time that we were treating him.

Sunday, May 27, 2012

Day 5: Description of a Spay and Different Lump Removals

Today was much busier than yesterday.  Early morning was spent mostly cleaning and doing some chores (feedings, cage cleanings, etc.), in addition to some regular checkup appointments.  Late morning was when it started to pick up, and we had a few surgeries scheduled throughout the day: two spays, and two unidentifiable lump removals.  I watched the first spay, which was on a Spanish bulldog mix.   Dr. Mark performed the surgery, and he explained how the incision is made right below the ribs, in between the kidneys (the incision is vertical, parallel to the spine).  After the incision is made, look for the Linea Alba (‘white line’ in Latin) where all the abdominal muscles come together.  He said you want to make an incision directly down that line, otherwise all sorts of muscle problems could come up if you don’t make the incision down that line.  Once he finished that incision, he cut the ligament of fat which separates the uterus from the body and pulled out the ovaries, uterus, uterine horns, and fallopian tubes (everything was of course attached together so he just pulled the whole bundle out).  He tied off the fallopian tubes, and then tore the broad ligament (the huge glob of fatty tissue around the uterus) and we were able to see the uterine horn, which he also tied off.  He tied off the uterus, cut off the uterus, uterine horns, and ovaries, and then placed the uterine stump back into the body.  He made sure there was no internal bleeding after replacing the stump, and then stitched the abdominal muscles, tissues, and skin back together with individual stitching again (I found out that they do individual stitches because that way, if one pops or something happens to one of them, all of the other stitches are still in place and will be unaffected.  I had never thought about/considered that before.).  Pat and I then turned off the machines and began to wake the dog up after we moved her to the recovery room.  When she finally woke up she seemed to be doing well throughout the day and was able to go home later.
The Spanish bulldog mix.   Her front legs are crossed across her body because it's harder for bigger dogs to balance on the surgery table when their legs are spread open, so they balance much better ehen their front legs are crossed.
                                                    The uterus and surrounding fat.
                         Another view of the uterus.  An ovary can also be seen by the clamp.
                                              An ovary, fallopian tube, and uterine horn.
                                    Dr. Mark pulling the uterine horns apart from the uterus. 
          The uterus, uterine horns, fallopian tubes, and ovaries which were removed from the dog.
                              The tied-off uterine stump, which he is replacing into the body.
                                                The dog all stitched back up.

The second surgery I watched was a lump removal from a dog that was a mix.  Dr. Mark performed this surgery as well, and the lump was going to be sent out for tests to see if it was cancerous or not.  The lump was on the right thigh of the dog, and Dr. Mark made a large diamond shaped cut around the lump, to make sure that any stray cells were taken out as well.  He cut off the diamond-shaped area of skin (since the lump was on the surface of the skin and not any deeper), placed that area in a jar to be sent out for testing, and then began to stitch the area closed.  He cut the area a bit wide so pulling the skin together to stitch it up was a bit of a tight fit, but he was able to stitch it up and then stabled over the stitches as well to make sure it would hold.  Pat and I again moved him to the recovery room and woke him up, and he seemed to be doing well as the day went on too.
     Dr. Mark removing the diamond-shape area of skin.  The pink spot is the lump being removed.
The underside of the skin area.  Skin cells can be seen, and the area of skin is just about fully removed.
                     Dr. Mark lazering off a couple of cells that were excessively bleeding.
Stitching the thigh back up.  The clamps on the far side of the cut are helping hold the two pieces of skin together while he stitches up the other side.  After making a few stitches, he would then staple the area he sewed to make sure the cut wouldn't accidently split open at any point.
                                      The dog's thigh all stitched and stapled up.

The third surgery I was able to see was another lump removal, only this one was a little different.  It was on the right side of a dog, and it was huge; it was about the size, if not bigger than, a golf ball.  Dr. Roberta performed this surgery, and since the lump was so big she decided to cut into the lump after removing it to see if she could tell what composed the lump.  She did the same thing Dr. Mark did, meaning she made a diamond-shaped cut in the skin, only hers wasn’t as large of a cut.  She had to dig a little bit to get the whole lump out, because it was under the skin; she didn’t have to dig too far though.  She then took the area of skin and lump out, placed them on a nearby table, and then sewed the two sides of skin together.  Nancy, one of the technicians, cut into the lump, and a bunch of brown goop was just pouring out of it.  Even though it was strange to my eyes, Nancy and Dr. Roberta said it was nothing to worry about; the brown goop was simply pus and other toxins which had gotten trapped under the skin and just kept growing.   So, luckily for the dog, the giant lump was harmless.
                                                       The lump on the side of the dog.
                                                     Dr. Roberta removing the lump.
                                            The lump removed from the dog and the skin.
                                  The brown goop (harmless pus, dirt, etc.) inside the lump.
                                                         Stitching the dog back up.
                                                      The finalized stitching.