So today was my second day in the Medicine department of my specialist clinic, and it also went pretty well. We had both the mini schnauzer with possible Addison's (which was confirmed today) and the motor neuron schnauzer with us again today, but the Westie from yesterday had gone home after his cardiac tests were done. In addition to those, we had a few other patients - a 12 year old Newfoundland, a DSH cat, a husky, and a mutt, in for various tests.
The most interesting things we did today were probably with the motor neuron schnauzer and the Newfoundland, as the others were mainly dealt with by the nurses, or by other departments. The schnauzer was looking much better than she had been yesterday, which had been an improvement on how she had been over the last half of last week - when we arrived this morning, she was in sternal recumbency (lying on her chest, fairly upright and centered) and was very bright and wagged her tail when she saw us. She also had a lot more energy, and seemed to be less withdrawn. She ate some food (shredded chicken and prescription dog food meatballs) and was able to urinate on her own, which was a big improvement from having to have her bladder expressed manually - it's not really pleasant for the animals, and dogs can get funny about urinating or defecating inside once they're toilet-trained. Since she was so much better, we started doing a bit of physiotherapy with her, so she doesn't lose too much muscle tone and to start getting her back on her feet, hopefully. (I'm not sure what was causing her problems, the last I heard of it was that it could have been a tumour, poisoning, or botulism, so it may or may not be something that can get better, per se)
Her therapy involved the use of a sling that fits into a rolling framework, with holes for all four legs. It can be set varying distances from the ground, but the sling supports most of the dog's weight while still allowing them to feel like they're walking by themselves. She seemed to really enjoy it, though she had a bit of trouble keeping her back legs under her and they kept slipping forwards in a sort of bunny-hop fashion. It was quite funny doing our circuit of the main area, since there were three students and two nurses all cheering and coaxing one staggery little dog around the corridor. She seemed to enjoy it though, likely because she'd been recumbent for nearly a week, and bed rest can't be all that interesting for a dog. We did another short journey with her in the afternoon, and found that if someone helped support the weight of her bum, she could use her back legs more easily. It's a pretty good step forward (so to speak) and she may be able to go home and be cared for in her home environment if it turns out that she can use a sling (around her lower belly, so that her owners can help support her weight) to get around.
Our other interesting client was the Newfoundland, though this was one of the...less appealing sides to nursing. She's 12, which is very old for a giant dog, and she has a variety of health problems, including very weak back legs, a heart block, spinal pain in the neck and hip regions, and more or less complete urinary incontinence. She can get up on her own, but has a sling that is generally used to help her up and down, so that she doesn't strain herself too much. The urinary incontinence was one of the worse problems when it comes to quality of life, since she basically just trickled urine about half the time. This meant that her bedding was damp all the time, the floors where she lay down would be wet when she got up even a few minutes later, and she was getting some very severe pus-filled nodules/skin tags/lumps around the urethral opening due to the urine scald - more or less nappy rash - caused by the incontinence and more or less constant dampness of that area. Added to this, she also smelled appalling.
For her, we ran some electrocardiograms (ECG) to find out what was happening with her heart, which led to us finding out about the heart block, and treating it with Atropine. which showed us that she also had a fair number of secondary problems with her heart, as a lot of the beats were quite abnormal even after treatment. She also had some radiographs taken, dealt with by Radiology, on her hips and neck, and had had some done of her heart and chest a few days prior. For the incontinence and urine scald, we clipped all the fur around the lower belly and perianal region, and bathed the area with some mild shampoo - we did this twice during the day, once when she was recovering from the sedation used for her radiographs, which allowed us to shave and clean the area much more thoroughly than when she was awake. There wasn't much we could do about the pus nodules except clean their surface, though she did smell remarkably better after the second wash.
One of the procedures that I got to do today involved the Newfoundland as well. She needed a catheter placed so that there was I/V access while she was sedated, and that's one of the tasks that we need to complete during the year. My teammates had been able to run the ECG's on some of our patients, so I was chosen to try and place the catheter, which I managed reasonably well for a first attempt. Since Newfoundlands are such large dogs she had big veins, which makes finding them quite easy - although they can also be quite tough-skinned, and the veins themselves can slip away from the needle tip quite a lot sometimes. Her cephalic vein also branched into the accessory veins quite far up her leg, with a lump on or near the vein about an inch above the branch point, which somewhat limited my choice of spots to catheterize. It's necessary to start as low as possible on the vein, so that if the catheter is not successful, you can try higher up the limb next time. I did find it harder than I expected to pierce the skin, but managed to get the vein on very nearly my initial penetrative angle - I had to correct slightly to the right, but got the vein immediately once I had done that. She did bleed through the stylette a little while I was advancing the catheter into the vein (we use over the needle catheters mostly, which have a needle with a hollow plastic tube over it, the whole thing is inserted into the vein and then the needle is withdrawn, leaving the tube in place, the end is blocked with a cap, which is then replaced with an injection cap, which has a rubber seal on the end that you can inject through without hurting the animal, damaging the cap, etc) but not very much considering her size. I also had some minor trouble taping the catheter in place, as she had very puffy fur and was by that point determined to lie on her side instead of upright, which made things slightly more difficult. Nevertheless, I was pretty pleased with my attempt, and I'm looking forward to gaining more practice.
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