Veterinary Internship: Day 12: Kidney Failure, Small Procedures/Diagnosis', Growth Bubble, and Broken Leg/Rod Insertion Surgery

When I first came in, I saw we had a white, domestic short-haired (DSH) cat that had come in sometime last night. Her name is Butthead, and she has kidney failure. She was very lethargic, but still able to slowly move around. She was being given fluids and Famotidine (a histamine blocker [histamine is a compound the body releases in response to injury, allergy, etc. It contracts smooth muscle and dilates capillaries, and Famotidine prevents this from happening]), Cerenia (a neurokinin receptor antagonist which prevents vomiting), and Clavamox (a β-lactam antibiotic and a β-lactamase inhibitor; certain types of bacteria produce the β-lactamase enzyme, which will break the β-lactam ring structure of penicillin-like antibiotics. This will cause the antibiotics to be ineffective against the infection, so the β-lactamase inhibitor of this antibiotic prevents the bacteria from producing the β-lactamase enzyme so that this doesn’t happen and the antibiotic will work. Also, this antibiotic contains β-lactam, which interferes with the synthesis of the bacterial cell wall and ends up killing off the bacteria. So, the point of β-lactamase and β-lactam working together is to use β-lactamase to prevent the bacteria from releasing an enzyme that will prevent the antibiotic from working, while at the same time having the β-lactam kill off the bacterial cells). Nothing had changed with Butthead’s medicines or state of being when I left, so I’ll check to see how she is doing tomorrow.

The DSH cat, Butthead.

Some patient appointments we had today were a bullmastiff named Sargeant, a bulldog named Titus, a Westie Terrier named Derby, a veiled chameleon named Charlie, and a white tabby named Pete Pebbles. The bullmastiff had unfortunately been euthanized right before I arrived today. I asked Dr. Lou what had happened to him, and she told me that she wasn’t quite sure; but based on what she observed and examined with Sargeant, she came to the conclusion/thinks that a tumor had ruptured in either his heart or abdomen (or both), because he had fluid and blood filled up in his chest and abdomen, which was of course painful and uncomfortable for him. There is also really no way to fix this once it’s happened. Because of this, the family decided to euthanize him. He was a really large dog; after helping Lauren make the clay remembrance paw print for the family, I helped Nancy bag him and place him out in the freezer for All Paws. For a quick update, after I helped with Sargeant, Buddy (the dog who had gotten into a car accident around day 2/day 3 and who had been in getting his drains checked on day 6) came back today to get the last bit of his stitches out. He had healed up nicely, which was really good to see.

Sargeant, the bullmastif.

Happy Buddy after getting the last of his stitches out.

Titus came in because he was having inappropriate urination; meaning, he was going to the bathroom in the house, which the owners said he had never done before this past week. Dr. Karen was thinking that he may have a bladder infection, and she needed a urine sample to run tests on so Tracey took him outside so he would go to the bathroom. He wouldn’t go to the bathroom while they were outside, though, so Dr. Karen took a thin tube and inserted it up his penis, through the urethra, into the bladder so obtain the sample. After the tests were done, she couldn’t find anything wrong with his urine, so she told the owners to observe his behavior and dietary habits for the next couple of days and if nothing changes, to bring Titus back in and they will run more tests. Derby had a dental appointment in addition to her growth removal, so Tracey performed the dental procedure first and then Dr. Kris took the laser and lasered the growth off of her neck. The chameleon, Charlie, had a growth bubble on the top of his head. He kept trying to bite, so we wrapped him in a towel and Dr. Lou opened up the growth with a needle while Vet technician Karen held him for her. A lot of pus and other clear fluid came out of the bubble, but then there was something harder in the growth that just wouldn’t come out, no matter what Dr. Lou tried to do. She originally was going to recommend having it surgically removed, but she instead flushed the inside of the growth out with saline solution and sent him home with antibiotics to kill off any bacteria in the growth (I don’t know if Dr. Lou changed her mind or if the family said ‘no’ to the surgical procedure).

Titus, the bulldog.

Side view of Titus. He was a chubby yet playful boy.

The Westie, Derby.

The lump on Derby's neck.

Charlie, the veiled chameleon.

The growth bubble on Charlies head (the green and brown striped sphere is his eye, and the brown-grey sphere right above that is the growth bubble).

Pete Pebbles was the only surgery (besides a declaw) that we had today, and it was a major surgery. He was brought in today for vomiting, and while he was being checked on the doctors realized he had a broken leg. According to his owner, he had been limping for about five weeks, so his leg had probably broken five weeks ago. However, the owner claimed to not even know of such a circumstance, which makes no sense to me; and it irritates me that the owner realized something was wrong but chose to do nothing about it, because now the animal has been in unnecessary pain for this long of a time. The leg was fractured at the knee, and since this happened five weeks ago the bone naturally started to heal on its own. Also naturally (and unfortunately), the bone healed very crookedly, and in the wrong area. Dr. Mark took the cat into surgery to fix the leg. He gently ran his blade through the skin, tissue, and muscle to the bone, and then spent a bit trying to cut and pull off the scar tissue so he could directly access the bone. Once he got to the bone and contemplated what he was dealing with, he re-broke the knee so he could fix it properly. However, because the bone had started to heal so crookedly, the edges of bone that had been rubbing together were extremely crooked now and he couldn’t get them to stay together because they kept slipping and moving; therefore, he placed a pin in the kneecap to keep the bone together so it would heal properly. Stephanie got him a sterilized drill and pin, and Dr. Mark diligently worked at getting the pin in over the course of about 45 minutes (he considered putting two pins in, but the bone is fairly small and he didn’t want to take the chance of damaging the bone, or having the pins conflict with each other). The pin was quite long compared to the size of the cat. He drilled the bone all the way through the thigh bone (and through the skin up at the top of his thigh; the pin has to go all the way through the leg to ensure that the pin is at the correct angle. If it’s even slightly off, it could ruin both the bone and the procedure), and he worked on regaining control of the pin before switching sides and starting to slightly drill back the way he came so the pin would also go into the bones at the knee (he called this a fracture grade [going through the thigh bone], reduce [gaining control], and normal grade back [gently and partially going back the way he came from to connect the two bones with the pin]). After he connected the two bones with the pin, he moved the leg to make sure everything looked okay worked properly, which everything did. Dr. Mark then cut off the excess pin sticking out of Pete Pebbles’ leg, and sewed up the surgical incision and the hole caused by the pin going through his leg. After bandaging and wrapping the leg, we placed him in recovery on some blankets so he would be fairly comfortable and relaxed when he woke up.

Dr. Mark slicing through the skin, tissue, and muscle of Pete Pebbles' knee to access the bone.

Cutting and pulling away all the scar tissue on the bone.

A view of all the different muscle and tissue layers. The light purple/grey triangle in the middle is the bone.

Another view of the different layers and bone.

After re-breaking the bone; the bone here is sticking up, by Dr. Mark's thumb.

Getting ready to drill the pin into the bone.

Drilling the pin into the bone.

Regaining control of the pin before/while switching sides.

The pin all the way through the thigh bone (which is again sticking out with the left side of the pin). As I had said, it was a long pin compared to the cat.

Moving the leg back and forth, after drilling part of the pin back into the other bone, to make sure the leg moved properly and to make sure the bone movement and pin placing looked okay.

Stitching the incision up.

Cutting off the excess pin before stitching that small hole up (Dr. Mark had to make the hole that the pin made in the skin a little bigger because the skin was getting caught/wrapped in the drill, so to stop that he made the hole a little bigger, as will be seen in the next picture).