Tuesday, June 12, 2012

Day 17: ACL Surgery and a lot of Firsts

            Today, not much happened before the afternoon hit (we didn’t even have that many tech appointments).  The only real procedures that we had this morning were a neuter on a tiny Shi Tzu and a dental on a Saint Bernard.  The Saint Bernard, named Charlie, was a little aggressive towards a lot of us, which made him really difficult to deal with.  But he was deaf, so I’m sure he was scared and frightened because he couldn’t hear us talking to him and never really knew what was going to happen when we would come to get him.  Everything was able to be done and no one got hurt, so all in all everything worked out fine with him.  Spike is feeling much better today; in addition to having his energy back, he’s not vomiting anymore, and he’s passing solid stools again.
The deaf Saint Bernard, Charlie.  Normally he would have been up barking like crazy and trying to jump the gate, but I was able to get a picture of him while he was taking a nap.

The afternoon today, however, had a few firsts for me; my first time seeing a torn ACL and ACL surgery, my first time trimming nails on a conscious dog, and my first time measuring out and giving medicine to an animal by myself.  The ACL surgery (or what we thought was an ACL surgery) was on the back right leg of a Pitbull named Roxy, and this surgery was an interesting one because rather than the ACL (anterior cruciate ligament) tearing in the knee joint, the CCL (caudal [posterior] cruciate ligament) tore instead; Dr. Mark said that it’s a very rare occurrence for the CCL to tear.  During the surgery, he placed extracapsular (outside the capsular ligament of a joint) sutures from the patellar tendon (tendon that crosses over the kneecap) to the caudal tibia (the groove in the kneecap where the CCL and ACL cross) and fibular head (the top of the bone that runs between the knee and the ankle).  Doing this would make the tenants slip less, so in addition to helping the torn ligament heal, it would also help prevent it from happening again.  After placing the suture and sewing the incision up, he removed a small mass cell growth on the inside thigh of the back left leg.  The mass cell was very tiny and not much of a lump at all; when I first saw it, I thought it was just a small discoloration on Roxy’s skin.  However, it was, in fact, a mass cell; Dr. Mark told me that while most mass cells are bigger and you can usually tell right away that it’s a mass cell, some of them come in weird shapes and sizes and an eye always has to be kept on the lookout for them.  This procedure was the same as the others: cut a large (relative to the size of the growth) diamond shape in the skin around the growth, remove that part of the skin and place it in a jar to be sent out for testing, and stitch up the skin.  After this was done, Roxy was all set to be moved to the recovery ward to be woken up.
This picture shows the anatomy of a knee (even though it's a human knee, it's pretty similar anatomy in dogs).  As it can be seen, the CCl/PCL is crossed directly behind the ACL, partially why it's a rare occurance to tear and a tricky tear to fix.

Cutting away tissue to get to the tibia and torn ligament.

Dr. Mark feeling around to see what he has to work with.  The femur can be seen sticking out next to his finger. 

Moving the leg up and down to see how the kneecap and torn CCL move.

The drill and small drill screws he'll use to make a hole in the fibular head so he can loop the extracapsular sutures through and connect everything.

Drilling the hole into the fibular head.

Connecting everything (the patellar tendon, caudal tibia, and fibular head) together.

Suturing the incision up.

The area circled in black is the small mass cell that needed removing.

Making the diamond-shape cut in the skin around the mass cell.

Cutting/pulling the skin area with the mass cell off.

The last couple of things that I was able to do before I left today was trim nails on a conscious dog for the first time, and give a kitten its medicine.  These were some big deals for me when it comes to my hands-on experience, because caution has to be taken when doing them, especially when doing them for the first couple of times.  Since I’ve never trimmed nails on a conscious dog before, I had to be really careful about the dog (Sandy, a Dachshund) moving and pulling her legs while at the same time, being careful to not cut too far down, which would cause her to bleed and feel pain.  I was a little slower than the other techs are when they trim nails (which is understandable), but I didn’t cause her to bleed and the techs told me I did a very nice job.  That, of course, made me feel really good about this task!  It also made me feel a bit better about trimming nails.  I still don’t like nail trims (the anticipation of waiting for the dog or cat to start freaking out is what freaks me out—I hate anticipation), but I think with each nail trim I help with (or actually do myself, now), I’m starting to feel slightly better about them.  After I trimmed Sandy’s nails, Nancy asked me if I wanted to give medicine to a stray kitten (whom I call Cream Soda).  The medicine the kitten was on was Doxycycline V.A.L syrup, which fights upper respiratory infections.  The dosage was 0.13 cc’s of the medicine, so I correctly measured out the medicine (while also getting rid of the air bubbles that came into the syringe with the medicine), and then gave the kitten her medicine.  Again, this was a happy first step for me because each week I’m being allowed to help more and more with medical tasks.  The fact that I understand the medicinal dosages and am starting to better understand the medicines, in addition to the fact that I’m now starting to be able to give the medicine myself, makes me very happy.  It also makes me feel much more helpful for the Veterinarians and techs, in addition to feeling much more helpful to the animals themselves.
Cream Soda, who has the upper respiratory infection.  Her eyes are red, swollen, and squinty becasue upper respiratory infections also affect the eyes (therefore, the eyes are a key symptom of an upper respiratory infection). 

The Doxycycline V.A.L syrup.

The syringe (after I gave the medicine, hence the brown).  This specific syringe is meant for small amimals, and it's measured in the tiny amounts of tenths of a cc (same as tenths of a mL). 

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