Surgery and Anesthesia

Howdy Friends!  It's been a while, and I've been very busy.  This quarter I have three classes:  Anesthesia, Small Animal Surgical Assisting, and Advanced Hematology.  I've been keeping very busy, to say the least.  Let's do a little run through!

Advanced Hematology
In this class, there are four of us and we get to draw blood on all nine animals every week, and we get to run a Complete Blood Count (CBC), Chemistry Panel, and Snap Tests (quick blood tests to check for certain diseases such as heartworm), and look at the blood under a microscope.  We've done this stuff in the past, but never on a weekly basis such as this.  It is really fun to hone my skills, and get better and faster at doing these routine things that I will be doing in the clinic in a few short months!

Surgery and Anesthesia
These two classes go hand in hand.  In class, we learn about surgery and how the anesthesia machine works, on Tuesdays, we have surgery.  As technicians, we cannot perform surgery, but we can assist.  At school, we only do neuters and spays on dogs and cats.

There are three basic positions that we learn how to do things.  As Scrub Nurse, we have to actually scrub in (surgical scrub, sterile gowning and gloving), and we have to sterilize instruments and everything else that needs to be sterilized for surgery in the Autoclave.

An autoclave sterilized instruments and other surgery equipment using pressurized steam at 121 degrees Celsius... that's about 250 degrees Fahrenheit!!

This is what we look like when we are scrubbed in... we cannot touch anything that is not sterile!  I haven't worked in this position yet, but will do so next week.

As anesthetist, the animal under anesthesia's life is literally in your hands.  Basically, when an animal is under anesthesia, just like a human, their heart rate and respiratory rate are depressed, among other things.  If they go too far "Under" they could suffer serious complications including death.  As anesthetist, you are responsible for doing a complete physical exam, pre-anesthetic blood work as outline above, lots and lots of charting, calculating and administering anesthetic medications, putting in an IV catheter and hooking up calculated fluids, putting in an endotracheal tube (see below) and hooking up anesthetic gases, and most importantly, monitoring the patient throughout surgery and recovery.

Once the patient is under anesthesia, there are lots of monitoring devices hooked up to them to measure heart rate, blood pressure, temperature, breathing and more.  You also have to know the "stages of anesthesia" (depth of anesthesia), and be able to tell the doctor when he or she asks.  You have to be able to adjust IV fluids and gas anesthesia to keep the patient in the correct plane suitable for surgery.  We are lucky enough to have a third instructor on hand during surgery to help the anesthetist one on one.

The final position that we learn is the Circulating Nurse.  Basically in this position, you do whatever you are told to do.  This includes restraining for the anesthetist to put in the IV and endotracheal tube, scrubbing the patient for surgery, helping move the patient, charting everything that goes on during the surgery, cleaning the surgical suite from top to bottom, and assisting with getting things such as scalpel blades and sutures, and helping the scrub nurse and Doctor get into their gowns while remaining sterile.  I was the position last week, and it was pretty fun, and very stressful trying to keep up with the Dr.'s notation during surgery!

My First Surgery
The first week of surgery, I was the anesthetist.. known to be the most time consuming and nerve wracking position of the three!  I was nervous, but confident.  My instructors are just wonderful!  It was awesome to do all the things I mentioned above, including many things for my first time.  It was the first time I placed an IV catheter that I actually USED (hooking it up to fluids) it, first time placing an ET tube and anesthetizing an animal, first time calculating and administering controlled drugs, first time recovering a patient... WHEW! I'm glad it's over because it was a lot to take on in one day!

BUT!  I made it through :)  My patient was a dog neuter.  He was a sweetheart, and seeing a patient under anesthesia is always a little bit comical.  First, they are stumbly and "drunk" looking, and then they are completely limp and you can move them anyway you want them to.  Much easier to trim nails and stuff too ;)  Oh, and their tongues almost ALWAYS hang out :P

Anyways, also as the anesthetists, you are responsible for recovering the patient, making sure it can eat and drink water without vomiting, and you are responsible for post-op medications and care twice a day for the rest of the week.  This also includes discharge instructions for the humane society.

Wrap-Up
This quarter has been a whirlwind so far of emotion and knowledge, and putting both of those to the test.  I have a few other things to post, but I will break those up into a few more posts.

I promise to try to write more, too.  But we all know how that goes ;)  

IV's and Bunnies

IV's

On Wednesday in my Small Animal Nursing/Nutrition class, we started practicing putting in IV catheters.  We practiced using a rolled up magazine with a rubber tube filled with IV fluid attached to it using vet wrap to simulate a vein in a leg.

It was kind of neat to know that we will be placing these IV catheters on real animals next week.  Eek!

Bunnies

On Thursday, I picked up five rabbits from the High School we visited last week so we could do some learning with them.  All of the rabbits were SUPER friendly and very fun to work on.  Here's some things we did:

SubQ Injections

Nail Trims

Gave Oral "Medications"

And Blood Draws (From the Ear!)

I got my blood draw on the first time!  Their ear veins are so tiny.. so I was super happy.  My bunny had dark hair too, so it was much harder to see the vein :D

Urinalysis

 We also performed some routine urinalysis on some dog and cat urine.  We didn't find anything, but as we always say...good for them, bad for us :)

I also had my first interaction with a blind dog.  He was the "son" of one of my instructors.  He was a hound, and it was so sad to see the scared, vacant look in his eyes.  But he was such a sweetheart!  

That's all for now.  Will write more next week :)  

Meeting So Many New Animals!

Menomonie High School

On Tuesday, we visited a local High School and their agricultural department to learn about some new animals. We worked with hamsters, gerbils, degus, chinchillas, a California King Snake, mice, a pot belly pig, ferrets, guinea pigs, rabbits, a sugar glider, geckos and a tortoise.  I figured I'd highlight the important notes below.

Basically, we went to the H.S. to learn more about species we will not come across in the classroom.  We took fecal samples, ear cytology samples, skin scrapings, etc. to try and learn more about these species.  We took the samples back to class on Thursday and analyzed them.  We did a general physical exam, including a TPR (temp, pulse, respiration) on those we could.  We also did nail trims on those who needed it.  We each were assigned an animal to learn about and present to the class...including interesting things we learned. (See below).

Hamsters

We didn't do a whole lot with them, and I didn't learn much more about them than I already knew.

Gerbils

My animal was the gerbil.  I got to measure a pulse (320 beats per minute!), and the respirations.  We didn't have a device to measure temperature on an animal this small.  I learned that Gerbils are illegal to own in the state of California (mostly because people release them and they can cause agricultural damage), that they have very poor eyesight, and that they can die after chewing on a fibered tape such as duct tape.

One of the gerbils had alopecia (hair loss) on its nose, and I later found out that they discovered it was allergic to the Pine bedding they had been using for his substrate.  

Degus

Degus are basically a larger version of a gerbil.  The biggest thing I've learned about them is that they're biters ;)

Chinchillas

Chinchillas are on our "do not touch" list, a list of animals that we are not allowed to handle, per the rules in place through the school.  

California King Snake

The California King Snake is named a King Snake because it will eat other snakes...including venomous snakes such as rattlesnakes.  They can do this because they have an enzyme that breaks down the other snake's venom; however, they can still be killed by a direct bite to the brain or heart.  I didn't get to hold him, although I was interested in doing so.

Potbelly Pig 

The potbelly pig lived outside in a pen, and was able to roam free in the courtyard.  I learned that they can be restrained similar to a dog or cat, and that they also like to squeal whenever they are restrained :P

Ferrets

Ferrets were also the animals on the "do not touch" list, but we did do ear cytology and fecal samples on them.  We didn't find anything abnormal.  One of the ferrets had severe alopecia on its back, but I don't know if we learned anything about what was causing that.

Guinea Pigs

We got to play with the guinea pigs, and they were really fun!  The ones I dealt with were really chill.  We got to do nail trims on them, and they REALLY needed it.  It's SO much fun doing knowing that doing something so little will make SUCH and impact on the animal.  Some of these "G. Pigs" had nails so long that they curled over, and they had to walk on them.  Can you imagine your toenails being so long that you had to walk on them... and then some stranger coming about and trimming them to a normal length...so you can walk comfortably again?  This is the high I get from helping these animals!

Nails very long.. need to be trimmed!

Trimming nails :)

Rabbits

I've dealt with rabbits in my past on a very minimal basis.  My grandpa had a bunch of them at one point, but they were not very people friendly.. and always ran away from us.  On Tuesday, I got to hold one for the first time!  Rabbits have a very unique and convenient feature about them.. when you flip them on their back, and gently stroke their chest or their nose, they will go into a hypnotic-like state.   This makes them very easy to work with!  I got to hold a rabbit, flip it on its back, put it "to sleep," and also put it back into its cage.  The one I worked with was very nice :)  

Sugar Glider

A sugar glider is basically a rodent that has "wings" and can fly.  They are nocturnal (sleep during the day, awake at night), and they are really cute!  The one we encountered was sick...most likely from a nutritional deficiency.  We didn't do much with her because she was sick, but I know she was taken out of her cage and they did some sort of sample collection.  I was busy helping with a guinea pig nail trim at the time.  Here's a picture of a Sugar Glider:   SOOOO cute! :)

Tortoise 
The tortoise that we met was about 5 years old and weighed a whopping 18 pounds!! He was really cool, and all we basically did with him was say hello and obtain a fecal.  It was cool to learn that he will outlive most of us (100 yrs+)!

Conclusion

I think the field trip was AMAZING and so well worth it.  I had a blast, and got to learn about and handle animals I had never dealt with before.

P.s....Blood Drive
Also this week, I donated blood to the American Red Cross!  It was my 3rd overall donation.. and I felt great about it :)


Hope your weekend is awesome!  See you next week!

Working Outside of the Box

Small Animal Nursing and Nutrition
For our SANN class today, we got to work with three cats this week that seem to have some sort of neurological issue going on with them.  We reviewed several "neurological exams," simple tests to help determine if the issue is something with the brain, or another system.

One thing we do is called conscious proprioception.  You basically flip a paw upside down, and a normal animal should automatically flip the paw back.  An animal with a neurological problem may not flip the paw back over.

We ran several other simple tests like this including pupillary light reflexes.

We then went back to the classroom and discussed wound care, and practiced applying a bandage and a splint to a stuffed animal :)  Here's a picture of mine!

Work

After class, I got to help Dr. Morrow do further testing on the neuro cats.  I helped restrain for three blood draws, and then took the blood back to the lab to run a complete blood count (on a machine), a chemistry panel (on a machine), made blood smears, stained them, and examined it under the microscope.  Below are the machines that we use.  The first machine counts the blood cells and the second machine. tests different chemistries.

Vetscan HM5 (CBC)

Vetscan VS2 (Chem Panel)

We looked at the cell morphology and did what's called a differential white blood cell count where you count 100 WBC's and note how many of each of the types of WBC's there were.  Here's an example of a counter we use.  I call them dingers because they ding when they're done ;)

It was really cool to be able to work on these things again, since in the normal curriculum you stop doing them for a few months after you finish a class.  I got to perfect my blood smearing technique (no easy task!), and today was also the first time that I ran the blood machines on my own.  It was a lot of fun working in the lab without 8 other students in there too! 

Two exams tomorrow, and then it's my weekend!  Will write again soon! 

Quarter 5, Week 4

Monday
Yesterday, I had class and we worked on some things in the lab including administering ear and eye drops, cleaning ears, and my partner and I even gave our dog a bath! :)

After class, I helped Dr. Morrow with intake exams.  I basically bring the animals in, restrain for the exam, bring them back, sanitize the exam tables, and bring in the next patient.  It is an awesome out of class learning experience because I get to learn about things that may not always be brought up in class.  For example, I watched further testing for hearing and eye sight on a cat that had its extended third eyelid such as the one below.

Helping out with the physical exams has also helped me learn more about each of the animals that come in each week, and greatly increases my experience with handling, restraining and more.


Tuesday
Today, I had our Lab Animal class (LAEPP), and we did mostly lecture.  During the lecture, we were talking about rats and mice, and they are prone to a condition called "chromodacryorrhea."  Our instructor asked if anyone knew what that meant and I did a quick medical terminology breakdown:

Chromo/dacryo/rrhea
Chromo = Color
Dacryo = tears
rrhea = discharge

I had heard of a condition before where rats excrete red tears and I announce "Red Tears?"  I was right!  I was told "good job!" and I also announced, "Medical Terminology for the win!"  It was extremely cool to use information that I learned A YEAR AGO and still apply it today.  Many people end up forgetting, but Medical Terminology is one of those things you need to keep using.  It was awesome!

Chromodacryorrhea

In Advanced Clinical Skills, we went over some lecture and did some basic cytologies.

Physical Exams
For our Small Animal Nursing and Nutrition Class (SANN), we have to perform a physical exam on a selected animal once a week.  We have to do a full once - over, Temp, Respirations, and Pulse (TPR), palpate (feel) different structures such as kidneys, bladder, and lymph nodes, and write up a physical exam form and SOAP.  A SOAP is a form of recording medical information:

S = Subjective (things such as 5 yr old female intact black lab, gentle, etc)
O = Objective (TPR, things found on your physical exam such as lacerations, dandruff, broken teeth, etc)
A = Assessment (Assess your findings)
P = Plan (What do we do next?  Prescriptions, vaccinations, toe nail trims, etc).

It is pretty intense, but it's something we get to work on and it's awesome knowing we will be doing this for the rest of our careers!

That's all for now.  I will try to write again this week.

Have a good one! :)

First Post of My 5th Quarter

WOW!  I just typed "5th Quarter."  In less than 11 months, I will be graduating!  Woop Woop :)

I've been super busy with classes this quarter.  I am taking three, but they are sure full of homework.  Alex even mentioned how much more homework I have this quarter than any other.  I have Small Animal Nursing and Nutrition, where we learn about all the basics of nursing including everything from physical exams to nutrition to nursing procedures like putting in IV catheters!  It is a whirlwind of information and there are LOTS of workbook assignments... and thinking!

In Advanced Clinical Skills we are learning the laboratory side of things such as taking skin, fecal, urine, and blood samples and running tests on them, looking at them under the microscope, etc.  These tests are used for diagnosing tons of things like parasites, urinary problems, dietary issues, determining whether or not a wound is infected, etc.

In Lab Animals, Exotics, and Pocket Pets we are learning all about non-traditional pets like mice, rabbits, gerbils, rats, reptiles, etc.  We'll be doing blood draws, injections, radiographs, etc.  We'll be taking a field trip to the Menomonie High School to play hands on with a bunch of these creatures in a few weeks.  It shall be fun!  We're also discussing going to a pet store to check out some of their pets too.

I'm taking on more tasks at school too.  My instructors want me to help lead the Vet Tech Club.  I'm nervous and sort of excited to be taking on a role as such, since the VT club isn't exactly up and running.  I am also tutoring a fellow student in VT Math.  That's really fun and nice because I get to help someone out and get my math homework done too :)


Today
Today in SANN, we did several advanced physical exam techniques including what's called a Schirmer Tear Test, where you basically place a strip into the eye and it measures the dryness of the eye.  The picture below depitcs it.  You leave the strip for a minute and read the strip.  Anything out of a certain value indicates dry eye.

We also did what is called a Fluorescein stain on they eye.  This is basically a highlighting agent that will detect corneal ulcers (a scratch on the eye). You look at the stain with a black-light type device.

This depicts putting the stain into the eye.

 This would be a positive result indicating a corneal ulcer.  The ulcer is the big green spot on the eye.
A negative result would only show the green ring where the stain pools in the corners of the eye.

We learned to us a tonometer and an opthalmoscope today too.  I got to look through the eye and see the retina and the optic disk where all the nerves and blood vessels gather and go to the brain!  It was pretty sweet.  We also looked through an otoscope into the ear and seen the ear drum.

For the tonometer, you use a device that you press against the eye several times to get a reading of the pressure inside the eye.  An increased pressure indicates Glaucoma.  Below is a picture.

That's all for now.  I will try to update some more between all my homework, work, classes, tutoring, and sleep :P

The Year 2011

I thought I'd give you a quick recap of all of the things that I learned how to do in school this past year.  The following are mainly on dogs and cats, unless otherwise noted :)

- Restrain cats and dogs for various procedures

- Properly apply dog and cat muzzles, including making a muzzle from a piece of gauze

- Properly us restraint devices including a cat bag, rabies pole, and towels

- Trim nails

- Express anal glands (fun, fun!)

- Clean and medicate ears

- Obtain temperature, pulse, and respirations

- Maintain lab equipment including Complete Blood Count Machine, Chemistry Machine, centrifuges and incubators

- Apply an e-collar

- Collecting urine and fecal samples

- Perform various lab tests including packed cell volume, total protein, specific gravity, urinalysis and bacteria cultures

- Make proper diagnostic blood smears

- Collect and evaluate ear cytology

- Witnessed a necropsy

- Properly label medications

- Fill medication orders including liquids

- Reconstitute a dry medication/vaccine

- Dispense medicine to the client, including explaining how to give it, possible side effects, etc

- Administer subcutaneous injection

- Hand pilling both dogs and cats

- Administering liquid medications

- Setting up and maintaining an x-ray machine and developing room

- Set up for, take, develop, and read several different radiographs including thoracic, abdominal, extremities, skulls, etc.

- Perform a GI contrast study on a cat

- Radiographed a chicken, rat and horse

- Develop and use a radiographic technique chart

- Use both a stationary and portable x-ray machine

- Label, file and store film

- Cleaning intensifying screens

- Perform cephalic, jugular, and saphenous venipuncture (blood draws)

- Perform various blood tests including manual white blood cell counts and estimates, Snap tests, platelet estimates and white blood cell differentials

- Perform diagnostic procedures for Heartworm

- Collect and perform various lab tests on fecal samples to look for parasites

- Collect and examine skin scrapings

In twelve short months, I will have learned much more including dealing with pocket pets, exotics, equine and production animals, anesthesia, performing a full physical exam, implanting microchips, inserting IV catheters, and much, much more...and I'm still as excited as I was a year ago!!