Swimming at Night

It was fairly quiet last night. We had a big discharge session. Amongst them the 2 brothers went, still as bouncy as when they came in the night before.

The IMHA cat went home his PCV up to 16% post blood transfusion and will be an out patient while we await test results. His donor was still in as his Mum is ill and unable to collect him. He is an old hand though just feed him and life is good.

The RTA head trauma cat with wired jaw and other facial damage went home. He will need syringe feeding for a long time, possibly a couple of months and strict rest but is able to get that at home. Amazing that despite all he has been through he is so happy, still tries to groom himself as well. Not really a good idea when you can not close your mouth properly but it is his choice.

By a twist of fate we had in another diabetic dog that was in the same kennel as the one who was put down the day before with identical symptoms. It happened to be the only free kennel in Critical Care. This time the owners decided that they did not want to try treatment, it was an older patient than the other one.

The 2 strays, dog and cat reached day 3. The other stray, a big cross breed with a vaginal prolapse that the dog warden brought in, was finally collected at about 22:00 last night. She will to go to their kennels.
What a softie, as soon as you tried to grab her scruff to inject her she would throw herself onto her back to have her tummy tickled. This meant either struggling with a 25kg dog that was determined to not have an injection by acting cute or pulling a chunk of scruff out from under her and injecting that.
I don't think she knew the word nasty and would have been shocked to think that she had teeth that could bite.

A rabbit was admitted last night that was found collapsed. His owners having decided that it was better to leave him alone inside while they went out as it was raining. Not sure what happened to him but from comments made possibly something fell over and wacked him.
Thankfully his appetite was undiminished, once he was placed upright. It can be a nightmare syringe feeding rabbits most do not like it and get them selves very stressed, however you have too keep food going in as they need constant food. Catch 22.

I take my dog Wibble (The black/tan/white one in the photo) with me to work. We went out the back so she could have a quick loo break but l didn't realise it had been raining. Anything more than 10min of hard rain and the back area turns into a pool. We plunged into 4 inches of freezing cold water, carried out a mid air about turn and shot back inside shivering, winter has arrived.

Still have in the post op laparotomy Boxer with awful diarrhoea. Lovely dog, short temperament. He has nearly had a few of us now. Last night when l took his muzzle off he tried to take my hand off, he likes vary of attack, muzzle going on, muzzle going off, muzzle on, he gets top marks for perseverance.
He is a fussy eater when it is normal food but seems to think the idea of buffet a la VN is worth trying.
Of course on a patient that has such a short fuse you assume that the fates will deal a bad hand. They decided on a patient needing long term care, on a drip and needing lots of oral medication, because he has started to get injection reactions.

Management have pulled a really good one. Half of the night staff, those due to work next weekend have been booked to go to the annual Veterinary Nursing Conference. I am already pre-booked to cover day and midshifts and they can not get cover staff. Not many VN are willing to work either nights or weekends, those that are have booked for congress.
The head nurse who has been off for several weeks after "flight training" down a set of stairs and only got back last week wasn't informed till then. Will refrain from adding her comments on trying to sort the situation.

Pink Bunny

We had a couple of brothers in last night. Two terriers, happy and hyperactive that had been vomiting. They were in the same kennel, and although identical, they had different collars on so we could id them. Provided they did not swop collars to fool us, with the way they were behaving l would not put it past them.
Both were on Antepsin l over drew the amount needed, this allows for "paint effect". The 3 of us had a game with the yummy white stuff that l just knew they wanted to try. I lifted them out one at a time and medicated them. Sure enough they did not let me down l got smeared, the walls did and each other as they spat out the yummy white stuff. Oh well not the end of the world they got some and the other drugs were via injection so l know that they went in.

Diabetic dog is no more. After a long consultation between vets and his family it was decided that it was to much for him to cope with and overcome. He had no quality of life and was unlikely to ever pull through, he had just to much going on with his old body.

Siamese cat had great fun yesterday and was back in sweet mode, well 90% of the time. I gave him a small pink fluffy bunny cat toy. He hauled it through the kennel door as soon as he saw it. I was impressed he appeared to take the same dislike to the toy l had been messing about with during change over that the vet had. I thought it had been rather sweet still no accounting for taste. He proceeded to "kill" it for about 20minutes, snarling, biting, ripping and drowning it in spit.

I had to do a discharge last night explaining to owners how to inject their diabetic cat and how to look after the insulin, used syringes and basic info. The full talk hypo/hyper etc was to be given by their vet in a couple of days when they went back at a sensible time not 22:00 and when they were more confident with all that was going on with insulin injections.

All went well until l got to the end and the husband said well think we have it all sorted at home we even have a can of coke cola in case he goes low. I think my eyes crossed and l shuddered.
"Noo no just put that in a brandy or something and drink it yourself, do not give that to him at all" in l hope an emphatic not squeaky voice, while trying to think how the vets would feel about having a caffeine poisoned, inhalation pneumonia elderly cat with diabetes to treat.
"Get your vet to arrange a suitable commercial alternative or keep some glucose handy but for gods sake no coke"

I use a bottle of sterile water as practice and after a few pale looks from the husband who had a dislike of syringes and needles it went smoothly. Finally they decided that they were ready for a few practice injections of bagpus so l went and collected him.

I gave him a quick apology beforehand as l wanted the first injection to make a point in a controlled situation, that even if he gave a yowl it was not the end of life. I had my 2 trainees use the same insulin setup for a couple more practice runs before the first sterile water injection was given.
The resulting yowl got the response l wanted. They leapt 6foot into the air and he glared at them. l was able to explain why and they got the point, blunt needles hurt.
The second injection given l have to say rather bravely by the husband given his dislike of needles good old bagpus did not even blink, smiles all round, and the important confidence boost had worked.

They went off happy to start their new life of 2times daily injections. If they are unable to give them for the first few days then they are fine to take him to the vets and do it under supervision but both were happy with how things were.

We have a possible IMHA cat in or the posh name of Immune Mediated Haemolytic Anaemia. His PCV% (volume of red blood cells in a set amount of blood) was 8% it should have been around 30% at its lowest.
Unfortunately his brother was the wrong blood typing for transfusion but one of our donor cats fitted the bill, post transfusion he defiantly felt a lot better.

We had to send blood off to confirm what he had. Some sensible labs put in their info brochure what you place the sample into EDTA, Serum tube, slide or whatever, not this lab.
So l went off and trawled the net trying to confirm what tube they wanted blood in for Coombes Test. I checked labs we knew did the test, nope, general searches nothing. Finally in desperation and so we did not send off about 5 tubes in the hope one would be right l tried the labs own site and found the info, great half an hour wasted cause they wanted to save on printers ink.

Forked Tongues and Buffets

I am up suffering indigestion. One of the drug companies held a CPD meeting at our place and had a pre talk buffet, most of the food was uneaten. Bliss for those of us on late shift we get the left overs. Trouble was l did my usual and overate and am now waiting for the antacids to kick in, so thought l may as well do something constructive and write.

Heart cat went home today with enough pills to keep him rattling.

The Siamese is out of the incubator it was needed for other patients. As his red blood cell count is rising, his temper is shortening.
He has won the battle of the litter tray, knew he would. We just keep piling the washing up. He and l have got on fine all day. True l have not needed to inject him that helped, and early evening we had a lovely chat and cuddle.
Tonight on change over l was explaining this to the night nurse while my fingers were resting through the kennel door on his bed.
Next thing l have 2 holes in my hand and am swapping glares at the cat who is looking arrogantly at me and the night nurse who is creased up laughing.

We had an op tonight on a cat that somehow bit his tongue and had a lovely fork in it. He had not eaten since yesterday so it needed a fix. A quick GA some suture material and surgical glue and the vet had made it almost as good as new. It is a bit crinkled and a piece had to be trimmed but hey, beggars can not be choosers and at least his good looks are not affected. By the time l left tonight his stomach was enjoying the return of food as sloppy AD (mushy convalescent food) slid down it.

The RTA dog is doing well. She had her femur repaired yesterday, the one side of her pelvis done today. The other side of the pelvis the vet will see how she does, it may be possible to get it settled with strict cage rest and no 3rd op.

The diabetic dog is still not settling on her glucose, it is swinging all over and things do not look good. She has other health problems that complicate it but the vets may win yet and get her home. Poor lass it is understandable why she is fed up of us with having to get so many drops of blood. It is yet another needle hole and to do that we have to muzzle her and she hates muzzles.

We have 2 sad strays in, neither are microchipped. We all had our usual snarl about "wish that people would microchip their pets and make sure that they have lodged the details. And if any of their phone numbers or addresses change they notify the chip company".
There is one thing worse than an animal that doesn't have a microchip, one that does and the details are out of date and we can not reunite the family.

One stray is an old dog, blind, senile and confused. He circles the walk-in kennel banging into walls and occasionally ramming the door when the rattle tells him it is not solid like the walls. We tried him in a small kennel but he became even more stressed in that.
He has eaten but not drunk just tripped over the water bowl and squelched through it. So he will be fed food mixed with water, to get round the drinking problem.
Trying to calm him doesn't work, we may as well not exist, and if we try and restrain him he gets snappy and even more distressed. Tonight we sedated him to settle him down and allow him some sleep.

The other stray is a lovely cat who has been in an RTA. She has a severely fractured pelvis, a fractured hock and deglove injury. She has eaten a bit and is heavily dosed with pain killers and antibiotics.

Both are in as short stay, end of days. If they are not claimed within a few days they will be put down on humane grounds.
With stray patients such as these it is veterinary discretion some are put to sleep immediately on humane grounds, others will stay a few days like these two but unless owners come forward they will be put down on humane grounds.
If they are not to badly injured and are young enough to rehome then they are "repaired" generally through the inhouse stray fund and either CPL or one of the rescue groups take them on.

Even if owners came forward they would probably be put down by the owners. The cat due to severity of the injuries and cost of repair. The dog because there is lots of puppies out there and it is senile. Yes it is a harsh judgement on my part but it is the reality of the situation.

Goosed

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.