Festival

Festival has started again, and I'm already exhausted. At the moment I work 11 hours a day, 7 days a week with no time off until the end, but I may take a day off in the middle to allow for some healing. Posting shall be light unless something fun happens!

Zacks' Story

Zack (not his name actually) is a young male Border Terrier. In the manner of dogs he was investigating the garden in the morning and came across some small blue pellets. Deciding they looked tasty he ate the lot, not knowing they were slug poison.

By midday Zack was not looking very well at all so his owners rushed him to the vets as he had started bringing up something blue in colour. It was a horrendous day so the only person spare to see him happened to be me and so after explaining who I was I started a quick clinical examination to get some idea of his status. Zack apparently didn't enjoy this and started convulsing on the table.

At this point there wasn't much time to worry about the niceties, something needed to be done right away. I ran off to grab a vet and some diazepam (Valium). In a short while Zack was not fitting and had a drip to keep him hydrated whilst we looked up what he had eaten from the description given by the owner.

One of the more popular chemicals for killing slugs is called metaldehyde. Unfortunately it also kills other animals pretty quickly too depending on the amount they have eaten.

Time to get rid of any left in his stomach - gastric lavage. This isn't very pleasant and involves sticking a tube down the throat and in to the stomach whilst the animal is anaesthetised. The stomach is then filled with water or, as in this case, activated charcoal to try and dilute or soak up the poison. Zack also started passing blue diarrhoea - a bad sign as it shows he'd had time to absorb a lot of the drugs.

We left him alone with a lot of valium in a quiet dark room to prevent his nervous system becoming stimulated which may set off other fits. Throughout the rest of the day we took it in turns to keep an eye on him, monitoring for any changes or signs that the drugs we were giving were not working.

Around 5 he started to convulse again, although this time he did not respond to the diazepam meaning we had to re-anaesthetise him to stop the fits. By 6.30 this was beginning to fail too and we had to resort to more potent drugs to try and keep him stable.

All was well until 9.30 when he started to twitch once more. Again we gave him more drugs to control the fitting and organised a rota to keep him under surveillance all night.

It quickly became clear that Zack was not recovering as well as we would like. His heart rate started to drop to dangerous levels and his breathing rate also decreased. By 10.30 we were breathing for him trying to get him over the worst of the exposure, all the while his heart rate was falling.

At 11.30 he started agonal respiration. This was a bad sign. At the same time he started to shed his intestinal lining and we knew he would not make it through the night. Five minutes later Zack was dead.

We cleaned up in silence, exhausted by the efforts over the past few hours but knowing we had done the best we or anyone else could have. Home and sleep beckoned to start again in 7 hours time.

So far

This week I have:

• Operated on 3 animals
• Worked for 19 hours straight
• Looked after my own sick dog
• Taken consultations
• Discussed the pros and cons of treatments for numerous patients
• Saved lives
• Taken lives
• Been urinated and vomited on. And covered in faeces
• Worked with both small and large patients

Today though I was thanked by everyone at the practice where I've been doing my EMS for all the insane hard work. Great to know people enjoy working with me and trust me to do things. It gives me confidence I may survive this course after all! As my assessment put it:

"Extremely keen & very helpful, more than willing to put in extra hours. Contributes well to discussion of cases and has been invaluable this week for in-patient care. Basic surgical skills and confidence noticeably improved since last placement. Gets on well with all staff & clients. Can we keep him?"

I'd like to stay. Unfortunately I require money.

No Rest

I can't believe it's Thursday already, this week has flown by, yet I'm having problems remembering individual days. I remember castrating a dog on Tuesday and helping with X-rays on a collie with a broken leg. Yesterday however was chaos.

Collie dog needed her leg repaired paving the way for a long and complicated orthopaedic operation. First there was a small matter of an elderly dog with a tail pull injury - time to amputate his tail. After some x-rays and blood work his tail was dutifully removed, and this is where the fun started. One consultation - a sick collie - apparently she had been working for previous day and went downhill rapidly. She was very toxic and smelly, requiring urgent medical attention. I was pulled away from that case to look at another emergency that came in and assess for priority.

One of the few things that makes me swear in front of a client in a dog in full convulsions. History of eating slug pellets so the diagnosis wasn't challenging. Stopping only to grab diazepam I dragged a vet in to the consult room where we got to work.

A few minutes later another case came in. Somehow whilst on a walk a dog had tripped and cut her leg deeply. With one vet away on a call, another dealing with a dog with violent seizures and the last setting up to sort out collie2 I went to assess legdog. Another admit.

For a day that had started with a call at 0530, this was rapidly becoming very silly so I went for a walk to find food for the troops. We were all heading down a grumpy route and needed sugar and time to think.

At least two of these cases are worthy of separate posts. So that's what I'll do.

Post-op

It's been a strange week, culminating in me deciding to leave Scotland for a bit and head back to Wales for a short time. This decision was mainly due to boredom at having nothing to do; no current job and my climbing partner cancelled. More on what I've been up to later.

I'm unsure if the operation was a success just yet. My eye is still sore and I don't want to annoy it by trying to make it see single with normal glasses just yet. Last time it took a few days to adjust so I'll wait until the pain is no more. Might even post a pretty post-op pic if I can find it.

I don't really remember much about the day itself apart from a few strong memories. I remember being jabbed with the biggest syringe of propofol (an anaesthetic that's also used in vet med) I've ever seen. I recall waking up and moving beds. Some of the walk home is also in my head somewhere, although that was a little hazy.

One of the main things I remember is the feeling of relief knowing someone was coming to find me to take me home. Not someone who would drop me in Leith and leave me. Not someone who would pretend it was 2010 and I'd been in a coma. Someone kind and sensible who didn't take one look at my blood filled eye and run away screaming. Thanks :-)

Inpatient

Tomorrow is the big day of eye surgery and I'd just like it over with now I think. There are really clear instructions about not eating or drinking so all I have to do is turn up tomorrow at 8. It'll be interesting to see it from the other side of the anaesthetic as it were. If it all goes well and I don't have to be back for a recheck for a few weeks I plan to head back for more EMS, but at the moment we'll just see how things turn out tomorrow.

Dog vs Computer Surgery

I was fixing my computer recently and noticed quite a few similarities between that and a splenectomy I assisted on when seeing practice. First I'll go through the splenectomy, then the diagnosis and removal of a dodgy hard drive.

Splenectomy
As with all patients a thorough clinical exam and history was taken before the operation and the dog, Ben, was deemed well enough to undergo the operation. He was given fluids and taken through to the operating theatre.

Here we knocked him out, intubated him so he could breathe, and he was prepared for the surgery whilst we scrubbed up and put on sterile gloves to reduce the risk of infection. The vet made the incision through the skin, muscles and peritoneum in to the abdomen, exposing the enlarged spleen. Now came the fiddly bit - tying off all the blood vessels to the organ so when it was removed a lot of blood wouldn't follow. I was clamping and helping with the exposure whilst the vet tied off the vessels and cut. It wasn't long before the spleen was ready to be removed and was taken away in a kidney dish.

After a check to make sure there were no bleeding vessels we arrived at the longest part of the operation, closing the animal. Here you have to be very careful to make sure the wound closes properly or you may produce a herniation site post-op. Worst case is the sutures don't hold and the animal is found with its intestines hanging out. Not very pleasant, thus you take your time.

Hard Drive Removal
With very little pre-op care necessary for my computer (called Tigers) except backing up my important files I started quickly with the anaesthesia. The last thing I wanted was it to wake up when I was in the middle of the operation, so I removed the power cord and discharged the power supply.

Being all on my own I had to prepare the patient as well as myself. I vacuumed all the dust off the cover and went to work getting rid of my static by earthing myself on the nearest radiator. A quick bit of action with the screwdriver and I was in to the case, exposing the hard drive as I worked my way down. Now for the fiddly bit - extracting the power supply to the drive. Cutting any wires here is bad, as is pulling the wrong thing, but the power socket was hidden deep inside behind the graphics card. After safely isolating the drive from both power and data connections I made sure the wires weren't going to hit anything important when turned back on and removed the drive.

Finally the longest part of this operation - closing the case. I'm not sure why, but this always takes ages. I checked for wires in fans, stuck behind RAM chips and various other places they go to cause chaos and managed to screw the case back together.



I'm happy to report both patients are still functional and survived the ordeal. Anyone else see the similarities or am I just crazy?