Week 2 Day 3

Nakita's blood work showed that she does not suffer from Addison's dz and that only leaves kidney failure. Nakita's owners came in somewhat unannounced before Dr. Tugui could call them with the results. He took them into an exam room to explain Nakita's current situation and her options with having kidney failure. During that time I disconnected the fluids from Nakita and wrapped the catheter up in anticipation of her owners taking her home to spend time with her and make their decision. Dr. Tugui hopes to hear from them tomorrow.

Today was the day for Pixi's cystotomy. The Bichon that came in last week and we found a large urolith during what was supposed to be a ultrasound guided cysto. Dr. Tugui performed the sx and the urolith (composed of struvite) extracted was the size of a mentos mint. As soon as the sx was completed we took Pixi into radiology and took a lateral view of her abdomen the bladder was clear of uroliths.

A couple of hours before the end of the day Dr. Tugui had an odd appointment. A couple brought a cat in for a "sexing." The wife was convinced the cat was a male going so far to name the cat Maximus. The husband had an inkling that the cat may be a female (and pregnant!) after noticing a growing belly. After a routine exam performed by Dr. Tugui it was official, Max the cat is in fact a pregnant female. The doctor opted to take the rest of his afternoon to perform a pregnant spay on Max. We got right into prepping for sx. We got Max into sx quickly and Dr. Tugui removed 5 nearly full term kittens and spayed Max in the process. Cleaning up after the sx took me right up to the end of my day.

Week 2 Day 2

I assisted with the two surgeries we head this morning. I induced and intubated both patients. I chose the etube size for both dogs which were small breeds, a pug x and a min pin. The tubes both fit well and they went onto iso easily. Both neuters went well and finished quickly. On the min pin I was asked to do a deep skin scraping. This dog had been treated previously for demodex and Dr. Powell wanted to do a recheck. I performed my first skin scraping while the dog was under GA and the slide revealed no demodex. Dr. Powell will treat this dog one
more time before resolving it.

For my first practice tip I would like to talk about Dr. Powell and his use of lidocane. Ever since the birth of his youngest child, Dr. Powell uses lidocane on his patients for nearly every sx. This idea came to him while witnessing his wife's c-section and both the nurses and the doctors almost always had a syringe of lidocane in hand to treat his wife pre-op, during the sx and post op to manage her pain. So now during his surgeries he uses lidocane whenever he can to manage pain pre operatively and during the procedure. He has had me squirt lidocane into a spay incision just before he begins suturing. Today with both neuters he injected lidocane into each testicle and SQ right along where he would make the incision for the sx. This was done just before I did my final scrub on the patient.

Nakita the rotti x that came in yesterday for rads and bloodwork was back again today. Her BUN and creatinine was elevated. Dr. Tugui talked to Dr. Powell and they suspected either kidney failure or addision's dz. Dr. Tugui asked for us to perform a ACTH stim test and to get her on some IV fluids. She was to stay overnight on the IV and wait for the test results to come in the morning.

Week 2 Day 1

Monday was a good day. I got to do a dental prophy with Lynn supervising me and checking my work. I had fun and Lynn said I did a good job I really do enjoy dentistry.

The majority of the rest of my day was spent cleaning and organizing the cupboards and sx pass through in the treatment room.

A female rotti x came into Dr. Tugui with diarrhea. He ordered xrays and Jocelyn assisted him with that. I was busy with a euthanasia with Dr. Powell. The cat we euthanized was very icteric and anemic and very close to passing away on his own. Dr. Powell suspected catastrophic liver failure. The poor kitty was in rough shape and had been sick for a long time before this point. After the euthanasia I was asked in to radiology to pull blood on the dog. I had a bit of trouble initially with Dr. Tugui hovering over me and my confidence plummeted. The last couple of times I have tried to pull blood on other patients I have had difficulties and my confidence is waning.

At the very end of my day Helen came to the back and asked if I would talk to the owner of the dog I did a dental on. Lynn was unavailable. So I went up to the front and talked to the client. I stumbled through a bit but, I think I explained all I needed to her in terms she would understand.

What was supposed to be Week One Day 5

I had some issues with Moodle on Friday so to update you on the sick cat that came in Thursday afternoon. I discussed this cat's situation with Dr. Powell on Friday morning. Dr. Powell suspected kidney failure but, he could not speculate as to why. This kitty was only 7 years old. Dr. Powell called the owners after talking to me and informed the owners of their cat's situation and suggested that he be put down. Dr. Powell did not expect the cat to get better but, to get worse overtime. Euthanasia was the best option for the cat. The owner had to talk to her husband and called back a couple of hours later to give us the go ahead to euthanize the cat.

I also wanted to state two goals for my time here:
-to become more comfortable talking with clients both in person and on the phone. I find I am a bit awkward at both and because of that I am reluctant at interacting with clients.
-to become much more confident in blood collection. I still find myself very nervous when it comes to this routine procedure.

Practicum Day Four

Day 4 - It was much busier today. The morning was full with 2 cat spays, one mature dog spay with lumpectomy and a dental on a beagle. I floated between them all, spending most of my time with Lynn and the dental. Dr. Powell called me over to the sx patients to do cystos on the prepped (anesthetized) patients. I did a successful cysto on a yorkie and on one of the cats. Eventhough they were anesthetized it was still a confidence booster and a chance to hone my skills. I also expressed the bladders on the two cats and Dr. Powell showed me his technique which was very efficient.

I helped out Lynn with her dental on a 9yr old f/s beagle with "sewer mouth." This dog had some advanced periodontal disease. There were many extractions which Lynn did all but one. She saved one for me to do, a very loose canine which didn't require much elevating to get it out. The tooth was in poor shape and it looked like the root had abcessed. We left that empty pocket open to let the body work the bacteria out instead of suturing it in. I like helping Lynn with the dentals because I have an interest in dentistry. Lynn told me I could do the majority of a dental with her next week and I'm pretty excited.

We had a few interesting cases come in today. I was helping with a ultrasound guided cysto on a Bichon Frise when Dr. Tugui found a large mass in the dog's bladder on the ultrasound screen. He immediately wanted radiographs so Jocelyn and I took Pixi into radiology. We took a lateral view of her abdomen. Dr. Tugui saw it on the screen and told us we didn't need to take a VD. The urolith in the bladder was very apparent and she will need a cystotomy to remove it. Another case involved a f/s ragdoll with hindlimb ataxia. Dr. Tugui ordered radiographs and it showed decreased bone density that was especially apparent in the femurs. The doctor learned that this cat is on a raw food diet that consists of meat and really nothing else so he suspects she is suffering from mild hypocalcemia. He suggested a addition of calcium into her diet. I not sure what exactly he suggested to the owners. Our last case for the day was a 7yr old m/n DLH cat with leathargy and vomiting. Dr. Powell wanted blood chem, a cbc and a u/a done on this cat. I tried pulling blood twice from the jugular and was unsuccessful so I asked someone else to do it. They also were unsuccessful pulling blood from the cat's jugular so they collected from the femoral vein. Dr. Powell did the cysto and I ran everything through the machines. This all got done at the end of the day so I wasn't able to go over the results with Dr. Powell. The cat is staying with us overnight. So I'll know more ion the status of this cat tomorrow.

Practicum Day Three

Day 3 was a bit slow. We had a substantial snow fall in the Fraser Valley overnight and it caused some traffic issues.

Two of our morning appointments were cancelled by clients so that left us with just one sx for the morning. I assisted Dr. Tugui (a recent vet grad from Quebec) during the induction, intubation and neuter. I got to learn a bit more about him.

As soon as I came this morning Jocelyn told me that Jake crashed when Dr. Powell came in last night to check on patients and he was euthanized. It was nice to know that the owner was able to say goodbye before he passed.

With the slow day I did a lot of organizational things, which I enjoy doing. I see a lot of organizing to do in the clinic and I hope I am able to complete some of, if not all of it while I am here. I am used to a highly organized, compartmentalized clinic from where I worked at last summer. The tech there was very organized which I like to be as well. Sardis has limited space and to have more organization would utilize that space more efficiently. Of course I am asking Jocelyn before I set to task with anything.

Tomorrow I am supposed to meet the 4th tech working at the practice and it should be busier.

Practicum Day Two

Day 2 - I am happy with my practicum site already. I do a lot and learn a lot. I know this is not the case in other placements. Don't get me wrong, I am not doing everything perfect but, I'm learning from the mistakes I've made so far. I placed a catheter in a patient using Lynn's technique. I helped her with her dental today. I did a thorough cleaning of the patient's ears and expressed his anal glands. I again pulled blood, induced and intubated patients. I can feel my confidence increasing with every procedure I do. It feels good.

As for Jake, he did not improve overnight nor did he get any worse. I never heard anything of the blood work we sent to idexx yesterday, it may not have showed anything so that is why it wasn't mentioned. He had another 1L bag of LRS hooked up to him today but, without the added KCl. I pulled more blood from Jake with Lynn's help and ran it through the VetLyte. His K was back to normal and his Na and Cl was a bit elevated. Other than that we really didn't do much with Jake today. Dr. Powell called his owner to give her a prognosis on Jake. Dr. Powell believes Jake will not improve and his pneumonia will probably get worse as he continues to aspirate what he vomits up. With this poor prognosis Dr. Powell leaves the decision up to the owner whether to continue on with treatment or euthanize him. She stopped by for a visit to see Jake in his current positon and possibly to sway her decision one way or another. I found her crying next to him and Lynn came by to console her. Dr. Powell also came by to talk to her at length about his condition and plans for the next step. I will have to see tomorrow what decision the owner made.