Friday, August 5

The good, the bad, and the prolapsed.

The Good: Cutest pug ever, today! I wish I'd had my camera. Usually, being a low cost shelter, when we get pugs they are mixed with stuff like Jack Russels, beagles, and chihuahuas. Or, they're the skinny, bug eyes type pugs, the longer faced types, or freakishly long-legged types. This was a smooshy faced, fat-rolled, breed standard pug! He was gorgeous and affectionate. His name was 'Pudge'. We also had a 137 pound St. Bernard!! That was intense, I've rarely seen dogs that big. We had to neuter him out on the prep table, because we couldn't safely carry him into the surgical suite. :) When he stood up he was taller than me, and I only outweigh him by a pound (probably because I had breakfast, whereas he was fasted overnight: give the man a meal, and he could have topped 140).

The Bad: For one reason or another, we were at the clinic until 8:00. We didn't finish surgery until 6, and I'll have to go in early tomorrow to finish cleaning up. It comes from being short staffed. We only had one doctor for 38 animals, and only three techs to reset an entire days worth of laundry, surgical packs, instruments, cages, tables, floors, etc. We're supposed to be getting a new intern soon! But they always have to leave before the cleaning... :(

Okay, are you ready for this? PROLAPSED RECTUM.

We had a male feral cat who was brought in to be euthanized. I always feel a tormented when we have to euthanize aborted fetuses. Thankfully, we're separated enough from the shelter that we have never had to euthanize a healthy animal, or a sick animal that could otherwise be healed. We've let ferals with severe upper respiratory infections, puncture wounds, eye infections, and missing limbs go back to the wild once we've done all we can (with a shot of a long-lasting antibiotic). But this cat...YIKES.

A prolapsed rectum could be caused by many things, including innate factors (hernia, loss of ennervation to the sphincter), obstruction, inflammation, diarrhea, parasites, and severe enteritis. The external sphincter gives way, and the internal lining of the rectum pokes out. More common is an incomplete prolapse, where just one of the layers is forced out of the rectum and does not retract. It looks like a clump of tissue, or an inflamed ring around the sphincter. A complete prolapse, like this one, has multiple layers and a more extensive portion of the rectum and colon protruding. This cat has a section as long and thick as two fingers completely outside his body cavity. I won't put a picture here, because even for me....*shudders*

Generally, Dr. S says, treatment for owned animals includes a surgery to replace the lining in its original place, then sewing up the anus slightly to prevent a recurring prolapse the next time the animal defecates. It requires continual check-ups and proper maintenance by the owner, but it's not necessarily a life-threatening condition (especially if the cause of the prolapse is attended to as well as the symptom). But for feral cats, who will definitely not cooperate with the removal of stitched or further check ups, who get into fights and mate like crazy...a prolapsed rectum means a death sentence (I'm trying to find out if you can still defecate with a complete prolapse...). We sedated the cat, only about four or five months old, and then euthanized him. Euthanasia cases like these are not such teary moments: I know here it was the right thing to do for this cat. Though I'm sure he much would have preferred to die in a more Tom-Cat appropriate way, rather than peacefully sedated with his intestines poking out.

Tuesday, August 2

Tail Amputation

I got to assist on a tail amputation today! It was super cool.


This poor cat: he came in from the shelter totally filthy and emaciated. His frame suggested at his peak he must have weighed about 10-12 pounds, but he weighed only 5. His intake papers said that he was found wandering around the metro: that certainly explained the dirt! He was covered in a greasy blackness that rubbed off on your hands and arms when you handled him. If you've ever accidentally touched the side of a metrorail car, you'll know what I mean. It's a mix of exhaust, grease, dirt, rat filth, and various underground detritus. The poor boy was so covered in it he looked nearly completely black, though he was a tuxedo cat underneath it all. His tail was almost completely gone, except for a stub about two inches long, with the remnant of bone sticking out at the tip. He must have been pinched by some equipment, or even maybe injured by a train.

And yet! He was the sweetest! He just wanted to be held and loved; trying to rub his face against yours, rolling over in your arms, trying to touch you with his nasty paws...my heart broke for him! He was so sweet, and didn't seem sick at all except for his skinniness and injury. He also didn't act at all feral, even when we gave him his sedatives. I think he must have belonged to someone, and either was abandoned on the metro (frankly, it wouldn't surprise me: people around here can be so stupid), or accidentally found his way down there and couldn't get back out again. If he had been a feral cat he probably wouldn't have been quite that skinny, being well equipped to chase down the mice and rats that try to pretend they don't live there.

First we made sure he was negative for FeLV/FIV. Then I sedated him, and began to clean up the tail. I wish I'd had my camera. When it was cleaned, it looked like the image at top, except for the half inch or so of bone that stuck out through the skin and muscle. It was scabbed over, not bleeding very much at all. Still, we wrapped a tourniquet around the tail close to the base to prevent excessive bleeding during the surgery. After removing the scabs and dead skin, it looked quite clean. There was no pus, though Captain Doctor said the swelling at the base indicated that it had become infected. I shaved the hair up to his pelvis, being very delicate with the clippers because his skin was paper-thin: I knicked him several times, nevertheless. I'd wanted to shave off his mats and dirtiest parts, but I was worried that I'd do more damage than good. I gave him some fluids before he went in to surgery, and spread a little bit of syrup on his gums. Usually we give the kittens some syrup after surgery to raise their blood sugar to give them a bit of a jump start. Head Tech suggested I give him a little beforehand to take off some of the stress his body was under. I'm not sure how much it would help, just sitting on the gums, but I guess it didn't hurt.

I'd never been able to watch a surgery like this before. Since we're predominately a spay/neuter clinic, I never get to see much more than the occasional dewclaw removal. I know as far as orthopedic surgeries go, amputations are pretty basic. But I was still VERY excited, especially since I got to scrub in to assist. By assist, I here mean 'hold the bloody mass of tail and occasionally bend it'. But still. Excitement.

First, Captain Doctor felt around the tail so he could find which articulation he wanted to cut. He found three: one closest to the body, one furthest to the tip. The one furthest to the tip did not have enough of the skin left around it to satisfactorily close up the amputation, so he chose the second one in. 


He cut away some of the skin at the tip of the stump that had formed flaps and pockets. He said the inflamed tissue was fighting infection, but was still good and could be used to close up the amputation. Using his scalpel blade, he separated the good skin from the muscle of the tail so he could access the articulation. As he cut away the connective tissue, and then into the coccygeal muscle I had one of those moments that impresses on you just how much you have yet to experience. I could see the perimysium around the tiny muscle fascicles! I was dumbfounded! It looked just like that one textbook diagram that every anatomy/physiology book has, with the muscle extending into a fascicle extending into a fibrous bundle, etc. Beautiful.

Captain Doctor went through two blades trying to separate the tail bones, because we don't have any proper equipment for that sort of thing, here. I swear, the first time I work at a proper clinic it'll be like a primitive Shaman taking a tour of John's Hopkins. The vertebrae finally split, and he showed me the joint. It looked so small, to think it had held through such a traumatic accident! I had a newfound appreciation for my own vertebrae. I flushed the newly formed pocket with a bit of diluted lidocaine to keep it numb. Then Captain Doctor put in some subcuticular sutures to close the open wound right by the bone. To finish the amputation, he put in some nylon skin sutures: since they're non-dissolvable, they'll have to be taken out again in ten days. But they will allow the site to drain, in case there's some residual bleeding, or if the infection begins to form pus. We sent the cat back to the shelter with a shot of antibiotics, so hopefully the infection will diminish by the time he returns for suture removal.

With the tail amputation sorted, Captain Doctor went to perform the neuter: and the testicle slipped. When the vets start the procedure they make an incision in the scrotum right at the testicle. When they pull the testicle out, they have to pull firmly to break it free of the connective tissue. When Captain Doctor went to do this, the spermatocord just dissolved in his hand, and was retracted back into the abdominal cavity. YIKES. Since the cat had been through a lot already, the vet didn't want to open his abdomen unnecessarily. He finished the neuter and asked me to monitor the cat for bleeding.

Oh boy, did he bleed. At first there was nothing, and so I was more concerned with monitoring his thready pulse, his dusky gum color, and giving him some more fluids. After about five minutes I checked the incision site again: his tail was doing beautifully, but the left side of the scrotum was bleeding and swollen. When I applied pressure, I forced out some gelatinous blood clots. I continued to apply pressure while Captain Doctor finished up the feral cat spay he was working on, at which point some bruising appeared in the area above the penis. WELP. He was bleeding internally from the spermatocord remnant that hadn't been tied off (who'd have guessed?). Captain Doctor brought him back in to surgery and made a small incision in the abdomen right about where a spay incision would be. After poking around behind this cat's enormous bladder, he unearthed a few more stringy blod clots, and then the bloody stump of the spermatocord. Crisis averted!

Choo Choo, the metro cat. I'm really happy that we were able to help him. He's a very sweet cat with a very sad story. I'm sure he'll find someone to give him a home soon! I wish I could have taken him home and given him a bath and five hundred sandwiches. Then my mind would be at peace. :)

Sunday, July 10

Sugar

Today we had a kitten die at the clinic. This small, plump, two month old kitten named Sugar. Since the shelters are always full of kittens at this time of year, she and her sister had been placed in a foster home.

With cats and kittens like this, who come from the shelter or a foster home or live as ferals, we never have a medical history. All we can do ausculate and check for signs of present illness. As a result, we've had several (most of them feral cats) react poorly to the telazol that we use as an anesthetic drug, and pass. This very rarely happens: we have done thousands of surgeries since I have been here, and it has happened only six times before today. Three were feral cats who died from heart failure after they were hit with telazol: we're unable to monitor the ferals while they're going to sleep, except by visual cues. Ferals can be very dangerous and very quick, so we never remove them from their traps until we're sure they are completely anesthetized.  Another feral cat died after his surgery- the vets think he had an underlying condition, because there were no complications during his neuter. One time we lost an underweight kitten (1 pound 13 ounces): we actually caught her apnea and extremely low heart rate early: she was still alive, but she never fully revived from the anesthetic, and we eventually had to let her go. The last was a truly ferocious privately-owned cat that gave us such trouble upon check-in that the vets were completely unable to examine her. They think she must have had a weak heart, or a murmur, because she died before she even made it to the prep table.

In each of those circumstances, I've always wondered if there was more we could have done. We warn owners that since we are a low cost clinic, we do not have equipment for emergency situations. We routinely turn away animals that are too old, too sick, too young, or too fat. These factors increase the risk of spay/neutering in any facility. While I respect and appreciate that we are giving a much-needed service to people that otherwise couldn't afford it (or are just cheap bastards), I wish that we could make enough money to afford equipment that would let us save lives when the situation arises.

Today, though, wasn't a case of not catching it quickly enough, or not doing enough. It was simply watching life slip through my fingers.

Head Tech was watching the beach (a pile of blankets and heating packs on which the animals recover after surgery). She left momentarily to bring a pair of kittens back to their cages in the back. Moments after she left, I did a sweep of the beach- a few cats still had their tracheal tubes, and so I went to make sure none of them were about to wake up and find themselves in danger of choking on their tubes. As I checked Sugar's gum color (a good indicator of , I noted that she had no blink reflex, but her color was still pink and flushed. She had been off the table for half an hour, and if her tracheal tube had been removed she should at least have been blinking. I went to feel her heart, but only felt my own pulse in my fingertips. She wasn't breathing.

 I swept up the kitten, brought her to the prep table and set her up with an oxygen mask. Protocol dictates that we re-tube animals that aren't breathing, because it might be something as simple as an obstructed airway (collapsed trachea, excessive mucus, aspirating on vomit...). Unfortunately, I can't tube a kitten on my own (they have such tiny tracheas! I haven't had enough practice, and I didn't want to make things worse). I called Captain Doctor to my assistance, and he immediately started chest compressions. Every few minutes he would stop and listen for a heartbeat. I am still kicking myself that I did not immediately ask him to help me insert a trach tube. The kitten's heart was not beating, she was not breathing, but her color remained pink and she was still warm. She hadn't been crashing for long. I thought for sure we would be able to revive her.

But. Here is where working in shelter medicine haunts me. In the middle of the procedures, Boss came upstairs and told us the cameramen were one their way to the surgical suite: we were being filmed today, for a news story about our feral cat program. She told us to keep trying for five more minutes.

Only five. I know that in a place with such inadequate emergency technology there's little chance that we could revive a kitten after ten minutes with just chest compressions and epinephrine. But it's not unheard of! And after ten minutes she was STILL PINK AND WARM. Even though my rational side knows better, I I can't help but feel that if we could have kept going, we might have made it. But because of some ridiculous publicity stunt, after five minutes with no change they had me bundle her up in a biohazard bag and take her down to the freezer.

I shouldn't have left her. Even without oxygen, I could have kept up the compressions, just in case. I feel so terrible, this is a death that's really going to stick with me. I swear that when I'm a vet, I am going to go above and beyond the call of duty for every animal that is retrievable. I also swear that I will stop being afraid of bullying the vets. I've been an unlicensed tech for only a year- I have no right to criticize or question their decisions, and of course they know better than me. But I'm so afraid of getting above my station that I didn't ask Captain Doctor to place the trach tube, and I'm still kicking myself for it.

Courage! Integrity!

Thursday, July 7

Playtime with Random Word Generators

Random Word Generators are delightful things. I don't know if you've ever used one for recreational purposes, but I highly recommend it. These generators are used to stimulate creative thought. Your brain is classically trained to look for an interpret patterns. If you flash random words across the screen, your brain involuntarily starts a sort of word association game with itself that is both an exercise and writer's-block penicillin. It is also apparently where really bad blog names come from.

  • Luxury Madness
  • Pyrotechnics Sheepwalk (??)
  • Wifely Foreconscious
  • Stately Pinnipeds


Okay, actually I love that last one. It would make a great name for a band.
There are many of these generators around the internet, as you can imagine. CreativityGames.net has a cool one that just gives you 1-8 random words. There are Anagram Generators, Robot Name Generators, even Complete Story Generators! I am having so much fun today.

The one that I've been poking around with is the simple generator by watchout4snakes.com. I am so excited. I'm pretty sure I could generate my own entire religious text with this baby. You can do one word, multiple words, a whole sentence, or an entire paragraph. The generated little nuggets of word-power seem less like random dribble and more like the cryptic and esoteric words of an internet prophet.

I've taken the liberty of accumulating some of this wisdom:

When will the spare eye complement the ear?
A suffix swings a palace inside a biting imperative.
Why does a sunrise slave?
In the detail frowns the harsh grain.

The inverse world persists into the parent.

Every once in awhile we get something approaching true prophecy:

A shocking mob ascends on top of a rose.

The continuum acknowledges an anarchy.

The scheduled moron exits. 

Around the twin errs its destructive pro.

A flute stirs the future farce over every graduate. 

 I think my favorites, though, are the paragraph generators. They can give you something approaching hint fiction, which I would love to compile someday (if I ever feel like breaking some copyright laws).
The isolated elephant staggers
Kate misplaces Snape. The registered ideal feels the hot consequence. Snape despairs.

The clone kisses a disappointing exercise. 
Charles Darwin hunts. How does a framework fear? Will Wolverine catch the man? Underneath a consequence suffers a writer. Charles Darwin isolates Wolverine.

How can Chaucer burn Gregor Mendel? Another drunken worth scotches Chaucer. A choice walks the friend. Why won't the invaluable leadership outline a socialist? 

Love farms a phoenix without the witnessed shot. A person errs. The supernatural weighs love across a burst accent. Love frustrates The Doctor. The Doctor stalls beside a promise. 


That last one would make a great Doctor Who episode.



~*~

Wednesday, July 6

Late Night, Early Town

Yikes. Today was a crazy day at the clinic. I wish I'd had my camera.

Started off coming into the clinic to find Cheerful Tech wearing a serious expression. "Head Tech is upstairs crying her eyes out- we had a cat come in with really advanced mammary tumors, I just thought I'd warn you."

I was grateful for the warning: I can handle the guts, ovaries, cystic uteruses and aborted fetuses, but when something takes me by surprise I can have a pretty visceral reaction.

Once when we were spaying a rack of feral cats, I placed one orange tabby on a prep table only to immediately yank back my hands and mash my eyes closed. "Head Tech? There is something really weird about this cat." She came over, and I heard her make a sound of disgust. I had to take a few deep breaths and prepare myself before I could open my eyes and asses what, exactly had freaked me out. The feral cat had a broken back leg that had healed wrong: it was shaped like a hockey stick, and pointed out and away from her body. It was just so aberrant that I had to physically compose myself. Once I knew what it was that I was looking at, I was fascinated. The leg must have gotten caught in a trap or a bit of machinery, because it was completely dislocated and totally useless. It must have just flopped when she ran, it could have born no weight. (Badass Vet insisted that it was inhumane to leave the cat like that, and offered to do a leg amputation. The feral trapper-liaison however, insisted that the cat was fine, and had been for months. There was a big debate about whether to euthanize the cat, amputate, or to just release her. Eventually we just left her as is, despite the vet's professional opinion. It's strange to work in a clinic where the vet's don't have the final say.)

Random tangent aside:  I mentally prepared myself for what I'd see upstairs. We've had cats with mammary tumors before: it just looked like developed mammary tissue, as if she was lactating. Or it's just a hardening around the nipple. But this cat... my Head Tech was standing by the prep table, with the cat all wrapped up in a blanket. It looked like a young cat, maybe only a year old. She was so emaciated you could see her backbone, she probably only would have weighed four or five pounds on her own: but the extent of her mammary tumors was such that it literally doubled her body size. Her tissue was so swollen it looked like someone has placed two tube socks under her skin. She was so taut, her skin had developed ulcers from. I wish I could have taken a picture to show you, because I wasn't even sure what I was looking at, at first. The cat below (excuse the poor resolution) is actually a LESS advanced case than the one this cat had.

Six of her mammary glands were swollen to the size of my fist, three were necrotic with ulcers, one had just begun to ulcerate. She was lethargic and not very responsive, but she was still purring. :) What a sweetheart. It broke my heart to see her this way.

Apparently, a month ago her owners took this cat to their regular vet and he diagnosed her with a false pregnancy. The vet didn't run any blood tests to verify this diagnosis, and didn't take a biopsy. Two weeks went by and it got worse, not better, so they went back- same diagnosis. They assured us that the first time they went the tumors were much, much smaller. The vet said one way to solve the problem would be to get the cat spayed, to remove the uterus and prevent the over-production of estrogen. Our vet was INCENSED. Dr. Mom lodged a formal complaint against this cat's regular vet, claiming it was nearsighted and sloppy not to have noticed that they were INSANELY RAPIDLY GROWING TUMORS. Imagine if, in one month, your breast tissue swelled four times its usual size, and your doctor told you 'Oh it's fine, just hormones.'

Dr. Mom gave a very bleak prognosis for the cat. The owners were heartbroken, they kept asking if there was more they could have done, or if they'd only caught it earlier...? But Dr. Mom said it was such an aggressive cancer,  even catching it in the beginning stages might not have helped. It grew so rapidly, and (judging by the size of her lymph nodes and size of her liver) was already metastasized. She couldn't walk, because the swelling prevented her even from standing, and she'd stopped eating and drinking. The only humane thing to do was to euthanize the poor baby. We offer that service, if the owner/shelter requests it. But the owners wanted to spend one last night with their baby cat, and so Dr. Mom allowed them to take her home only after securing a promise that they'd made an appointment for euthanasia the next morning.

It was heartbreaking...but also EXTREMELY COOL, medically speaking (fom the point of view of someone who's had limited animal-cancer experience, anyway). In humans, generally tumors don't get that far: they are diagnosed by regular checkups, or become symptomatic long before they become outwardly visible. In animals though...either the owners simply don't understand the severity of the problem (like these guys) or are generally unaware of their pets health and don't notice until things get serious. Since we deal with lots of neglected animals (ferals, from shelters, and less educated owners), we get to see medical problems in the late stages...entropian animals with corneas so scratched they need multiple eye surgeries, mange so severe the animal is nearly balding, infected bite wounds, the works. I have never seen anything like this cat's tumors, and frankly I hope never to see it again.

 Most mammary tumors in cats are malignant, and most are classified as adenocarcinomas (epithelial cancer in glandular cells). If it's caught early enough (generally through regular check-ups from the vet and routine bloodwork), surgery or chemotherapy are the most common treatments. Surgery is a bit dodgy though: you can either remove just the tumor, the whole gland, the gland and it's surrounding lymphatic drainage system, or the whole mammary set. Even still, if you miss a portion of the tumor, surgery might break up the remaining cells and make metastasis more likely. Chemotherapy can be used (drugs: doxorubicin and cyclophosphamide), but it doesn't seem to be as efficient at reducing tumors in cats as it has been in humans. Radiation is almost never used as therapy for cancer in cats.


I really need to get a vet manual/ tech manual. We don't deal with the diagnostic side of medicine a lot, so I'm missing out on the experience!