Day 33: Pyometra Description (Spays and Neuters are Important!!!!) and Gastric Dilatation and Volvulus

                Today was a very busy day!  We were packed with technician appointments, and we also had a couple of emergencies.  The first emergency was a transfer Shepard mix, named Mack, who had GDV (Gastric Dilatation and Volvulus— basically, stomach bloat and twist).  As I said on day 6, stomach bloat and twist (GDV) is when the stomach bloats and twists 180-degrees.  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.  Mack was found with the GDV yesterday, at the kennel in which he was boarding at.  However, the vet who concluded that he had GDV didn’t perform surgery, nor did they send him over to our hospital until the next day! I couldn’t believe my ears when I heard that.  Mack was in so much pain, and the person who looked at him at the kennel, being a Veterinarian, knows that he is in a lot of pain and could die within a day or two.  I couldn’t believe it and didn’t understand at all what was going through that Veterinarian’s mind when he/she was looking at him.  But anyway, Mack made it to our hospital and made it through the surgery!  Getting him prepared for the surgery was difficult, because we were giving him anesthetics and hooking him up to the anesthesia machine, giving him fluids, and were also trying to get a tube into his stomach (through the twisted part) to get anything and everything out of his stomach.  That took a while because we couldn’t get the tube through, but once we did all sorts of thick, bloody fluid came rushing out and continued to come out for a couple of minutes.  And since the blood and fluid had been sitting in the stomach for a while, it smelled awful.  Once the fluid stopped coming out, we moved him to the surgery room and Pat got him ready for the surgery while Dr. Todd prepared for the surgery.  The surgery took a while (about an hour and a half or so [including the time it took to tube/drain the stomach before taking Mack into the surgery room]), because in addition to draining the stomach, blood kept needing to be drained from the surgical sight (so Dr. Todd could work properly) once the surgery was underway, he had to check the spleen to make sure it wasn’t damaged (the blood supply can also be cut off to the spleen when twist occurs—in such a case, the spleen would have to be removed), and Dr. Todd had to make sure the stomach was still relatively okay as well.  Part of the stomach was, of course, blackened (dead), but Dr. Todd said the dog would be okay.  He made a small incision in the dog’s body wall, and then sutured the stomach to the body wall.  This prevents the stomach from twisting again; however, the stomach can still bloat again, which is still an emergency situation, but not life-threatening like the stomach twisting.   No one knows for sure why the stomach bloats and/or twists, but the possibilities are that the dog could have poor motility, a tumor, a foreign body, drinking and/or eating too much too fast and then exercising and/or having a large air intake.  After Dr. Todd sutured the stomach to the body wall, he re-checked the innards to make sure everything looked okay and then sutured Mack up.  He was moved to the recovery room, and since he is staying the night to be observed, he was still in there when I left at the end of the day.  Even though he’s sleepy, dazed, and in pain from the surgery right now, he (much logically) seems to be feeling much better than he was this morning when he came in.  He was, of course, receiving antibiotics, pain medication, and fluids, and he should be feeling even better tomorrow!

Mack when he first came into the hospital.

His bloated stomach.

Placing the long tube down his esophagus, fighting to get it through the twisted part (this took a while), and finally getting it into his stomach to drain anything and everything that has been stuck in there.

Getting the tube in place to drain the stomach contents into the bucket.

The contents draining.

Massaging the stomach (and moving/flipping the dog over a few times) to help the contents get out.

Mack being prepared for surgery.

Blood clots began to drain from his stomach once the surgery began.

Making the incisions and starting to look around the area in the abdomen.

Moving organs around to get to the stomach.

The stomach; it can't be seen as clearly in this picture because of the lighting, but the darker parts of the stomach are completely black (the black parts are the dead tissue of the stomach).

The spleen; it was being checked to make sure it was okay and healthy too (which it was, thankfully).

Getting tubing ready to drain all the blood and fluid around/in the abdomen area.

Draining the blood and fluid out of the area.

The container on the side where the blood and fluid was draining to.

Making the incision in the body wall and suturing the stomach to the body wall, to prevent it from twisting again.

The finalized suturing and stapling.

                Later in the day, we had another transfer patient (a boxer named Ippy), who had pyometra.  Pyometra is a disease of the uterus caused by hormone fluctuations, where the uterus fills with pus.  This is another emergency case that causes serious pain for the animal, and can cause death if not treated quickly.  When pyometra occurs, the uterus has to be removed; so essentially, the animal has to be spayed.  Note: pyometra can be avoided by spaying your animal when they are young.  This is just one of the many reasons why you should spay or neuter your animal when they are young; many, many problems can arise if your animal isn’t spayed or neutered.  Jen, Nancy, and I first took x-rays to see how big the uterus was (it was huge), and then we injected her with an anesthetic, hooked her up to the anesthesia and oxygen machine, and took her into the surgery room and prepared her for surgery.  Dr. Amanda performed the surgery, and had a bit of a difficult time for a while because a) the uterus was huge, b) it kept getting caught on/tangled with other organs, and c) the uterus was so huge, even the littlest amount of force could cause the uterus to burst (which, of course, would cause the pus to get all over us, in addition complicating the surgery all together); so, Dr. Amanda was being extremely careful.  When she was finally able to get the uterus out, tie off the stump, and cut off the uterus, Stephanie and Jen weighed it and it weighed about seven pounds!  As I said, it was huge.  After Dr. Amanda stitched her up, Jen and I moved her to the recovery room.  I’m sure she felt so much better (besides the pain caused by having surgery) when she woke up!

Ippy, right when she arrived, right before x-rays.  She felt miserable.

The entire light grey area under her spine is her uterus.

Ippy's enlarged vulva, which was also dripping with the pus from her uterus.

Carefully retracting the uterus out of the body.

The whole 7-lb uterus once it was all out of the body.

Another view of the uterus.

Cutting the cuterus out after tying off the uterine stump.

The finalized suturing and stapling.

Day 32: Cysts and Strange Muscular Movement

Today was another really slow day.  We had no new patients in the recovery room or dog ward, besides a Pomeranian named Cutie who was getting spayed and a Domestic Short-Haired cat named TJ who was getting a cyst removed.   TJ’s cyst was HUGE; the biggest I’ve seen to date!  Dr. Mark removed it, and before he even did the procedure he knew the cyst was perfectly harmless (a giant pus-filled cyst and nothing more) because it was very squishy, and on the skin rather than under the skin.  Therefore, he just cut the skin around the cyst to remove it, and then sewed the skin back together.  He told me I could put on gloves and open the cyst if I’d like (which I wanted to), so I did; and just as he had said, the huge bubble-cyst was filled with pus fluid and nothing more.

Cutie the Pomeranian.

The giant cyst on TJ.

Dr. Mark removing the cyst.  As it can be seen, he is solely cutting the skin and no deeper, because the cyst was on the skin rather than under the skin.

Right after I had cut the cyst open.  The liquid all around it is all pus, and that's not even half of the amount of pus that's in the cyst.

Me squeezing out more of the pus.  As I said, it's completely fluid.

                In the afternoon, Buddy (the mini-lop rabbit from day 1 that was neutered and wouldn’t eat) came in because of his front right paw; he has always one this strange thing where hops with that paw sticking out to the side (as can be seen in the pictures), and that’s how he hops around, he really doesn’t use that leg or paw.  The owner doesn’t really know why, and she brought him in today because she thought his leg condition was getting worse.  Dr. Lou and Dr. Kris looked at it and felt the leg, and Dr. Lou said she could feel that the muscles in that leg were different than the muscles in the other leg.  But, there really wasn’t anything they could do about that, but it also wasn’t anything harmless to Buddy so it didn’t really matter (that nothing could be done) anyway.

Buddy, the Mini-Lop rabbit.

Dr. Lou feeling the muscles.

This picture shows how stranglely he hops with this leg/foot; as I said, he hops with t out to the side like this.

Another view how he hops and turns with it sort of pushed back and out to the side.

Day 31: Medication Ingestion/Poisoning and Bite Wounds

                Today was a little bit busier with technician appointments than the past couple of weeks have been, but still relatively slow when it came to surgeries or pets having actual issues or emergencies.  There was a neuter and a spay, and in the corral area of the recovery room, we have a Husky mix named Bear who had eaten Ibuprofen (and possibly some Zyrtec as well).  She was being given Famotidine (to protect the stomach and prevent it from being upset from the Ibuprofen/Zyrtec ingestion and/or from any other antibiotics she was being given), Carafate (to help treat any ulcers she was getting from an upset stomach), Misoprostol (help treat her upset stomach), Tramadol (to help reduce any pain), charcoal (to help get the Ibuprofen and Zyrtec out of her body), and fluids to hydrate her.  She had come in sometime on Sunday, and she seemed to be feeling better now.  She was very energetic and didn’t seem to be feeling badly at all; she also didn’t throw up or have any diarrhea during the day (unlike Bailey from day 24).  So, that is definitely a good sign.

Bear, the Husky mix.

                Later on in the day, we had an emergency of JoJo, a Doxy, who had gotten attacked and bitten by a pit bull.  She had two large holes where teeth had gone through, and she had some other smaller places on her neck where teeth had made other marks (but not large holes).  Dr. Lou first gave her some propathol (a type of anesthesia), and once she was asleep and hooked up to oxygen and a gentle, continuous flow of anesthesia gas, her holes and wounds were flushed with saline solution, and then Dr. Lou felt around her throat and in her wounds to search for any pockets (cavities in the skin as a result of the injury).  She did find some, so she inserted a tube through the hole wounds to drain the bodily fluids that would start to fill up in the pockets.  This way, the wounds would be able to heal. Dr. Lou sewed up the holes and then sewed to the tube to her skin so it wouldn’t move around or fall out.  The tube is going to have to stay there for a few days (up to a week) to make sure all the fluids get drained and to make sure the wounds are able to heal properly.

Side view of JoJo the Doxy.  She was very chubby, and it made her very cute.

JoJo.  She was very shy and seemed very worried (she was a bit shaky), but she was very sweet and calm for us.

Giving JoJo the Propathol.

The two major holes/tears in her neck.

Flushing the wounds.

Dr. Lou checking for (and discovering) the pockets.

Placing in the drainage tube.

Sewing up the excess hole area (that the tube isn't occupying).

The finished project, with the tube cut the the appropriate length, sewn to the skin (so it won't move around or slip out), and the excess parts of the holes (where the tube isn't occupying space) sewn shut.

Day 30: Upper Respiratory Infections

                Today was another day where not too much happened, besides mostly simple checkups and some Tech appointments.   I spent about half of the morning in the isolation room (stray cat ward), cleaning out each cage and giving all the cats new blankets, litter, water, and food.  During the earlier period of my cleaning, I was cleaning the cage of three kittens that had come in a few weeks ago, and I noticed one of the kittens was continuously sitting in the corner of the cage, even when I would scoop her up and place her out of the cage so she could run around the room and play with her siblings while I cleaned (she kept moving back into the cage).  I noticed she had her head down as well, so I scooped her up again and lifted her head; she had all sorts of goop around and coming out of her eyes (she could also barely open her eyes), she had a lot of yellow congestion coming out of her nose, and she seemed to have a fever as well.  I knew right away that she had a bad upper respiratory infection based on these symptoms. These three kittens had come in with upper respiratory infections, but this kitten had an infection worse than her two siblings; they all received ten days of Doxycycline., and since she has an infection that is even worse than the one she had a few weeks ago, I narrowed it down to either she didn’t fully recover from the infection she had before, or she either has a weak immune system or something is wrong with her immune system.  I took her out into the main area and showed her to Pat, and asked her what medication I should give the kitten.  Pat told me to squeeze some Terramycin (medication placed in the eyes that fights off bacterial infections, as such) into her eyes for now, and more medication would most likely be added later when a doctor or another tech was able to take a look at her.  I took her back to the isolation room and placed some Terramycin in her eyes, and since we had an unused cage at the time, I set her up a place in that cage away from her siblings (a] to try and prevent her siblings from getting the infection [even though they had already been exposed and therefore there is a possibility they would get it], and b] so she wouldn’t be bothered by her siblings and get some rest).  I gave her food, water, a litter box, and some extra blankets, and as soon as I placed her in the cage she curled up in her litter box and went to sleep.  I placed a blanket over her so she would stay warm, and let her be so she could get some rest.  I checked on her periodically throughout the day, giving her more medicine, wiping the goop and congestion out of her eyes and nose, and if I found her awake I gently stroked her head until she fell back asleep, though that usually didn’t take long; a couple of minutes at most.  The poor thing was exhausted.  I hope that she will be feeling a lot better when I can see her again on Monday.

The poor sick kitten.  This was taken right after I had wiped her eyes and nose, though some more goop and congestion is already starting coming out of her eyes and nose again.  She looked at the camera for a moment, and then curled up and went right back to sleep, poor thing. 

Day 29: Infections, Vaccines, and Tendonectomy Description

                Today was a bit busier than yesterday was; there were a couple spays and neuters and there were also a couple of patients we were taking care of in the recovery room: Purple, a Weimaraner puppy (six weeks), and Skittles, a Lhasa Apso.  Purple came in because of vomiting, fever, and an increased WBC (white blood cell) count, and she was receiving sub-q fluids in addition to the antibiotic Ampicillin (to fight any bacterial infections she may have).  Skittles is an old dog that can’t see well or hear, and because of that she was a bit aggressive because she never could tell what was going on or what was going to happen; she came in because she was having seizures.  She was receiving the tranquilizer Diazepam to help calm her down, and the doctors were recording her seizures.  Once I left the recovery room after I first arrived, Nancy was finishing shaving and beginning to wash a dog named Abbey.  Abbey was an old and cranky dog, and she was a long-time patient of the hospital.  I helped Nancy finish washing Abbey, and when we were done we dried her with a towel and Nancy allowed me to give Abbey her injections of a rabies shot and a booster-26 (protects against distemper and other such viruses) shot.  A rabies shot goes in the upper thigh of the back right leg, and a booster shot goes into the shoulder area of the front right leg.

Purple, the shy Weimaraner.

Skittles, the old Lhasa Apso.

Abbey after she was groomed (we all had fun picking out the scarf for her!)

Abbey as she was getting groomed.

                Dr. Amanda performed a neuter and a tendonectomy on an older Domestic Short-Haired kitten later on in the morning.  I have never heard of a tendonectomy before; it is a surgery where an incision is made in the toe, and a small piece of the tendon leading to the claw is cut out of the tendon line.  This prevents the cat from jutting its claws out, and therefore prevents the cat from scratching anyone or anything.  The claws still have to be trimmed of course (because they still grow, so the owner needs to trim them now and then so that the claws don’t get so long the cat can scratch things), but they can’t stick their claws out anymore.  If anyone is considering a declaw for their cat, I HIGHLY recommend getting a tendonectomy instead.  A declaw is extremely painful to a cat because, as I explained on day 8, the first joint of their toe is removed because that area is where the claw is held (so that would be like a person getting the top of their finger or toe removed to the first knuckle).  As I said it is really painful to the cat, and the cat also has to learn how to walk properly without that joint.  With a surgery such as a tendonectomy around, I feel like a declaw is unnecessary.   A tendonectomy is far less painful, and it provides the same type of idea that a declaw would; the only difference for the owner is that every now and then, they need to trim their cat’s claws.  I highly recommend a tendonectomy over a declaw.

Smokey, the tween kitten recieving the tendonectomy.

Smokey neing placed under the anesthesia right before the procedure.

Diagram of how to block the nerves before surgery.

Dr. Amanda blocking the nerves.

Dr. Amanda making an incision in the toe.

Dr. Amanda pulling up and cutting the tendon (white line in the picture).

The inside of the toe after cutting off a small piece of the tendon.

Smokey all bandaged up after his tendonectomy.