Dog Crash

In UK you do not have to be qualified to do anaesthetics on a patient. The rcvs say that the vet is able to direct things.
This system means that vets can continue to pay poor wages so qualified veterinary nurses do not stay in the profession, and there is a lack of qualified nurses so unqualified are used.
You can pack shelves at Tesco one day and the next start at a vet and be put in charge of an anaesthetic; this is not unusual in many practices. In fact a lot of them do not even have a qualified veterinary nurse on the premises.
To be fair some unqualified auxiliary have been in the profession for years and are very good but it is still an excuse for bad wages and lax rules.

The following is an event that happened to me recently when l was working with a locum vet and shows exactly why A) This system is so dangerous and B) Why the vet should listen to the anaesthetist because they are at the sharp end not rumbling round in the animal’s guts doing a different job.

We had a small dog on the table having an operation. I had had to go and find some instruments for the vet so had left my patient unattended for a few minutes. I got back and he had started to puff a bit. I did a quick check on him and was about to turn my patient down slightly as he was going too deep.

Vet: Turn him up he is puffing.
Me: No he is going to deep l am lightening him.
Vet: “No l said turn him up he is getting puffy”
Me: “He has no jaw tone and his eyes are…”
Vet: Snapping “I want him up”
Me “Suit yourself” so l turn him up to 3
Vet: A couple of minutes later “He is still too light he is puffing worse”
Me “Yes l know he is too deep”
Vet “No he isn’t deepen him up to 4.5”
Me: Getting ready for the animal to crash and debating internal odds on how long this will take “Fine” turning patient’s anaesthetic gas up to 4.5

Within a couple of minutes he had crashed and stopped breathing. I was waiting for this little side trip under GA to begin. I smacked off the gas just left him on pure oxygen and started to breathe for him. It took 10 minutes until he was stable enough to breathe on his own. I also had to re-stabilise him back under anaesthetic.

The vets comment when she saw me start to do ippv on the dog stopped breathing “Oh has he stopped breathing?” She did not see it stop breathing as she was busy with her operation, happy the dog was not puffing. What would have happened with the shelf stacker?
I ignored her and just got on with my side of things. WW3 did not need to be brought in at this point and l was chewing my tongue.

So if you have a pet that is going to have a general anaesthetic, ask if it is a qualified nurse or a second year vn student (you do anaesthetics in second year) who will do the anaesthetic. Things can and do happen, l have had patients crash and been unable to do anything to bring them back, but it is less likely and circumstances like the above one are a lot more correctable because l knew what was about to happen.

Bittter Sweet

We had a 7year old Labrador brought in with end stage heart failure and end stage pregnancy. Mum had less than a week to go and the pups should survive although it was doubtful if she would.
The idea was to stabilise her and then see about a caesarian the vet gave the owners very low to negative odds of her surviving. She was placed on oxygen and given medication.

The theatre was set up for an emergency caesarian and l also set up the medical prep for an emergency “cut and grab” if the bitch crashed. If she crashed before the operation then there would be no attempt at saving her she would not come off the table alive all efforts would go to saving the puppies the correct assumption being to save her they would die in the time it took to revive her and the odds of her pulling through revival attempts with pups in her were non existent, they placed to much stress on her body.

After about 1.5 hours there was no visible signs of improvement and her stats, were slightly worse. The vet called me over and said that when he finished his present consult we would go ahead. He would give her propofol(to induce anaesthesia)and l would tube her (a tube placed into the trachea to maintain the airway and provide 02 and anesthetic gas and remove said used). We would place her straight onto her back no clipping or cleaning just go straight in and get the pups out and she may survive via crash kit and luck.

I was giving a last check to see that everything was right in theatre. Kit open, crash kit open and ready, tube to hand all plugged in ready to roll when the auxiliary called the bitch had crashed in her kennel.
We shot through. The other vn and l grabbed her and placed her upside down on the medical prep table. She was starting to chain stoke which is dying gasps. We did not tube her the vet gave a “now” and l put the propofol into her. If she was still alive she would feel nothing.

The vet made a long slice midline and pulled open her abdomen. Blood flowed out as arteries and veins were left unclamped pooled then ran and dripped off the table. The vets hands gripped and rolled out the slippery uterus and he sliced through horn one. Fluid now joined the blood the table and floor became a red green slippery pool and the golden body of the mum became red green merging with the table.
The vet pulled out neonate pup’s and started to shove them into waiting hands. I pulled up a syringe full of euthatol. A long slice through horn 2 and those neonates pulled out and passed over.
By now the prep area was awash with blood and fluid. Apart from the pool on and under the table it was up the walls from flip back pulling out the neonates, and feet were walking through the pool to and from table 2 where neonates were taken a few paces for reviving, cleaning, drying and checking (cleft palette and anus present) table 2 also had discarded placentas thrown onto the floor mingling with dirty towels from drying the neonates.
As the vet was about to get the last one l was told get ready and as he pulled the last pup out l injected the euthatol. Mum had probably already gone by this stage but we were not taking any chances.
It had only taken minutes for the procedure; from the original “crash” call to euthatol was about 5minutes.

There was 6 live pups all strong and screaming no deaths there. The vet went back to his interrupted consult and the other vn sewed up the mums abdomen while l did a quick tidy up of the area. As soon as mum was sewn up l placed the pups back onto her dead body to try and see if they could get any colostrum out of her. They got some out but as usual with newborns it took time for the idea of suckling to sink into their little brains and the time meant that it was drying up fast within their dead mum.

An hour later the pups went home, it was a bitter sweet moment we saved 6 lost 1. By the time the pups left the building medical prep was shining and clean. No signs of the life gained and lost that had happened such a short time before.

Ego meets VN

Well l have surfaced after my 8 nights. I did a few short comments and some twitters but nights just takes the enthusiasm out of doing much l get to tired.

The following happened last year we had a day vet covering nights he was a good vet in “knowing his stuff” he was a lousy ego driven people dealer though for those he considers beneath him.

We had a bloat (GDV) case in and l went to set it up. Over the year’s l have set up for a lot probably a a couple of hundred or more of these op’s so l know what we use. There were a couple of auxiliaries on as it was only about midnight and they popped in to help setup.

The dog was prepped and transferred and the operation was about to start. I heard a bellowing coming from the op theatre so went through and was approached by a screaming vet about where the F**King hell was his suction.
I looked at him totally blankly as we do not use suction on bloats. One of the night vets tried it once a few years back, it didn’t work so we never use it.
The screaming continued as l was saying this and was told “l put it on the note of what l wanted set up and other things l wanted are not here” This was screamed along with a lot of other expletives.
Blank look from me what note? The attack unfurled and l won’t take this sort of thing so attacked back. I refused to scream but made sure he heard me and I gave back what was thrown at me soon we had a full scale war going on.

I stormed off came back with the suction and set it up and the other bits he wanted then went to look for the note. I found it eventually the idiot vet had written it on the back of an anaesthetic form and left it with the pile of said forms on the prep table. One of the aux. clearing up had moved them to the side out of the way.
I got a grudging apology from the vet for his behaviour and gave a grudging one back for all l had called him in return, 2 insincere apologies to smooth things over.

Later on the anaesthetic nurse said to me that she had seen many men angry but had never seen one go so berserk, she had been worried he would hit me and was not sure what to do she had been genuinely terrified.
I told her “That would have been his biggest mistake” and not to worry as l certainly wasn't, as had been obvious at the time.
Apparently afterwards he said he would appreciate it if she never mentioned him loosing his temper or what happened. I told her the entire night staff had heard it and already knew so he was a bit late for that.

The vet and l still work together every so often for a few hours on various shifts and are ultra polite to each other.

Shootings, Chocolate and Work

Sorry it has been so long since l wrote or replied. I have been on the good old work treadmill but covering 2 different practices, several days going from the day shift to the emergency job to cover part of the late evening shifts. That means that l have only really glanced at the computer to tired to bother.
Then this week l got hammered with this bug that is going around and have had about enough energy to get me from shift start to shift end with nothing left over.
High temperatures and hacking cough is not my idea of fun. I may as well have lived in a sauna l have been so sweated out.
All l want is to get fit, l have just got over my last problem of 3 weeks cold and laryngitis but it seems health must wait.
Food has been on my list of l can’t face much and l have had so much chicken broth l am about to start to crow.

On the work front the feeling of good will seems to as usual be lacking to many animals. There has been a lot of older abandoned dogs appearing needing veterinary care, mainly for cold and arthritis. Stray puppies are doing the odd guest appearance but they won’t really start to hit till Xmas day and beyond.

Last week we had a cat in that was owned. It looked to have been attacked by a dog and was full of holes. We gave a quick x-ray to check for ruptured diaphragm (from being shaken) or any other x-ray obvious injuries and lo some scum had shotgun’ed the cat.
I lost count at 35+ pellets, it is not easy to count them your eyes tend to get confused.
He was quite bright considering the holes in him. His tail will probably have to come off as that has been fractured in what’s called a high tail base fracture, thankfully his urination isn’t affected.
He had a pellet removed from his stomach and a couple from his intestine. Some may need removal from his legs but the majority will be left as it is better than going aimless hunting and if they are not causing a problem then they are left.

The same night we had a small terrier in. His owners had gone out and come back to find their house broken into and the dog stabbed once into the chest.
Air had leaked under the skin and he was very blown up. His skin felt like bubble wrap as the air rippled under it in the fat, not a nice feeling. He was stabilised overnight and a thoracotomy sorted him out.

Parvo dogs have been pouring in. One night we had 4 in isolation and one stray with kennel cough. The small day practice l have been at has also had several parvo dogs in.

Good old Xmas poisonings are starting to make their way in as well, raisins, grapes and chocolates top the charts at the moment.

I am not a fan of American Bulldogs. The ones l know have all been darn right nasty. That has changed and l have fallen for a big lump of one.
He came in because he had eaten a tea-towel, socks and a few other items, apparently the breed is as bad as Labradors for scavenging. All l have known the AB to scavenge though is human body parts, whichever its teeth can close on. The socks and other items reappeared, tea towel hadn’t.
What a sweet dog, stood there while dripped just trying to give sloppy licky kisses. Post op he was in a walk in on a duvet and then l wrapped him like a big sausage roll in a flower duvet. All you could see all night was his nose, even awake he snuggled in.

A couple of days later he came into the small day practice l am at for an op check. He was a bit subdued still but gave me a nice welcome. I chatted to the owner while Bruno (not his name) sat on my lap trying to give more sloppy kisses while l sat on the floor in reception. Apparently his sister had a pair of pyjamas removed from her not long ago.

2 days after that Bruno came back in for another check and he bounded in. He heard my voice as l came round the door to greet him and almost knocked me over.
His long suffering wallet….sorry owner, said he had removed some newspapers from Bruno that day so he was on the mend.
They do try and keep him separated from items but with kids on hand l don’t think it is too easy.

The American Bulldog is a very powerful breed and needs to be line checked carefully for temperament especially and health. I had a history lesson on the breed in the UK and it was the usual. Bad lines brought over from USA and bred with garden breeders for money.
Then a few dogs carefully chosen and brought over from USA by a breeder and bred but a higher price and carefully checked potential owners. Bruno comes from the careful lines and it shows, too many do not.

The emergency hospital is part of a corporate setup and they have upset the whole night shift. There was an Xmas party H/O said they would pay £25 they were quids in. It was to difficult for the majority of us to get to and day shift were going enmasse, and quite frankly was not really anyone’s on nights cup of tea, a drunken night out with non work friends. Not that we do not like them just they are a different world and most day and night shifters do not really meet.

We wanted a nice get together, chat laugh and just unwind so we organised our own, although l am a locum l am included as l spend so much of my life there and doing stupid shifts and getting them out of the brown stuff.
This split party had been done other years. There is a whole setup of night shift starting at 13:00 in the afternoon and ending at 8am, collection drivers, vets, veterinary nurses, receptionists, auxiliaries. Some staff were not going to go to bed, others missing a couple of hours of shift and going it at about 15:00 not 13:00 (day shift were fine about that) Some of us due to work that night and forgoing a full days sleep. It meant we could all get together and have a lunch time gathering. The place chosen was an all you can eat pub. £5.99/head.

The practice manager rang up H/O on Tuesday to get final clearance and was told tough they should have gone to the night meal. The fact it meant that out of 20 who put their name down for the day meal about 5 could have gone to nights was not their problem.
A letter signed by a lot of us has been sent in not that we expect it to do any good. Night shift is a set group of people who only do nights and unsociable hours. There is bank holidays and weekends and all those family gatherings they miss. If their normal work pattern falls on a weekend they do not get extra. They get less holiday than days and less for covering bank holidays. Yet again night shift has been shafted.

Nights With a Difference

Well it has been a 4night shift of cases that we normally see in singles coming in in pairs or triples unconnected to each other.

2 cats in needing back legs amputated due to damage from cars, both damage to the right hind and both long haired dark tortoiseshell cats.
1 dog in that needed it’s front leg amputated. Running around in the woods it had somehow ripped the whole lower section of it’s front leg off. Apparently only 1 bit of skin held it on. When l got in the leg was all padded up prior to the op the next day once he was nice and stable. I am told that even the vets and nurses looked ill when they saw the damage, the dog was dark brindle. A doggie version of dark tortoiseshell in cats

3 dogs in attacked by other dogs and a lot of damage done to all of them. One of the dog attack dogs was a stray. Severe bite wounds to her front legs and shoulders. When she was under GA for clip and clean they pulled some scabs off and a fountain of pus erupted.
She was very flat for 2 nights, then at about 5am the third night had an “ok no more malingering” moment and started to eat and try to stand. It took till the end of the 4th night before she could walk without falling over.
Her tail never stopped wagging although we muzzled her to inject her as she was so sore and some of the injections sting, even then all she did was cry.
I had a word with the collection driver and he is going to arrange for her to go to a friend of his with an animal rescue to be rehomed. She is a very sweet dog and l am crossing fingers for her.

2 bitches in unable to urinate and blocked solid with bladder stones. Both needed operations, very unusual for bitches to get blocked.

2 animals brought in by police, made a change normally we have to send the collection van.
1 cat that 3 police brought in the back of their van after 2 cars had hit it [cat]. This cat needs to choose a lottery ticket. Apart from bruising it was unhurt.
The second was a dog whose owner had been arrested for being stupidly drunk and abusive. It was a very sweet dog the copper wanted to adopt it and was upset that it was owned.

2 dogs with ear damage that needed head dressings on. One was one of the dog attack dogs with neck and ear wounds. Usually we only get the odd head dressing animal through.

2 jaw cases one a stray dog. His mouth wouldn’t shut, thinking it was a broken jaw he was given a GA. Nope his teeth were so rotted he couldn’t shut his mouth. All teeth removed and about 8hours post op he tucked into a bowl of sloppy food. If anyone wants to rehome a grey grizzle lurcher about 6 or 7 years old let me know, he is great with other animals. This one will also go to rescue.
The other jaw case a young cat with facial damage including a fractured lower jaw according to the owners they have no carpet and the cat was having a mad half hour, couldn’t stop, slid and smacked into the wall.

1 hard talk with police control and badgered an inspector at "Someplace Police" into giving us a fwin for collection of a dangerous dog, and rspca giving a log to have it put down. The Inspector was reluctant as it was a put down at owners request and not police request but the owner couldn't get the dog to us.
I found out afterwards that the law has changed about a month ago and neither police, rspca or us knew. The collections driver did and told me when he brought the dog in and said we couldn't put it down and why.

Now if a dog bites someone and the police are informed it is not allowed to be put straight down, even at the owners request, the police have to prosecute. And they can not prosecute an owner if the dog is dead. So it goes to special holding kennels until post court case, then it is put down. A wonderful waste of police time and money and added stress for the dog.
So l could have trumped the inspectors reluctance without horse trading damm. At least l know for next time because the will be one, Inspectors are tight with their fwins.

This does not take into account the usual post op recovery cases, heart and kidney failure cases, isolation dogs with diahorea and vomiting, RTA pets, general medical cases, and bunny with gut stasis.
The bunny we had in was evil and although not eating normal food was partial to human fingers which made syringe feeding and giving bolus fluids fun.

Ahh well l have just agreed to another load of nights. I wish l could say l liked days as much as nights but for all my moaning about nights and the lack of sleep it is my favourite because you never know what will come through the door next.

Could You Just.....

The owners were new to the area and booked the dog in for a routine castration. So it was slotted in with the normal set of ops and the day was fully op and consult booked. One vet was off ill on the day but all was planned and doable, just, without the duty vet needing a stress break (hit of double strength coffee and several bars of chocolate)

Alas the best laid plans of mice and men…

On pre-op check it was discovered that the owner of the dog for castration had neglected to mention the dog was cryptorchid. In other words only one testicle was descended. This is a potently dangerous situation for the animal. Testicles are supposed to be outside the body to be kept cool, trapped inside they can mutate into tumours. Sometimes it is a major hunt for the reclusive testi. It may be felt it may not. It may be in the abdomen, or in the groin almost “home” or any point between the 2 areas. It may be tiny and easily confused with other bits of muscle or fat or a fair size. The vet can spend over an hour chasing it down thinking they have found it every few minutes leaving a large area to suture up post find of the errant testicle.

The owner continued with her shopping list. While the patient is asleep, could we just remove both hind dew claws, the dog had badly ripped a hind dew claw a couple of times in the past year, and the nail was growing back in strange shapes. The owner was worried it may happen again, oh and clip all the nails.

The dog had an umbilical hernia. It was tiny, there was no lump, just a small hole that his old vet had once felt, could we just repair it.

Could we just give him a nice deep ear clean, the dog had recurrent ear problems so while he was asleep, a clean would be ideal.

Oh and an identichip would be the icing on the cake, or by now to be precise, the straw that broke the camels back.

Post unavoidable “vet stress break” the hn called a vet to help from one of the practices quieter neighbouring branches. The op’s were started and I landed the above fun job as the hn had the dental to do, she pointed out l hate dental machines.

I placed the identichip as soon as he was asleep. With how much there was to do sods law said something would make us forget it. Yes it was on my anaesthetic op sheet, ops board and consent form but with the way the day was going, l was taking no chances.

The hidden testicle was possibly felt in the groin and after a lot of groping and going a lot deeper than originally thought would be needed the errant article was found. The dog got lucky only 2 abdominal and 1 prepuce wounds, main testicle, hidden one and hernia repair.

Hind dew claws were simple to snip as only skin held them on. All that was needed was a couple of stitches a side and a dressing. I took over the dressings and ear clean as they were at the end of the op and the vet wanted the “powder room” She dragged the hn away from her coffee and gossip. Sorry, “work based discussion” to cover the anaesthetic for me.
The hn and call in vet’s 4 ops of dental, that had potential to turn into a nasty job, had turned into a short scale and polish, and the 3 cat castrates were pretty quick only minutes. She and the call in vet had a nice hot mug of coffee and a chat, making sure we saw them.

His ears were not too bad. I got a bit annoyed looking for the chunk of gunk that l couldn’t clean and realised it was stuck in the otoscope end. As I pulled the scope out the ear l caught the gunk and it pushed to the side so when l looked down in case it was inside the scope nothing was there, pushed back into the ear it pushed the gunk back into view.

Finally done, 2 of us carried him all 50 kg of solid dog back to his kennel. Oh the joys of human nurses that have special hoists. We snuggled him under his blanket and stood up to stretch. As l pushed my hand into my pocket to pull out my packet of smint, my hand slid down though a smelly wet brown mess. It was a gift to me in my pocket from my bloody patient as we carried him back to his kennel and l hadn’t realised. So much for a nice smint. Next time l carry the front end of the patient.

The Maggoty Cat

It is not often we get a maggoty cat it happens about 2 or 3 times a year, usually maggots are rabbit based. In this case the cat “Monty” had gone missing and been found about 4 days later when he dragged himself back and was found in the garden.

Monty had been hit by a car there was head injuries and as it was hot enough for flies they had gone straight to the wounds. Monty had a fractured lower jaw so was unable to groom himself and anyway did not feel up to it.

I am not up on how long different maggot species take to hatch but apart from the tiny yellow dots attached to Monty’s coat a lot had hatched and made their way into the wounds to start eating. It was all the more upsetting because cat’s are generally fastidious in how clean they keep themselves.

Monty needed a general anaesthetic so that we could x-ray him. It is never easy to get decent x-rays of an animal due to their shape unless it is a lateral (lying on their side) it requires troughs to support them on their backs, ties to straighten or hold their legs, foam pads to support under their legs and often tape to hold the legs in more difficult positions.

Under anaesthetic we were able to pick the maggots out of the wounds and clip off all the eggs. Maggots are pretty difficult to kill. If there are not many l tend to squash them, if lot’s l put them into a bowl with some Ivomec in.

Monty had a fractured femur, he got away quite lightly usually cats who have been hit by a car suffer from a fractured pelvis as well as other bones. The surgeon placed an external fixator on/into the leg. These are well tolerated by animals.

Monty had another common cat problem a fractured mandibular symphysis (join in his lower jaw) and this was wired post his x-rays. The lower jaw of cat is not one solid piece but 2 parts joined in the middle with a bit of cartilage. Trauma can break this bond. Wire is fed under the tongue and around the jaw. I found some photos on the net that explain the procedure.
Usually unless there is other facial trauma cats are back eating within a day or 2 of the procedure. In about 4 weeks the the cat is given another ga and the wire removed.
Monty was fairly good about eating but did need syringe feeding to supplement his own intake.





He was discharged after 4 days to attend outpatients for checks, dressing’s changes and a couple of admits for anaesthetics to have various bits of iron removed until he was back to normal. He was scared of going out of the garden but appeared otherwise happy with life.

Travels of a Pellet

Jake was a big fluffy domestic long hair cat 8 years old. The other week he ended up at the emergency vets. He was found on the Friday night bleeding and collapsed. Initially it was thought that he was yet another victim of the metal monster, a car. He was placed in critical care on fluids, pain relief antibiotics other medications overnight to stabilize him.
The car theory was disproved when he was x-rayed and a pellet lay in his abdomen. Unfortunately, instead of stabilizing he was deteriorating, so the decision was made for him to go to surgery. When l got into work at 13:00 he had just gone through, in fact was in surgical prep being shaved.

An incubator was prepared for him, a heat pad placed along with a nice deep bed and we got on with our normal jobs. I was in critical care covering for lunch breaks and doing odd bits. After about an hour and a half l went through to see why they were taking so long.
Jake was in what is best described as a state of repair, his intestines were not in but out and what had been hoped to be a straightforward op was settling in to a marathon.

On its travels the pellet had started by dragging dirt and Jakes long silky hair deep into the body, this had to be removed or it would set up infection.
The pellet continued in and out of the stomach causing 2 holes that needed closure and had allowed stomach contents to leak out into the abdomen.
The pellet then hammered on and made 3 holes in the intestines. Major damage had occurred and again contents had run into the abdomen, 2 sections of damaged intestine had to be removed and the ends reattached to each other, this means that his small intestines are now shorter by a few inches.
The spleen was damaged but had stopped bleeding and the decision was made to leave it in, the option would be there to go back and take it out if the need arose.
Finally after all hair was removed, all holes found and closed and no more bleeding evident, he had to be flushed. This involved several liters of warm saline flushed through his abdomen to clean the organs and remove as much of the leaked fluid and remaining foreign material (hair and dirt) as possible so minimizing the chance of peritonitis.

Nearly 3 hours later he was brought back to critical care, placed into the incubator on his heat pad and bed and snuggled under a blanket. He came round slowly but as soon as he was conscious enough he took up what we fast learned was his favorite position. Blanket kicked off and on lying on his back, legs straightened at full stretch outwards as if he was sunbathing. He is a big cat and filled the incubator. I do not recall a position like that a recovering animal, usually they curl up and try to ignore everything, but not Jake.
He had a long way to go and was still at high risk of peritonitis, and his spleen was still not out of the woods. He had come through this far though and was treating his recovery like he was sunbathing this was one cat that was not going to feel sorry for himself.

By mid evening he was round and taking a mild interest in life but the incubator was getting to hot, it isn’t temperature regulated. I moved him to a kennel and placed an oxygen tube next to his face, and yes you guessed...straight back to sunbathing position.

Sunday he was brighter and had a little bit to eat, when he wasn’t sunbathing. Needless to say everyone fell for him. His purr made listening to his heart difficult; just as well there are pulses! Cats purr if they are scared or if they are happy, but his body language was not scared just contented.
On Monday he was subdued and there was a worry that things may be kicking off inside of him. I was not back in till Friday and one of the first things l asked was how he was. The brilliant news was that Jake had pulled through and gone home. Thankfully Monday’s quietness had not progressed. He still has a lot of recovering to do but the vets and veterinary nurses had done their job now it was down to his family to do the rest with antibiotics and outpatient trips to visit the vet and tons of TLC.

If you allow kids to use a pellet gun then teach them that animals are not sport. The pellet that hits an animal will often mean a slow lingering death and is not funny nor does it make you a big man for shooting an animal.
While l do not advocate hunting, if you have to hunt animals it must only be recognised game animals. The hunter should be an experienced marksmen, and using a killing shot on the animal. If the game animal is injured it is the hunters responsibility to track it and kill it. No real hunter would ever consider it right to leave an animal harmed and in pain they have more respect for their prey than that.

Jake post op, as he appeared in the local paper



A photo of Jakes x-ray the pellet very visible.

Bank Holidays Night's

Had a busy 4 bank holiday nights, with a high but not uncommon good weather case load which was yet again a good example to have pet insurance for dogs cats and rabbits.

Surgically we had a mix of major and simple cases with stitch ups, x-rays and repairs for dog or cat RTA’s or attacked by dogs (quite common), bloats, splenectomys, diaphragmatic hernia repairs (abdominal contents end up in chest cavity, breathing becomes somewhat difficult), pyo-metras (get your bitches spayed and avoid this), eye removals and other surgical cases.
Eyes always turn my stomach when they are hanging out; Eye pop outs happen a lot in the smaller flat faced dogs, a bang on the head and no proper orbit to hold the eye in place…. Splat.

Recovering all the above post op and general medical cases in such as: FUS (blocked bladder cats), fitting dogs, kidney or heart failure cases, haemorrhagic gastro enteritis (bloody shits-pouring out) vomiting and a general mixed medical bag of other medical cases.
There seems to be a spell of fitting dogs going through the area at the moment. Not sure if human nurses have spells where you get a lot of a certain type of medical case in.

In the exotics section we had a head tilt duck belonging to one of the staff who was very sweet, various rabbits another common patient, rats and ferrets.
Finally isolation was occupied just to make sure that there was a long extra walk to trudge during hourly obs checks.

One stray that was uninjured but came in as emaciated was not, he was just hyperactive. Weight did not get a chance to settle on him. He spent the weekend in as none of the rescue kennels collected.
When he came in I put him into a walk in kennel, went back 5mins later to dog ward and as l opened the door this white streak shot past me, stopped for a chat to Wibble and on my “oy you git” looked at me with a catch me smirk and shot up the passage. I cornered him at the connecting door.
Needless to say climbing out of a walk in kennel earned him a place in a smaller inescapable standard hospital kennel and he treated us to the “staffie bull terrier scream” all weekend. This seems to be an inherited trait that certain SBT have, no other dogs do. Think magnified nails on a board with full lung power for hours and it gives you an idea. He wanted out, his fault he could have had space.

A lunatic cat who was a recovering surgical case from yesterday decided last night he felt better and played the game of ‘fling yourself out the door because the human will catch you before the floor’. He also grabbed me nails out (the only way!) when checking the patient next to him so l had to have one hand fending off or tickling him through his kennel door.
I was playing 'squeeze the head' last night whenever l did his stats. Hold head between hands and squeeze gently but firmly. As soon as l stopped he would hassle me for “more more squeeeeeze pleaseee” honestly you would think he was the only patient in the place, a total purr bucket.

On Sunday l was holding a cat and trying to stop him pulling out the vet's eyes as he was in a bad temper when the evening nurse standing chatting mentioned that did l know the cat was peeing. I suddenly realised what the warm wet feeling was. I was soaking my entire tunic had soaked it up like a sponge. Needless to say l went on a dry top hunt.

A splenectomy (tumour ruptures on the spleen) came in on the second night and off the table at about 03:00.
Last night, which was thankfully my last night, we had a bloat dog with splenectomy. This happens quite often as the stomach twists the spleen gets involved and also flips and is unsaveable this does not involve tumours but trauma. He came off the table at about 4am.
On change over the student VN went to triage a dog and came back with a dog who had been retching. One look and l told her to go meet me at prep table while l set up drips as he was another bloat case.
The vet came over stole him for an x-ray which was great because he lifted him onto the x-ray table for me and saved me the hassle of lifting the dog onto anything so l could do his iv lines and take bloods. Rugby playing vet’s have a use l keep telling him that.

At least l was able to avoid the op. After l got fluid lines in and sent the bloods off with the student for running l passed it over to one of the newly arrived vet nurses who gave me a jaundiced “no need to be so happy” look over her mug of tea as l went off to finish patient change over, before running away to my bed.

Post Spay Bleed

It is not often we get in a patient that is such an emergency the vet doesn’t have time to do anything but operate straight away, with barely time to do a proper hand scrub. In fact l only remember this happening once not long ago. Going straight in as the vet was about to do was virtually unknown and was an indication of just how bad the dog was.

I was ambling up from dog ward to do the stats in cat ward when the vet, arms full of dog pouring blood came fast down the passage. Propflo, kit, spay bleed was all he said as he turned the corner and headed to theatre suite.

Sometimes a bitch spay will bleed. It may be a suture has slipped because the owner has allowed the bitch to jump on or off furniture or allowed a slightly nutty bitch to run around despite instructions. Maybe a suture slipped as it was not tight enough. The bitch may have been in season when spayed and everything is engorged this can cause problems post op. Usually a vet won’t spay in season bitched but they may have to for some reason or she could just be coming in and was not checked properly on admit or not showing much and was missed. Bleeding may be generalised ooze as she has an undiscovered clotting defect or for some unknown reason.
Usually the first line of defence is a tight belly wrap to put pressure on and keep a close eye for strike through and pray there is none.

Operating on a post op bleeding bitch is never easy. They have to find the short stump remaining from what was removed, buried somewhere in the abdomen amongst all the abdominal contents. And while yes, the vet knows roughly where it is, real life is never that simple. They also need to check all surrounding areas for any bleeding.

I pulled up 15ml propflo, a bitch spay kit and sterile gloves then headed to theatre. The vet had an et tube ready. He barely had to wave the anaesthetic under her nose (so to speak) oh well if l had not pulled 15ml he would have wanted more. I connected the gas, unrolled a kit and while the vet scrubbed up l gave her a clean and undid the skin sutures on her abdomen. We had to use surgical prep moving her to theatre would have taken to long.

Gloves on and back the vet took a deep breath then snipped out the remaining internal sutures. Blood bubbled up in a red flood that ran over the sides of the bitch in small rivers, the vet went hunting.
I put popped 6 (large) abdominal swabs onto his kit. The small normal ones were as useful as emptying a dam with a teaspoon.

“What’s her name” l asked to put it onto my op sheet.
“Don’t know, verbal consent”
“Tsk your helpful” l mumbled he flicked a grin at me.
“You want fluids in her” l asked?
I got a grunt l translated as yes and was about to yell for a hand (so l did not have to leave the patient, theatre is a bit away from the main area) when the auxiliary appeared. She had tracked the vet following the blood trail and wanted to know what to do about the owner in the waiting room.
Well l said after you have helped me with a leg you better print a consent form and we could go from verbal to written consent.

I don’t like placing catheters when the animal is on the op table. The leg is sticking into the air and so it is high, instead of bending and looking down you are looking up. You have to consider the vet operating and can not move the dog and have to worry about sterility. Once it was in l attached a bag of No11 some bolus of voluven and placed more into the bag.
Blood transfusion would wait for now. We have a limited supply unlike human hospitals. Once the bleeding was controlled then the vet would look to give blood transfused. No point putting it in if it runs out and we have no more blood. It also depended on the owner due to cost.

People have complained about vets and costing. The NHS causes a problem in that people have no idea of cost, and then start to call vets greedy for charging a market price without realising the cost of the treatment. However go to a country that has no NHS and try and get human treatment. I am not sure that they would operate let alone do fluids, drugs and assessments until they had credit card or insurance details.

The bitch was weak stats but stable and pure white under anaesthetic. I prefer stronger stats, stable and pink but at least she was alive even if she fitted the term ‘just alive’.
Mutterings were coming from the vet and he was shifting instruments about obviously struggling.
“Want another kit you look to be getting low on ‘bits’ and should l scrub up” l asked
Another grunt, this vet was usually a happy soul who would normally make a comment with a big grin and was always good natured, all l was getting was grunts. Things were not good in the innards l perceived.
I placed another kit for the vet and called for the other nurse to take over the anaesthetic while l scrubbed up and pulled on gloves.

Scrubbing in can be confusing. As a vetnurse you get so used to NOT touching anything and suddenly you have to touch instruments and op sites.
It works in reverse for vets. If they are observing they are forever being “OYED” by the vetnurse as they are about to reach in and touch something. In fact some vets will only observe if scrubbed, it saves them being told off.

I had to hold instruments in various positions to keep them out of the way. Instrument rings on various fingers, hand tilted and fingers splayed to try and follow instructions and one hand free to pass instruments or hold others.
The vet was struggling, he had found the stump but there weren’t any slipped sutures, instead it was a sort of general ooze from different areas.
Finally everything was as ooze free as he could get it. Part of the problem was there was no set vessel bleeding. When he tried to suture the tissue that was bleeding it was very friable and tore easily.

When he decided he did not need me any more holding instruments l took back the anaesthetic, the other nurse went to check the inpatients and eventually he closed the patient up.

I gave her a clean as best l could to remove as much blood as possible but did not want to wet her down to much. After that and while she was still recovering he helped me to put a tight belly wrap on her.
Not the best of dressings as she was floppy but made easier though when you have a rugby playing vet holding the patient in the air as if she was lightweight. Was he a football player he wouldn’t have been able to hold her, ok l am biased but it is true.

Normally we do not want owners to wait but in this case we made an exception because of the circumstances and the owner was still in the waiting room, the auxiliary had made her tea. The vet went out to have a word with her and get himself a cuppa, and everyone else bar me, I only like my Dr Pepper.

Post operatively the patient was placed onto another iv catheter and a bag of blood was attached to that. She was closely monitored for any more bleeding, thankfully there was none and after a couple of days she went home, making a full recovery.

All operations even routine carry a risk, the vast majority are free of post operative problems. For my mind and most others in the veterinary profession the benefits of the standard elective operations like spay and castration outweighs post operative risk.
Un-neutered males or females are at high risk from tumours, babies and pyometras, hormonal problems, species specific virus passed during sex or fighting not to mention injuries caused with others of same sex after the mate they want or accidents with cars while looking for the dog/cat in heat.

If you do suspect anything post operatively after any operation on your pet, or if you are worried about anything, contact the vet straight away. In this case it was very obvious but it is not always and it is better to be safe than sorry.

Ferret Op

Ferrets you either like them or hate them. I happen to be in the like them camp. They can be smelly but so can a lot of things and they are generally sweet natured. They do not often bite but if they do then those teeth really do lock into their meal, and if it is your finger, their logic is simple, it was there, so obviously it was meant to be their meal.
Ferrets are very playful and can bend into amazing shapes, not to mention get through incredibly small holes.

Ferret Females are called “jills” if you are not going to breed them they should be spayed. If not mated they will remain in season. You can use a male ferret that has had a vasectomy to bring them out but spaying is a lot easier.
If they are left in season they may get infection via the vulva but that is of minor concern. The real danger is she will also continue to produce estrogen which will lead to bone marrow suppression and anaemia and finally death if left untreated.

Tonight we had a very worried owner turn up with her ferret, it had been spayed yesterday and the sharp little teeth had chewed through the sutures. This resulted in the incision opening up and a sloge of fat called omentum hanging out.
The owner, and most people mistake this for intestines. Luckily though animals that break sutures in their abdomen through chewing or other methods do not generally dump intestines out, although l have seen it happen but only a couple of times.
It is almost impossible to use a buster collar on a ferret, if they are going to get their stitches out then they are gonna do it and nothing anyone can do will stop them. In a dog or cat though, if you are given a buster collar, use it.

The owner needless to say was distraught; l calmed her, promised her that the little ferret would be fine it was not as bad as it looked (and no, it really wasn’t too bad) and left her filling in paperwork. I took the little maniac into the back.
She was most unhappy at being restrained especially as she was a meat eater and could smell blood and wanted a snack the fact it was herself was immaterial. One of the nurses tried to sort a buster collar so l could let go the writhing ferret but it was impossible to keep it on her so l held her, in every conceivable shape she was bending herself into.

She was given a GA as soon as all the paperwork was filled in and was thankfully soon sleeping peacefully. I had cramp in my hands. My main worry was the wriggle bot would decide my fingers smeared with blood were a snack and try to take a chunk out of me, to be fair she was very well behaved though.

Within half an hour everything was stitched back inside. This time she had sub-cut (under the surface hidden stitches) so that there was nothing to “worry” on and chew through, and a line of surgical glue was a final layer over the incision. The bruising on the incision site is due to her teeth chomping away and nails scrabbling. She was snuggled into a blanket, given a couple of “hot hands” (silicone gloves filled with hot water) and allowed to come round slowly till her reversal injection was due shortly after l left.

As you can see by her pre op photo l snapped, she is not worried and just wants to know what is going on and who is who. It took about 6 photos to get that one she was so wriggly, l had almost given up.

Hey Where Am l?


Asleep and about to be preped


Omentum Cleaned and Trimmed


All Hidden, Start Resuture


What Incision?


Recovery

Bloat (Photos Warning)

Had a busy night on Wednesday first a caesarean, a fast clean in theatre and a GDV/spleenectomy. The German Shepherd was a lucky dog. The owners thought that he had some fluid in his abdomen as he looked big and was retching.
The collection driver took one look got the dog into the van, verbal permission for starting treatment and got back to us fast. Bloat is a killer and every time l think people know about it l realise that there is someone that doesn’t.

Bloat or give it the fancy titles used, GDV, Gastric Dialated Volvulus, Gastric Torsion, Gastric Dilatation. This little gem has one outlook if not treated, a very nasty painful death. Bloat can affect any breed of dog however it is very rare that it will affect the small breeds. Usually it is the large or deep chested breeds. Amongst them Great Danes, Mastiffs, German Shepherd, Weimaraner. It is easier to say if you have a large breed dog then it carries a risk of GDV.

Several reasons seem to apply to why bloat happens but no one is really sure. Hereditary is defiantly a part of the reason. Some sort of chemical imbalance, exercise after a meal so there is a lot of lots of puffing sucks in air, enough goes to the stomach for problems to start. Often dogs that are fed one large meal a day are at higher risk and several smaller meals a day is often the better way to feed. Post GDV that is always the meal regime recommended.

The dog’s abdomen will look “bloated” as it fills with air which does not escape. The stomach does one of 2 things. It either twists or the entry and exit sphincters close off trapping air and food in the stomach. The food starts to ferment and produces more gas with no way out.
Dogs start to retch but nothing except sometimes froth may come up, known as unproductive retching/vomiting. Dogs will often cry as it is very painful.
As the stomach gets bigger it presses on the main blood supply as well as twisting other blood vessels and the body goes into shock. The blood supply cut off to the stomach which starts to die as necrosis sets in.
Sometimes as in the case the other night the spleen becomes caught up in the torsion and had to be removed as it became damaged. The spleen is full of blood when removed, last nights one was about 4 times normal size so there is a possibility of blood transfusion being needed.

Recognising the signs of bloat is easy dealing with it if you are used to it is easy. The emergency clinic l work at has what has been assessed as having the highest GDV case load in the country and there a GDV is a messy and backbreaking, because it is the big dogs that get them standard op. To give an idea there was a blot in Monday night and one in Wednesday.
The general vet practices go pale at the thought of a GDV it is the big ugly scary unknown operation, probably the one vets and vet nurses dread the most. In fact if they are unlucky they will get 1 a year.

Quick idea of protocol is:
1) Give strongest painkiller available to the practice
2) Place 2 iv catheters of the biggest bore you can. May not be possible as veins are in such a state but one must be placed.
3) Take bloods although may not be run (checked).
4) Place dog onto fluid and waz in the first 2* litres at high speed. (*Amount based on animal size)
5) A size 14G 2" catheter to decompress if needed by inserting into the stomach, this buys time for examination, lowers some of the pain and compression on blood vessels.
6) An ET tube and oxygen etc must be handy, they can collapse during decompress
7) An x-ray conscious or under GA can be taken or jump that and start to place stomach tube.
8) Other drugs as the vet deems needed.
Assuming the tube goes in then it is a dilatation if not under GA then needs a GA (general anaesthetic:
A) Have an empty bucket (stomach gunk to go into)
B) A bucket of water and a funnel
C) Pour water into stomach tube to flush stomach
D) Lots of incontinence sheets around op theatre
E) A step to stand on when pouring water, need to hold it high, then jump off stool and aim at end of tube at bucket. May need to jiggle tube and rock dog to get contents out and repeat for as long as it takes stool>>pour>> bucket>>stool>>pour>>bucket...
This in theory is easy but the vet wants things passed over or you need to check the patient and the tube falls out of the bucket and floods everywhere.
You slip getting off the stool, try not to fall and damage yourself on walls, tables or whatever and drop the tube which adds more smelly slodge to the walls and floor.
The paperwork you are trying to keep the op details on gets wet and of course not only rips but is impossible to write on properly.

Once the stomach is empty and the bucket and op theatre are full of smelly fermenting brown sludge the vet may do one of two things. Wake the patient up and arrange when it is better to do an elective gastropexy. This is an operation to suture the stomach to the abdominal wall to stop it twisting in the future. Or he will go in and do the op there and then. It is surgeon’s choice. There is a high probability that the dilatation may occur again and may turn into the dreaded torsion.

If the tube will not advance then the patient is prepped for surgery. The vet is threatened with castration via his throat if he tries to scrub before helping shift the dog from prep to op theatre. You would be surprised how many try this ploy and it is always the male ones.
Once the patient is “unzipped” the vet will then untwist the stomach manually. They may need to carry out a spleenectomy if the spleen is involved. Then flushing as per A to E is carried out.
If the stomach is badly damaged the necrotic dead black part is removed. This is done after the flushing so that stomach contents do not flood the abdomen.
Finally a gastropexy is carried out.
Once closed and cleaned they are back in critical care. General fluid therapy is continued, monitoring needs to be kept for heart arrhythmias that can occur and an eye on blood loss. Blood transfusions may be needed.

A long hard clean in a filthy op theatre it is amazing where the gunk gets to and it sticks like glue where it is thin and in other areas is a slimey drippy ick. Think l will go do human nursing they do not have this at 3:15am.

Intestines the thick red sausages the spleen is the black wadge on the right of them, everything is massively swollen.











The spleen when removed l laid it out for the photo, hard to see size but it is about 3 to 4 times the size it should be.

Blood

This is a request for help from all dog and cat owners of any breed but specific sizes and certain requirements.

It was just over a week ago l was placing a PBBuk blood bag onto a canine patient post op, relieved we had the blood in as it was midnight and did not have to play hunt the donar. True it was a fluke we had the correct type in for this patient, the one it was ordered in for had died but we had the blood in store. Dogs can take their first transfusion from any of the canine groups but idealy it should be the correct one.

I do not know about humans and blood but with animals we take a pre placement measurement of temperature, pulse, respiration (TPR)and check the gum CRT(capillary refil time). We then put the blood on at a very low flow rate and monitor TPR every 5min while sitting by the patient. If they stay stable for about 20mins then we move to 10min TPR for a few checks then 20(ditto) and finally we will up the flow rate, monitor them again for the first 15 min. If all stays stable we place them on full flow. If they have a bad reaction to the blood we are able to react instantly.

Until not long ago the law would not allow the storing of pet blood. When it was needed then donars were rung and blood sought for immediate use. Thankfully this has all changed and now storage is allowed. This has led to the setting up of the Pet Blood Bank UK

The website is based around dogs and you will not find cats mentioned there. However in 2008, PBBuk was awarded $15,000 from the Waltham Foundation, an organisation which provides funding towards research that directly improves the health and welfare of animals world-wide, which has enabled PBBuk to start the research project into collecting feline blood.

Like canine donors, feline donors will be required to meet certain criteria before they are able to donate. Cats should be indoor cats, fully vaccinated, friendly in nature, aged 1 - 7 years, in good health and a few other requirements. Full info for cat requirements are available via phone

PBBuk break the blood down into whole blood, packed red blood cells, fresh frozen plasma, frozen plasma, cryoprecipitate and cryo-supernatant just the same as the human blood service and this is then available all over the country to vets, sent via courier.
Yes vets do pay for the blood/products it is not free however it is not cheap to run the service and yes the cost is passed onto the owners of animals that have received the end product.

Some times it is not possible for the vets to order blood in and they need to use local donors but the PBBuk has made a huge difference. Before we only had whole blood from local donars. If a practice does not have many blood donors available and they have just given or do not have suitable blood type, or the one that did has owners on holiday etc.

Blood (and their byproducts) are not just a life saver for humans but for dogs and cats so if you think your dog or cat would fit the criteria and are interested in helping, please go to Pet Blood Bank UK and if you fit the criteria apply.

I have helped with a lot of donar dogs and cats and they all come off the table happy to have a bicci and a bowl of food. None have been harmed and many are multiple donors.

There was a situation l was peripherally involved in. A patient had died and the vet decided that the owners that were away may like an autopsy. Bodies for PM must not be frozen so it was left on the side in the back with orders to keep it cool. I asked an auxiliary to sling some wet towels into the freezer these could be placed over the body at various intervals.

One of the nurses decided to place some ice packs around the body to help. A lot of lab slides and tests are sent though chilled with blue ice packs. Practices keep these as they are useful. So the nurse slung a big blue “ice pack” on the dog.

A week later l went back to work and was asked about the dog as l had been there. I explained my part, the nurse asking then broke into shreiks of laughter. It was not a large ice pack but actually several bags of plasma in a blue outer bag.
I stared in astonishment, asking if no one had marked the bags on arrival. I was told well they were marked…inside the blue outer bag.
I am afraid l joined in the general laughter especially when told that it was now about £1000 worth of worthless mush, ok so it was not politcially correct but it was not a small one man practice, then l would have been upset, it was one of the big national groups in the UK and tough tits to them.
Just a pity that the donar dogs blood products ended up useless in that case.

Drips and Drops

I really need to learn to say no to work. I was rung up Sunday at 16:30 in the afternoon and said ok to working the 17:30-03:30 shift and as we were so busy l didn’t leave till 04:30.
Just as well l went in as from 22:00 there were 2 of us nurses and a vet with no auxiliaries, so we had to do their jobs the laundry, bins, cleaning and reception, phones as well as our own jobs.

I ended up doing the anaesthetics and assisting the vet on ops, l took x-rays (nurses job generally), did dressings (nurses are better at dressings than vets), placed drips, took and ran blood tests and the odd bit of inpatient ob’s to help when l got a chance.
The other nurse did the inpatients, a bit like painting the forth bridge never ending.
The rest of the jobs we shared between us. The 02 alarm has a fault on and at one point l ended up laughing hysterically, leaning against a wall as the other nurse marched like the honey monster snarling in frustration towards the alarm to slam it with her hand for the 10th time or was it the 15th l lost track.

We had a couple of major operations like removing a collar buckle from a stomach. The dog got bored and ate his friend’s collar FFS talk about a pimple brain!
“Duh l am bored wonder what l can do, l know l is gonna eat your collar”
His friend joined in and ate the studs and other bits of the collar that fell on the floor. After all it was his collar so fair is fair, x-ray showed they were moving through his intestines.
That was the op that ended late then l had theatre and prep to clean and mop post op, l refused to pack the kit though just slung it into the cleaning fluid to soak.

A pyo, the uterus fills up with pus and it is life threatening. Why oh why do people not get their bitches neutered when they are puppies. They would avoid the £700+ bill, the misery and illness of the animals.

Add that to the usual night time crop of x-rays of dog and cat RTA’s or accidents and temporary support dressing (if possible) till the patient is operated on.
Stitch up wounds, gastro enteritis - joys of Christmas dinners, blocked bladder cats and renal failures.
Wound breakdowns – Listen people use the sodding buster collars they are there for a reason, don’t sit and watch your pet chew the bloody wounds.
A rabbit, a couple of birds some medical cases and oh 2 Parvo dogs in isolation.

It added up to a fun round of work yourself silly night. Think it was 36 inpatients with 32 on drips. Not the busiest of nights but more than enough to keep us going without a break as we had so few staff. If one more dog pulled, ate or disconnected its drip line then there was going to be a group of hysterical staff on duty. Drip lines can be the bane of our lives. If you have a “Bad Drip Night” you know things are just going to go downhill.

At one point l had 5 redrips waiting for me. I tend to prefer dripping to holding and the other nurse on was happy with that as she prefers holding to dripping.
I had the locum vet holding earlier in the evening. He is a Jelco person. And is to bloody slow when we need to motor. Being male he can hold and talk but not drip and talk and l felt that taping his Irish mouth shut was a bit extreme as being the only other option.

There is 2 main makes of iv catheters (canulas) we all tend to use Surflo or Jelco. I have had to get used to Jelco with locuming about but generally if you can use one sort you will screw up the other. I am in the hate Jelco camp.
The other type is winged catheters. These have little wings next to the cap to suture them in. Not something you do with animals we chop them off.
We tend to use these for rabbit ears. Yes rabbits do need iv fluids and we give it via their ears. I also hate doing rabbit ears. We put a local on their ears but it never properly works. They jump at just the wrong second. The skin is so thin and veins so tender it is all done by hope.. “hope l am in this ***ing time”.
For those who understand sizes, 27 or 26 (purple, yellow) rabbits, puppies and kittens, 23 (blue) cats and small dogs, 21 and 18 (pink, green) bigger to huge dogs.

One Jack Russell broke 2 buster collars and chewed out 2 lines. The little git got a shock when his teeth descended on the 3rd line though. I left his buster collar off and he thought Christmas had come again, stupid vet nurse. I won that round though, l sprayed the line and dressing with bitter spray.
I also placed the drip into his back leg vein. This can be a difficult one to get, but often patients will tolerate it better here. The vein is very wobbly and the stylet on the catheter bounces off it, you have to give a hard jab but not to hard so you go straight through the vein and blow it. The hind legs are a difficult shape (The vein goes diagonally towards the back of the leg just above the animals hock from front to back, run your finger round your pets leg there and you will see what l mean about shape, lumpy, bumpy and a rounded leg.)

There was a lot of short legged dogs last night, again a nightmare to drip. We call the short front legs, Queen Ann legs. The veins are very loose and wobbly, run in weird shapes around the legs and are a nightmare to find let alone drip. These dogs tend to wriggle a lot often try and bite as well and there is no decent handles on them to grab.

The drip lines used where l was disconnect part way up. This is useful when you have dogs to walk and swop lines for some reason or trying them off drips for a bit. The down side is that they can come apart and when this happens blood flows out till it clots. The clot happens fairly fast but not fast enough that the bed is not a blood bath (blood mixed with the fluid leaking out of the bag spreads well).
To sort it you disconnect the whole line and flush the blood this comes out like a hard long worm, then reattach everything. Change the bed, which was probably cleaned about 10minutes before when they peed or pooed on it.

Then there is the restless walkers, round and round till your drip is one long snarling twisted mess and pulls out the leg. Mind you not that it was dripping anyhow. Even if you manage to untangle the drip line before it pulls out they damage it with the tight twists. We were to busy though to give hourly boluses. At least there was only one “walker” and she was a non critical dog, being a recovery and going home the next day, we ended up taking her drip out.

I was so glad to get home last night and climb into bed forgot to drink my coffee. I fell asleep while trying to decide if l should reach a finally warming up arm and hand out to the cold air to grab the mug.

Chrismas Eve on Duty

On Christmas Eve l had been down to do the 14:00-22:00 but was asked to swop at the last minute to 17:30-03:30. I slunk into the house at gone 4am slurped a mug of coffee, tripped over books because the stairs light blew and l happened to be looking up at it when it flashed and seared my eyeballs and all l saw was flashes for 10minutes.

Work was as expected busy. I went straight into the kennel area on arrival to be told “Hurry up you are in theatre in 10minutes”. We had a splenectomy op (removal of the spleen). The patient was stable for the first part of the op. The last part was a bit of a nightmare as the patient did heart stops and other fun games with me. I was the anaesthetist for the op. Anyhow we all survived, the vet and l with more grey hairs, the patient minus a spleen. His recovery was good though considering the op and a bag of blood was dripped into him, along with other fluids.

Spleen operations are always a guarded diagnosis. In older dogs the spleen is often the target for tumours. They reach a certain point then rupture. The abdomen fills with blood, the body goes into shock and the spleen needs removing to stop the bleeding or the patient dies. Bleeding has often gone on over a week or so with the owner thinking the dog is a bit off colour then the dog's collapse.
The liver and other organs are checked for mets (spreading tumours). If there is mets then generally the patient won't come off the table, 98% of the time if you find mets then they are well advanced. The owners are rung and recommended that the patient is inoperable. Even if they came round the shock of the operation will mean they die within a very short time post operatively often within a couple of hours and it is not fair on the patient.

There were several minor ops during the night. Including a border collie that was very nervous. A nervous dog is the worst if it bites you. They are scared so make the first bite the one that counts. Luckily he didn’t bite, well l got called over by the vet who decided to get him out and the vet seemed intact. He had decided to do a “just” op. These will “just” take 5minutes in this case a quick leg stitch. It ended up as tendon repair and not as straightforward.

A diaphragmatic hernia repair was ending when l left. I kindly gave the night nurse that one, figured the other 2 ops l was involved with was my quota for the night, l did the inpatients instead.
A diaphragmatic hernia (rupture) is caused by extreme trauma, in the cat’s case due to a car hitting it. The diaphragm amongst its other jobs is the “muscle barrier” between the abdomen and the chest. Puss had a lot of trouble breathing because his liver, spleen and stomach were sharing space in his chest with his lungs, if he had not been castrated his testicles would have been in there as well.

We had a Doberman in who weighed about 50kg. At one point his drip line blocked so l so l sat on his bed in the walk in kennel to undo it, clear it and reattach it. This was not too easy. I ended up trying to fend him off my lap. He had a mental image of himself as being a tiny little puppy not a blimming big but sweet lump. We came to an agreement; he sat on my lower legs/feet and crushed those while l sorted his leg out. When left alone he howled until you went in gave him a cuddle then he shut up for about 30minutes. Seemed 30seconds gave 30minutes of silence in his currency.

Day shift had managed to get a lot of inpatients home, thankfully. Still we added a quite few into the empty kennels. Including a wild goose with one leg, the practice manager will take the goose. He has a huge pond and all water birds go to him. The vet and l upset the night nurse. She is a veggie and we discussed how the best way to cook the bird. Would the loss of one leg mean that it was lacking for those who liked leg meat etc? It cheered the evening up she took the bait and hell, we reeled it in.

The little stray pup is still in. His leg is still borderline to be kept or removed. He can not use it and it sticks out straight. He is zooming around happy with life. I did manage to sort of snap a photo of him but it was hard as he does not like to keep still. If there is quiet spells he is taken out and allowed to run riot around the place, if busy he runs round dog ward while we clean his bed. The other night he dived into Wibble’s bed then peed all over it when he got overexcited.

Christmas day was spent having a quiet Christmas day at my parent’s house. None of us like the noisy type day that is generally beloved so for us it was ideal. I would like to thank my folks for a relaxing day.
Hub was given some stilton. Oh joy now whenever l open the fridge l get attacked by this tub of stinky stuff that smells like 2months worth unwashed socks. I regretted making the suggestion to my Mum about getting it as a gift when hub undid the tub and smelled deeply muttering about ambrosia. We defiantly differ on the meaning of the word ambrosia.
I got some money and am saving up for a Sony Reader. It means l won’t have my books falling apart because l read them so often.
I was also given a lovely laser fairy cut into a block, it sits on a small flashing reflector and I’ve placed my special crystals on top of the block. They look perfect as the light shots through the fairy into the crystals in different colours.
We gave my parents a digital photo frame, the Kodak P720. I would recommend it as a gift. I used a 1 gb card for it preloaded 120 photos from the past times and loads of space for new photos.

I am off until Monday and intend to catch up on about 200emails that have collected. And may even consider giving the house a good clean, assuming l am not sidetracked by falling asleep on the settee. My years of nights have played merry hell with my metabolism and now l feel tired at all different times. It seems this is normal amongst night workers. New Year resolution, learn to say “no” when asked to do last minute shifts and changes. And take more days off and cut down on double shifts.

Junior in his buster collar. We have tried him without but he wont leave the external fixator and wound alone.

The Rebar

Twas 2 nights before Christmas a couple of years ago, all was settling and nicely quiet. The dogs were in bed and the cats hunting mice.

Well not exactly. The bull mastiff decided that he would go for a pre bed yippee round the garden. The house was mid repairs and part of the garden held big 5ft+ re-bars. (reinforcing bars)
How Bruno succeeded in getting one through his thigh area no one knew but he was now in big trouble.
I had to go on the call out to sedate Bruno and give him a nice dose of pain relief and sedative, then help get him moved and back to the vets. I went with a now long gone driver called Sam.

When we got there Bruno was lying in his plastic dog bed in the kitchen. The leg sticking up in the air, supported on the bar. The owners were not kidding about the bar. Even though he appeared friendly, I passed the owners a muzzle to put on Bruno. With the way things were l did not want to go trying to upset him more, and I am too old for heroics. I drew up a dose of sedative and pain killer.

While this was going on and the drugs were taking effect there was a regular “thud” followed by digging then snarling and other fearsome noises coming from behind the locked door. This was their other bull mastiff who hated everyone. Apparently if she had got spiked then even the owners would have had problems handling her. And we would probably never have got a muzzle on so she could be sedated or handled. I guess there are some small mercies then, she was not the one spiked, and that sounded like a strong enough door to hold her away from us.

Sam wasn't really in the right job. He was scared stiff of all animals and was staring, like a rabbit caught in headlights, at the shaking door. I sent him out to dismantle all the cages in the back of the van. There was no way would we get Bruno and his bar in any of the cages, or in the back of the van with the cages up in it. The owners of Bruno were following us in their car and the cages were loaded in there.

Getting Bruno out of the kitchen to the van was not the easiest of jobs. First we had to get him out of his plastic bed, without causing him any more pain, he had had injections but even so it hurt. The bed was too wide to go through the door. We could not get him on the stretcher either as the bar was sticking out. Also he would have slid on the stretched as we would have had to tip it to get dog and bar through the door. In the end we got him on a blanket, sort of bending him around the doors and furniture in the tiny lounge.

Once he was loaded l sat in the back of the van to keep an eye on him, and try and support the leg to stop to much movement. This was not going to be fun l am prone to carsickness and was locked in the back of a smelly van. Bruno was very good with just the odd whimper if we hit a bump. It took what seemed like forever to get back and by then I was almost as green as Bruno felt.

The vet and l debated the fire brigade coming out and cutting the bar. We could not x-ray the leg to see where it went, due to the bars position. In the end the vet decided that he would try and pull it through slowly. If it was jammed then fire brigade would be called to cut it off, we would get our x-ray and take things from there.

That dog had to be the luckiest that night. The 5ft re-bar pulled smoothly out of the leg. On it’s way in, the bar hit no major blood vessels, no bones nothing, it just slid through the muscle like the proverbial “Hot knife through butter” and came out the same way. Bruno went home the next day.

Lung Foreign Body

The English springer spaniel bounced into us last week. He had a bad cough and was coming in for a heart lung check-up. His breath was like a charnel house but his teeth were clean.

Mike well experienced with what may be the problem took a couple of x-rays which tipped the diagnosis more in favour with his idea. There was a fuzzy area on the chest x-ray in the lungs which was suspicious.

A general anaesthetic and a scope down the trachea into the lungs confirmed what was happening. Springer’s and apparently Labradors are the main culprits for “foreign bodies” being inhaled into the lungs. They generally cause a cough and can be well tolerated. Often just the cough and no slow down in their lifestyle, oh and the bad breath. Do not mistake it for doggie bad breath. This is putrid and bad teeth/tooth smell is not even on the scale it is so tame.


A set of graspers was pushed down the instrument channel in the scope and the item was caught. It was fairly difficult and at first a few single grains were pulled up. This moved the main plug a bit into a better position and a 5th go the grasper's managed to get a good grip on the full plug. It was slowly lifted all the way out the lung.


If l thought the smell was bad before it got a whole lot worse as the plug arrived in what had been fresh air. The whole lot was shoved in a bottle ASAP so that we could get some more un-putrid air circulating, the plug was put to one side for the owner to see.


The lung was red and spots of pus still remained but would soon settle down.


An hour later the Springer was back to his bouncy self. There was still a bit of a cough but that would go pretty quickly. The plug was an awl of barley. The cough had started in about august which was cropping time (roughly) so that was about a 3 month window of how long it had been down in the lung.

*====*====*====*====*====*====*====*====*====*====*====*====*
Better photos views in thePhoto album

The Cat Pacemaker

Before l start a disclaimer...Sorry if anyone is looking for correct medical terms and words to describe operations or conditions. I am not into those and rarely use them. I like simple talk that anyone can understand, and anyhow, my spelling and grammar (better add word that before Curley pulls me up yet again) is bad enough as it is

*====*====*====*====*====*====*====*====*====*====*====*====*

We had the cat in today for his pacemaker. It is very rare for cats to have a pacemaker fitted. If they are at the stage they need a pacemaker then their hearts are usually to badly damaged to have one fitted.
Cats also clot very easily and throw thrombus (blood clots) a condition that is often critical in them.
Only a few cat pacemakers have been fitted in the USA and this was a rare one for the UK.
Dogs have pacers fitted fairly regularly and generally do very well on them. They have different type of blood (yes it is still red though)that does not clot as easily, and a better heart physiology to tolerate pacemakers.

This appeared to be one of the rare cat hearts that was suitable for a pacemaker. His exact age is unknown as he was rescued but possibly about 10-12years old. The owner was given a very guarded prognosis and all the possible options covered but she elected to go ahead.

Despite the initial worry from the vet about how puss would react being sedated, as opposed to full anaesthetic, to have his temporary pace lead placed via the jugular he was a star, just lay quietly.
It was a bit fiddley as the jugular is so small but Mike (The vet) is very experienced and with fluoroscopy to guide, it went smoothly.
Once the temporary lead was in place he was given propoflo for his anaesthetic and surgery began.

Surgery took about 2.5hrs (including prep). The surgeon made a midline incision in the abdomen and entered the chest through the diaphragm. He attached l believe it is called a unipolar lead (single pad lead) to the heart. This lead fed from the heart back through the diaphragm to the pacer. In cats this is placed in the abdomen. Puss had steady stats all the way through. It was one of those near perfect anaesthetics that you wish for and do not always get.

Recovery was uneventful and within about 3 hours he was awake and having some food. He had a swipe at me at one point when l was trying to sort his food bowl out.
I was giving him another check when the secretary came in, to see how things were going.
I shut his kennel door and was saying “He is…”
At this point puss gave a half mewy cry and crashed. I bellowed for back up as l got him out the kennel and he was being worked on within about 40 seconds of the initial crash, despite about 20 to 30mins of attempted resus we lost him.

A very s**ty end to what started out as a positive day. Why Puss crashed is unknown. The vet came up with a couple of ideas but with no autopsy there is no way of knowing.

Pacemakers and Strange Goings On

I got a phone call yesterday (Friday) at 10am. My old practice (one that wanted me for this Saturday night) it was 2 nurses down 1 on the 13:00-23:00 shift and the other for 15:00 – 22:00 that night.
As l was half way down the country, and wouldn’t be back till late. I was able to cheerfully say nope no can do.

Had a lovely but insane dog in for clinic Friday morning, going through to the consult room it pulled so hard it was walking on its back legs. The front paws swept the brochures, cards and bell off the reception desk in one sweep. The room had a blizzard of business cards fluttering about.
A little terrier stood under a chair with a look of distaste at such manners.

It was a busy interesting afternoon. We had a clinic for dogs due their annual pacemaker check for any developments or changes in heart rhythm as well as pacemaker function and battery depletion. The pacemakers have an average life of 10years.
During a break while we awaited traffic hold ups to spit out clients, we had a great slide show. Well had a great, from a morbid point of view.The pacemakers that are used in dogs and cats are human ones and the people that run the clinic are human nurses. They had a slides of problems that humans with pacemakers have encountered over the years.

I am crossing fingers we may have a cat in on Monday to have a pacemaker implant, won't say more in case it doesn't come off.

A Pacer implanted in a dog and A Pre Implant Pacer


Had an interesting experience Thursday night and while some may scoff others may understand so I decided l would put it up anyhow.

One of the vets brought up about the spirit (ghost) if or if there isn’t one here as it is an old Victorian house. He said that other nurses had sworn there was and was very noisy.
Now l figured there may or may not be something having a few feelings but you have too allow for imagination.
It is an old house and so l expect it to be noisy at night, there is not the normal daily bustle and noise to cover it. ‘Spooky’ feelings are bound to apply, in an old Victorian house, that’s how the horror and docutripe TV programmes (most haunted type) work.

Overnight at the house doors clunk shut. Despite the fact that l go round and made sure all the doors are shut every night, doors still clunk shut, bangs and creaks, pipes knocking and all types of noises. I reason it as the house settling.

I told the vet that there is a great (nice) spirit at my old place who was really helpful on nights. I had also asked him (spirit) to please not slam doors or have talking going on as l am happy for spirit to be about but it is the thought of strange humans on the premises that worries me.
Since l asked that, l never had another door bang or hear strange voices but others do still hear all of that.
I have had help, like flashing lights in ICU when a critical patient needed me and a few other happenings that were to strange to pass for normal.

Thursday night after we had our chat there was NOT a sound. No doors clunking shut, no creaking, no bangs, no rattles, nothing, nada grave quiet.

In the morning I said a thanks to whomever, it was a lovely peaceful night. You may scoff, but what other reason there could be?