Tuesday, 30 September 2008

Great Bowls of Water

Well the bloat/heart cat did not get off so lucky. It did throw a clot at some point post admit. The clot is not a bad one although any clot is bad in a cat, it is now on treatment for that. The hind leg is paralysed and dragging, there is a pulse and it is not in obvious pain, he seems happy and is rolling and purring and loves a tummy tickle. Treatment has started but with the heart as it even if he does go home he stands a good chance of more clots with a less positive outcome.

I went out to triage a GSD about 8 months old who may have drunk bleach. He was a bit noisy and being a GSD l checked he was ok before l approached. To make myself less threatening l decided to sit on the table, this being the only thing handy to sit on other than the floor and my knees hurt enough.
l did not look to closely and planted my backside straight into a red bowl full of water, l did not even know we had red bowls in the place!! and had not realised it was full of water as l was concentrating on the dog. My yelp and sudden stand up did wonders for the animal's confidence. I shot off got a couple of incontinent sheets and threw them over the patch dunno where the mops were, but never to hand when wanted.
After than l got on fine with him, possibly he decided anyone that sat in a waterbowl had to be too stupid to hurt him. He was fine and after the vet checked him he bounded out the door without a backward glance.

We are having a toilet type disagreement with a Siamese at the moment. He is in for anaemia his PCV is going up nicely, however Siamese seem to have a thing about litter trays.
"Simply not for the well bred Siamese darling"
So he puts his front legs in it and goes on the bed, or leans all the way over it and goes on the bed, or pushes the tray up in the air and goes on the bed.
So l removed the tray and put the litter on an incontinence sheet. Will see if he uses that, l have a feeling that it won't be used.
Maybe we should cover the whole of the incubator floor in cat litter, somehow though he would probably still avoid that.

Monday, 29 September 2008


I was on the mid shift last night which means l finished at 22:00. We were pretty busy most wards dog, cat and critical full with a suspect lepto in isolation. Still overflow and small furries was empty so it was not to bad.

Last night was the first time l have seen a cat bloat. Dogs bloats for us on nights are fairly common. Roughly one every couple of weeks. Cat bloats are pretty much unknown, in 7 years l have never seen one. This one presented as collapsed and screaming when it came in. At first the thought was it was a thrombus (a blood clot) but no the feet were all warm. A dose of our strongest pain relief was administered and when it started to take effect it would also sedate the cat slightly.

As soon as he was injected with pain relief a quick x-ray was taken and the classic elbow showing of bloat and the chest in a bad way. We had a locum vet on who is not used to bloats as they are very rare in general practice. I set up for him to do an emergency decompress.
With the first decompress we took about 80ml air out. The cat was more settled and iv catheter was placed. Normally one would be placed first but we had not been able to as the cat was in so much pain keeping it still long enough was impossible.
The second decompress removed roughly another 80ml of air. A final x-ray showed that the bloat was much reduced.
We did not want to do any more gas removal in case we caused more problems than we solved by adding holes into the stomach with a large bore needle and possible leakage.

The assessment of the night vet who came on duty later in the evening was that the chest was in a bad state, this lead to mouth breathing and to much air diverting to the stomach, the stomach filled with air and somehow it moved enough to trap the air. Withdrawing the air allowed it to settle back to normal position and expel the remaining air, thankfully, as the cat would never have survived an operation.

When l left the cat was sitting in his incubator purring away. He still has a long haul to go the heart and lungs are not good and he is over 10years old but he came through step one.

We had an unusual patient in, a goose. He had a bad leg cut 4 days before. It was felt that dressing and strict rest would do the job. He had been in overnight, then home for 3 days. Wonderful blue eyes he had and was very well behaved as he was a pet not a wild goose. The vet undressed the wound and BANG! out poured blood. Sods law a dressing was not going to work we would have to do an op. He reapplied a tight pressure dressing while l tried to not get attached into said dressing while holding the leg out.
I took goosy to an empty walk in kennel and he was a bit rude when placed in it. He had been wrapped up in a duvet for some time with just his head out so he needed a good wing swing. Trouble was l was clobbered by him but it was not personal as wild geese are this was more the lines of.
"Well it was your fault for not getting out my way"
Once he was happy he had both of them and they were working he allowed me to pick him up and place him on his newly made bed.

It seems to be Diabetic season at the moment and we have at least one animal in a day on a glucose curve.
This means glucose taken every hour or two hours for 24hours. Last nights one was a sweetie, allowing us to take blood and stats etc. as though it was an everyday occurrence. I took her general stats but her drip had stopped and wouldn't unblock when l adjusted her leg position and tried to flush it this did not work either.

I undid the drip line, bunged her (iv) catheter blasted the drip and reattached her line, went to tape it in and her teeth missed me by mm's, she made it clear l was on her dinner list, and sweet doggie was not playing ball any more.
Great, the drip line disconnected and blood decided to descend as it had a lovely open hole. While l could not get near my patient. My cussing drew a vet who asked if he could help. I legged it passed him for a muzzle and yelled yes stay there. I got back with vet and dog gazing at each other warily and thrust a muzzle on my patient before the teeth could move. While saying to the vet right get that iv in while l secure her.

Do you mean this he said holding drip line up and (iv) catheter attached to it. He reattached the drip line, she had moved and bingo... it had come out. Oh well so much for a sweet patient, she would have to have a redrip later, l was going off duty and she needed to settle down.

Friday, 26 September 2008

Veterinary Nursing UK

I felt that veterinary nursing needed a bit more of an explanation, in general, and on a daily basis than is available. It is neither all cute animals nor all horror stories. To be a qualified VN needs a dedication to a lifestyle that you will become disillusioned with yet addicted to.
I generally work with small animals, not large although l have worked with horses. So my ravings will mainly be based on the small animal sector, unless l am locuming at a large animal practice and get to do any work with said beasts.

The wages go from bad to acceptable and usually sit in the not great bracket. Training if done via NVQ is a minimum of 2 years and it is not easy to get. It has become complicated and training practices are closing their doors or already have full quotas, usually 1 or 2 trainees at a time. You can go the diploma route but that is just as hard finding placements.

You will get bitten, scratched, spat at and compare scars with other veterinary staff. Unlike your human counterparts, where abuse from patients is not tolerated, our job accepts abuse from patients, although it would be nice if owners warned us that "mummys snookums" is really a tiger in disguise.

There is no blocks on mobile phones so expect them to go off when you get to the most important part of the discharge, or just as you have finally got a grip on the rabbit, that the vet is trying to examine which is so spooked it keeps trying to leap over your head and splat against the wall. ... this leads to the splat that you were trying to avoid and the owner glaring at you for failing to protect their precious pet.
The hamster that is so sweet to the 6 year old child attached to the vet's finger with the tenacity of a limpet, you place mental odds if the vet will swear in front of mother and child, or manage to just stay red faced while making whimpering noises trying to remove the deadly creature.

You need to harden your emotions or it will tear you apart. This does not mean loose them it means sitting hard on them when you need to.
Putting down an old ill animal that has reached the end of a quality life, or a patient young or old that is dying from injuries or illness is l will use the term easy.
The young patient that the owner can not afford vet's fees for as they do not have insurance, or the animal is peeing on the carpet and to modify the behaviour is too much trouble. Now is the time you need to accept that this job is from hell but the patient is what counts and helping make their last moments less stressful no matter what you would like to do to humans in general or their owner in particular.

The good times roll around daily though and the animal in for a routine operation that bounces out with it's happy family.
The dying patient that was pulled round with intensive nursing and veterinary work, that everyone gave no odds of survival on, goes out with one last snarl at you for putting all those needles in to the ailing body and a silent wish in your mind that you do not need to do the post op checks, you just know that the former patient when fit, is going to try and eat you.
The owners that want to do the best for their pet and not only listen to your advice but follow it.
Anal glands and blow back from blocked cats can sometimes be aimed with deadly accuracy at a vet or other member of staff. This is great but bear in mind that they have the same "tools" at their disposal and will generally get you back when you least expect it.
Going out for a meal with work friends can cause green looks from tables around you when you discuss cases without thinking.
These and other goings on in life at a veterinary practice make the job worthwhile.

There is 101 tasks to do when you are a qualified veterinary nurse here is some of them.
You will find that you can eat a curry smothered in tomato sauce minutes after cleaning a kennel full of Parvo bloody, stinking diarrhoea and vomit.
Place iv catheters in puppies, kittens, adult animals or bunny ears.
Place urine catheters.
Run lab tests.
Monitor anaesthetics.
Clean up.
Carry out schedule 3 procedures.
Debt collection.
Hold animals while they are examined or put down.
Deal with dangerous dogs or feral cats, young children abusive or stupid owners.
Run nursing clinics include the following - post op checks, geriatric, worms/parasites, dental, firework fear, animal keeping, nutrition, weight clinics, nail clipping, anal gland emptying, behaviour (basic only for more intense problems find a COAPE or APBT member)
Discharge inpatients.
Triage animals.
Run reception.
Set up and take x-rays.
Face abuse from vets and/or nurses.
Work nights checking inpatients, alone in a high risk job with no security or back up, that costs money.
Depression is rife.

I have not yet decided if l love my job or hate it, but l have yet to find one that can compare with it for variety and interest.