Sunday, December 19, 2010

Learning how to tell if a dog is in pain

I completed my second spay lab, in which third year veterinary students spay a dog from a shelter or low income family. Unlike my first spay lab dog, this dog had a uterus! (In fact, she was in heat, so I was pretty confident ahead of time that she would. My boyfriend: “How can you tell she’s in heat?” Me: “She has a vulva the size of Texas.”)

Linnea was an extremely nice dog who was extremely unhappy about being in the spay clinic for two days. She pawed at the cage door so much the first night that we gave her a sedative to take the edge off. Her spay went well, but when it is only your second spay, you still don’t trust that you haven’t done something stupid and that the dog isn’t in real trouble. (One of my classmates reports that she actually went to visit her spay patient at the shelter several days later, to make sure she was okay. My classmate pretended to be interested in adopting the dog in order to get time alone with her, so she could look at her spay scar.) So when Linnea started making a lot of noise the evening after her surgery, I was very anxious.

First I asked the anesthesia technician if he thought she needed more pain medication. He pointed out that she had been a very vocal dog before the surgery, and was almost certainly just stressed now, especially due to the after- effects of all the other medications we had given her making her feel less than mentally competent. My spay partner Lily and I looked at Linnea anxiously after letting her out to pee. Lily said: “Well, she seems to be standing sort of hunched over.” I said: “Yes, I really would like to give her more meds!”

The veterinary intern came by around that time, for evening rounds, and I explained how Linnea looked painful to us. (It is veterinary jargon to say an animal is “painful” rather than “in pain,” and I have seen this usage really annoy non-veterinarians. I am not sure why we say it that way, but that is how it is.) Now, Lily and I had recently completed our anesthesia course, which had several lectures about how to tell if dogs are painful, but of course in the heat of the moment we had completely blanked on this. The veterinary intern simply put her hand gently but firmly on Linnea’s spay incision. Linnea didn’t even blink; she didn’t turn her head or growl or flinch. The intern said confidently, “She doesn’t appear to be painful,” and this time, I believed it.

Dogs do sometimes vocalize when they are in pain, but it is not the best way to tell. Many dogs in pain do not vocalize, and there are tricks of body language that you can use to tell what is going on in their heads. We had some fascinating lectures on that, unfortunately far too image-filled for me to reproduce here.

I learned from this experience. When you’re not sure how to proceed, take a deep breath and think back to what you were taught in class. We actually have received a very good foundation for clinical work, but it can be really hard in the moment to pull the appropriate fact out of the mass of information packed into our brains after three years of veterinary school!

Sunday, December 5, 2010

How to learn how to do ... lots of procedures

Recently I had my Small Animal Procedures lab, in which my classmates and I learned how to perform dentistry, take skin biopsy samples, do trans-tracheal aspirates, take bone marrow biopsies, and a raft of other procedures. I wouldn’t feel comfortable doing any of these procedures unsupervised yet, but I did get to actually do them with my own hands rather than just pick “do a trans-tracheal aspirate” as a multiple-choice answer on a test.

In the past I have described learning on shelter animals that need low-cost procedures, or ex-research dogs that are living at the school until they can be rehomed. This lab used the bodies of animals who had been euthanized at our hospital, and whose owners had agreed to allow us to use them. It is always somewhat disturbing to spend several hours with a dead dog, but this is the one use of animals for teaching that I am one hundred percent happy about. Learning on live animals is never perfect, although my school does its best to find constructive ways to obtain animals for us to use. We had to do so many procedures for this lab, and such invasive ones, that it made sense to use cadavers.

The trans-tracheal aspirate is a particularly interesting procedure to do. The idea is that an animal has some sort of infection in its lungs, and you want to know exactly what. So you thread a catheter into its trachea and down into its small lower airways, pump some fluid in, suck the fluid back out, and test it for bacteria. Okay, but if you thread that catheter in through the mouth, it is going to be contaminated with all kinds of bacteria that you’re not actually interested in, right? So how do you get the catheter in to the trachea without getting mouth bugs all over it?

You stick a big needle in through the outside of the dog’s throat directly in to the trachea, and thread the catheter through that. This means when you stick the needle in, you have to know when its point is inside of the trachea. You can’t see where the point of the needle is, obviously, and that’s why it’s a learning experience. This procedure was particularly hard for me. I kept sticking the needle in, being convinced it was in the right place because I felt a “pop” as it passed into the trachea, and then not being able to thread the catheter in. A tech told me patiently, “if the catheter won’t thread, that means it’s not in the trachea.” Goddammit. I tried again. And again. And eventually it worked.

This was a really enjoyable lab. Four of us worked on one dog cadaver. There were also a few cat cadavers for multiple groups to share. It felt good to do some of the procedures we had learned about, but scary to imagine doing them on living patients in the near future.

Wednesday, December 1, 2010

Veterinary fact of the day: feeding guinea pigs

We are having some of the final lectures for our zoo medicine course, and today’s was about pet rodents — guinea pigs, rats, chinchillas, mice, and gerbils. Coincidentally, we also covered many of the same animals in our lecture on laboratory animals, earlier in the day. Both lecturers emphasized the fact that guinea pigs require vitamin C supplementation. Unlike most other species, they can’t make it themselves, and if you don’t provide it in their diet, they will get scurvy. Some owners, we were told, are so dedicated in their C supplementation that they actually provide too much, which can also be problematic.

A lot of our zoo medicine course has covered good feeding and management practices. It seems like a large part of practicing on exotic pets (a term which includes things you might not think of as exotic, like rats and rabbits) includes making sure that people are managing their pets right. Basic husbandry is something that is rarely covered in our small animal medicine course, which is about cats and dogs. We assume that people know how to feed them and what temperatures to maintain them at. I think the really good small animal veterinarians, though, are asking their clients about all kinds of management issues and offering advice, not just waiting for a problem to crop up. Maybe vet school should prepare us more for that.

What I’m up to: I am sliding in to the last few weeks of the semester, and don’t have a lot of extra emotional energy for blogging. I miss it and will certainly be writing more when final exams are over. Next week is my second and final spay lab. Wish me luck for getting a dog with a uterus this time!