Today is the day. I don't have a lot to say. I've already been scratched, not maliciously, just out of fear. I'm nervous and unsure. I am worried that the second I get there, all the things I know to do will go flying out of my head. I will express my feelings to you by sharing an email I just sent to Dr. Surgeon OVH master of the day, Smalls.
"Despite my calm demeanor and obvious cool customer persona, I'm sort of tweaking right now. I am facing the gauntlet and considering heading to the fire-lit pub, full pint and warm sheepskin throw, rather than running through a passageway of large screaming, hairy men with clubs and stones, in the rain, stripped of my security and probably, lets face it clothes. Yes, I'm nervous. I seek comfort and ease. My natural state is to run away from this obstacle, like so many challenging experiences, and just leave it for another day. But I can't do that. I am being marched forward amid this channel of screaming barbarians and I just have to run as fast as I can and take the blows as they come, hoping for the glory that will find me on the other side."
Wednesday, October 27, 2010
Tuesday, October 26, 2010
Anesthesia
Tomorrow is the BIG DAY. I will be the "official" anesthetist on Dr. Small's (and our teams) first ovaro-hysterectomy (OVH). Our patient will be a kitten from a local shelter. First and best, I have complete confidence in Dr. Smalls (my fellow student and teammate). Secondly, I am terrified of anesthesia.
Now here's the deal, anesthesia is scary to begin with. You take an animal into a state of unconsciousness that inhibits not only their ability to move (obviously a goal) but to some degree their ability to do some basic things like thermoregulate, dictate appropriate ventilation or send blood around their bodies. Hmmmm...that could be a problem. You have approximately 4 tools to tell you if the animal is trying to die. These are heart rate, respiratory rate, blood pressure and temperature. There are some other tools we use like mucous membranes, reflexes and eye positioning as well.
To top things off, my anesthesia will be conducted on a CAT. Right. So what's the saying? "Its hard to kill a dog under general anesthesia and its hard to keep a cat alive." Awesome. Lets start by going through anesthesia.
You start out with some drugs. These are good drugs. Things like opioids and tranquilizers. The goals of these drugs is to chill the animal out and give them a nice buzz to make them more refractory to pain and get some actually analgesia on board. These drugs will help me get an IV catheter into a tiny kitty vein.
Once I've got that catheter in and my patient is purring away, its my job to take a really scary syringe full of something called an "induction agent" and get ready to induce (knock out) my patient. In this situation I'll be using Ketamine and Diazepam (Valium). So I'm going to inject this medication (in a very specific manner) and knock my cat out. This is the scariest part of the whole show. This is when cats stop breathing. The only way for me to get the cat breathing is to get the endotracheal (ET) tube in the cat and start ventilating for it. The clock is ticking. As you may recall from driving through tunnels or swimming, you can only go without breathing for so long. It may also be that when my cat is supposed to be knocked out and I'm about to put the ET tube in that it decides to wake up again. Then I have to give it more of the induction agent and try again.
Apparently cats like to close off the larynx (airway) when you try to intubate them, which makes things a little more difficult. Still, once I've got that tube in and I hook the cat up to the gas anesthetic everything is peachy right? Wrong. In order to monitor our patients we use a doppler (blood pressure), esophageal stethoscope (allows me to hear the heart and breath at the same time) and an esophageal thermometer. Using these 4 readings, I will attempt to keep this cat not only unconscious throughout surgery, but healthy, safe and ALIVE.
Reports from yesterdays group of students are that almost (if not every) cat woke up during the surgery and they all became hypotensive (low blood pressure) and hypothermic (low temperature). In other words, they were bouncing back and forth between two scary extremes. This should make for a relaxing afternoon.
So how do I feel? You know, not bad actually. I'm going to know what I can know and then what? What possible expectations could they have of me? I can simply do my best, know the information and use the minimal experience that I have. There are going to be professional anesthesiologists roaming constantly helping us and they are some of the coolest customers you will ever meet. Plus, it isn't as if everyone yesterday had a smooth and chill time and I'm going to be the one goof up. No this is hard stuff. Its tricky and specific and it takes time to learn it.
Tomorrow afternoon the learning will make the jump to light-speed.
Now here's the deal, anesthesia is scary to begin with. You take an animal into a state of unconsciousness that inhibits not only their ability to move (obviously a goal) but to some degree their ability to do some basic things like thermoregulate, dictate appropriate ventilation or send blood around their bodies. Hmmmm...that could be a problem. You have approximately 4 tools to tell you if the animal is trying to die. These are heart rate, respiratory rate, blood pressure and temperature. There are some other tools we use like mucous membranes, reflexes and eye positioning as well.
To top things off, my anesthesia will be conducted on a CAT. Right. So what's the saying? "Its hard to kill a dog under general anesthesia and its hard to keep a cat alive." Awesome. Lets start by going through anesthesia.
You start out with some drugs. These are good drugs. Things like opioids and tranquilizers. The goals of these drugs is to chill the animal out and give them a nice buzz to make them more refractory to pain and get some actually analgesia on board. These drugs will help me get an IV catheter into a tiny kitty vein.
Once I've got that catheter in and my patient is purring away, its my job to take a really scary syringe full of something called an "induction agent" and get ready to induce (knock out) my patient. In this situation I'll be using Ketamine and Diazepam (Valium). So I'm going to inject this medication (in a very specific manner) and knock my cat out. This is the scariest part of the whole show. This is when cats stop breathing. The only way for me to get the cat breathing is to get the endotracheal (ET) tube in the cat and start ventilating for it. The clock is ticking. As you may recall from driving through tunnels or swimming, you can only go without breathing for so long. It may also be that when my cat is supposed to be knocked out and I'm about to put the ET tube in that it decides to wake up again. Then I have to give it more of the induction agent and try again.
Apparently cats like to close off the larynx (airway) when you try to intubate them, which makes things a little more difficult. Still, once I've got that tube in and I hook the cat up to the gas anesthetic everything is peachy right? Wrong. In order to monitor our patients we use a doppler (blood pressure), esophageal stethoscope (allows me to hear the heart and breath at the same time) and an esophageal thermometer. Using these 4 readings, I will attempt to keep this cat not only unconscious throughout surgery, but healthy, safe and ALIVE.
Reports from yesterdays group of students are that almost (if not every) cat woke up during the surgery and they all became hypotensive (low blood pressure) and hypothermic (low temperature). In other words, they were bouncing back and forth between two scary extremes. This should make for a relaxing afternoon.
So how do I feel? You know, not bad actually. I'm going to know what I can know and then what? What possible expectations could they have of me? I can simply do my best, know the information and use the minimal experience that I have. There are going to be professional anesthesiologists roaming constantly helping us and they are some of the coolest customers you will ever meet. Plus, it isn't as if everyone yesterday had a smooth and chill time and I'm going to be the one goof up. No this is hard stuff. Its tricky and specific and it takes time to learn it.
Tomorrow afternoon the learning will make the jump to light-speed.
Saturday, October 23, 2010
K2 Visits UC Davis
I was walking out of an equine reproduction lab last week, tired and a little grossed out. We were practicing fetal manipulation and reaching your arm through a metal ring, into a large canvas/plastic sac to palpate a dead calf, is not the most joyous of experiences, no matter how practical it may be. So I was worn out and as I crossed the street from the Gourley lab, to the large animal VMTH parking lot the Holy Spirit told me to check my phone. I'm not the kind of person who gets a lot of phone calls in a day, so I was surprised and a bit alarmed when I saw that I had 5+ missed calls and several text messages. This is why after a while, you stop wondering why and just do what the Holy Spirit tells you.
I looked at the first text message and it read something like, "K2 attacked, at UC Davis." I stopped short and instantly called my good friend Karen. K2 and Karen entered my life about 5 years ago, when I answered an advertisement for a horse that was up for lease. She was a big, green broke, grey Holsteiner mare, and I fell in love with her the second I saw her. I trained her for many years and developed an awesome friendship with her mom, Karen. I finally got a hold of Karen and discovered that they suspected K2 had been attacked by a mountain lion. I walked over to ultrasound and looked through the window and there was that big, long-backed grey mare (now mostly white) standing in the stocks. So I put down my bags and walked in.
Another good friend was there with her, Siri, her trainer. After a big hug she filled me in on what was going on. The ultrasound looked clean, but with a lot of gas present in the cranial aspect of the hock, it was hard to tell if structures there had been affected. The decision was made to wrap the leg, eliminate the gas, and recheck her with ultrasound in a few days. My girl was sleeping over.
As soon as I knew K2 was there, any plans for the evening changed. Whatever was going to happen, I was going to be there for it. So we, Siri, K2's fourth year student and I, walked her over to the treatment room where the surgeon on her case wrapped her leg.
I volunteered to hold K2 so the fourth year could help with the bandaging and any medications she might need. I took the rope and I put my hand on her nose and as I began quietly talking to her, she looked at me and she knew me. Her eye stayed on mine and I felt her recognition, some stress left her body, she sighed and licked her lips and we talked. I know it sounds crazy, but we did. If you've never experienced that connection with an animal, I urge you to find it. There is nothing in the world like it. You can't force it or even ask for it. They just have to give it to you. Its their decision and that is why it is so powerful.
K2 stayed at the hospital for a few more days. The results of the follow up ultrasound were that while all her synovial structures were unaffected, she had torn a good portion of her cranial tibial muscle. Its difficult to say what caused the tear. It could have been the attack itself or the 5 foot jump out of her pen that she made to escape. But the result is that she will be rehabilitating for the better portion of a year. I was happy to see K2 go home. She hates being in the hospital and tried to colic twice while she was there. She will be better off recovering at home where she is happy and there are no llamas or alpacas nearby, but I will miss her and her pink nose.
On the up side to this entire event, I met a new surgeon in the hospital. . . .
I looked at the first text message and it read something like, "K2 attacked, at UC Davis." I stopped short and instantly called my good friend Karen. K2 and Karen entered my life about 5 years ago, when I answered an advertisement for a horse that was up for lease. She was a big, green broke, grey Holsteiner mare, and I fell in love with her the second I saw her. I trained her for many years and developed an awesome friendship with her mom, Karen. I finally got a hold of Karen and discovered that they suspected K2 had been attacked by a mountain lion. I walked over to ultrasound and looked through the window and there was that big, long-backed grey mare (now mostly white) standing in the stocks. So I put down my bags and walked in.
Another good friend was there with her, Siri, her trainer. After a big hug she filled me in on what was going on. The ultrasound looked clean, but with a lot of gas present in the cranial aspect of the hock, it was hard to tell if structures there had been affected. The decision was made to wrap the leg, eliminate the gas, and recheck her with ultrasound in a few days. My girl was sleeping over.
As soon as I knew K2 was there, any plans for the evening changed. Whatever was going to happen, I was going to be there for it. So we, Siri, K2's fourth year student and I, walked her over to the treatment room where the surgeon on her case wrapped her leg.
I volunteered to hold K2 so the fourth year could help with the bandaging and any medications she might need. I took the rope and I put my hand on her nose and as I began quietly talking to her, she looked at me and she knew me. Her eye stayed on mine and I felt her recognition, some stress left her body, she sighed and licked her lips and we talked. I know it sounds crazy, but we did. If you've never experienced that connection with an animal, I urge you to find it. There is nothing in the world like it. You can't force it or even ask for it. They just have to give it to you. Its their decision and that is why it is so powerful.
K2 stayed at the hospital for a few more days. The results of the follow up ultrasound were that while all her synovial structures were unaffected, she had torn a good portion of her cranial tibial muscle. Its difficult to say what caused the tear. It could have been the attack itself or the 5 foot jump out of her pen that she made to escape. But the result is that she will be rehabilitating for the better portion of a year. I was happy to see K2 go home. She hates being in the hospital and tried to colic twice while she was there. She will be better off recovering at home where she is happy and there are no llamas or alpacas nearby, but I will miss her and her pink nose.
On the up side to this entire event, I met a new surgeon in the hospital. . . .
Thursday, October 7, 2010
Rank
You arrive at the ranch early. The sun's light is just beginning to outline the tops of the foothills and the periwinkle hews of dawn are spending their last moments in the barnyard. As you cross the yard to the saddle house an excited rooster preemptively announces the hour and chickens scurry and flutter out of the way of your sleepy boots scuffing the dirt. Reaching the small but well made building that serves as a tack room you hear a faint stirring and a door creak on its hinge as one of the hands leaves the bunkhouse. You glance over as he lights a cigarette and you see him recognize your truck. He considers for a moment and then follows your path to the tack room and nods when he sees you before heading into the main house for his breakfast.
Entering the saddle house you look at the tools of your trade. Saddles, bitted bridles, hackamores, ropes, spurs, girths, chaps, tie downs, reins and in short leather, hang in an organized chaos from hooks and nails and saddle racks around the room. It smells like leather, saddle soap and dirt and horse and it smells like home. Different saddles have different functions. There are some beautiful saddles in this room, saddles you could ride in for days. Today you walk to one of the back corners and grab a dusty and scuffed up saddle with a deep seat and a high pommel. There are guards on the front of the stirrups so your feet don't get caught. There's no need for fancy silver conchos or straps for tying rope or bedrolls because this is a busting saddle.
Dragging the saddle behind you, you step back into the yard where the sun is now working quickly to warm the ground. Hands are moving about the yard and several brush past you to grab saddles. Its a short distance to the tall fenced round pen and you sling your saddle across one of the knobby poles before walking to the corral.
There's excited movement as you approach and a particularly nervous buckskin moves into a group of horses, trying to put more space between yourself and him. Ears flick towards you, nostrils flare and one brave little bay turns her head towards you and blows.
Pushing your hat back on your head you're joined by the foreman. He pulls out a cigarette and you watch the herd as he strikes his match. At the snap and flash several horses jump, others look and a few can't be bothered.
The foreman appears to be studying his boots as he slowly asks, "See that flaxen sorrel with the blaze?"
"Pretty," I said.
"He's rank. Tried to run one of the boys down yesterday."
"How you want him handled?"
"Leave him to then end. Get him separated from the others for a few days. Wear him down before you try to break him or you'll never get it done."
Driving to school this morning I would describe my mood as rank. I'm pretty much ready to run you down if you enter the corral. A rank horse isn't just a scared horse or a flighty horse, its a horse that is mean. Its unbroken, untrained and fractious.
The good news is that, during my first two lectures, while half paying attention and writing this blog. I began feeling less rank. I'm now less inclined to think, "Shut the hell up!" when a professor is lecturing on and on and on passed the fifty minute lecture period (Which happens nearly every lecture). Or likewise, run someone off the road because they're obviously in my way.
I attribute some of this to some great pictures of horses during orthopedics class. Just writing this blog has helped me calm down, finally being allowed to use the creative part of my brain for a few minutes. Most of all though, its the people I sit with every single day. The Smalls', Jones', Chells' that make me laugh because they are willing to be so goofy just to get me to smile.
This morning I will leave you with a quote and important information from the very entertaining Dr. D in neurology. "The Manx cat is an abomination." We laughed at first but apparently Manx cats, who are born without tails, have what is called sacro-caudal dsygnesis. This means that they are born with a range of malformations in the spinal column. Many will die in utero and those who are viable will not be sold by breeders until they are 4 or 5 months old and the full manifestation of their disease is realized. So don't buy one because we shouldn't breed animals like this. Its not responsible.
Entering the saddle house you look at the tools of your trade. Saddles, bitted bridles, hackamores, ropes, spurs, girths, chaps, tie downs, reins and in short leather, hang in an organized chaos from hooks and nails and saddle racks around the room. It smells like leather, saddle soap and dirt and horse and it smells like home. Different saddles have different functions. There are some beautiful saddles in this room, saddles you could ride in for days. Today you walk to one of the back corners and grab a dusty and scuffed up saddle with a deep seat and a high pommel. There are guards on the front of the stirrups so your feet don't get caught. There's no need for fancy silver conchos or straps for tying rope or bedrolls because this is a busting saddle.
Dragging the saddle behind you, you step back into the yard where the sun is now working quickly to warm the ground. Hands are moving about the yard and several brush past you to grab saddles. Its a short distance to the tall fenced round pen and you sling your saddle across one of the knobby poles before walking to the corral.
There's excited movement as you approach and a particularly nervous buckskin moves into a group of horses, trying to put more space between yourself and him. Ears flick towards you, nostrils flare and one brave little bay turns her head towards you and blows.
Pushing your hat back on your head you're joined by the foreman. He pulls out a cigarette and you watch the herd as he strikes his match. At the snap and flash several horses jump, others look and a few can't be bothered.
The foreman appears to be studying his boots as he slowly asks, "See that flaxen sorrel with the blaze?"
"Pretty," I said.
"He's rank. Tried to run one of the boys down yesterday."
"How you want him handled?"
"Leave him to then end. Get him separated from the others for a few days. Wear him down before you try to break him or you'll never get it done."
Driving to school this morning I would describe my mood as rank. I'm pretty much ready to run you down if you enter the corral. A rank horse isn't just a scared horse or a flighty horse, its a horse that is mean. Its unbroken, untrained and fractious.
The good news is that, during my first two lectures, while half paying attention and writing this blog. I began feeling less rank. I'm now less inclined to think, "Shut the hell up!" when a professor is lecturing on and on and on passed the fifty minute lecture period (Which happens nearly every lecture). Or likewise, run someone off the road because they're obviously in my way.
I attribute some of this to some great pictures of horses during orthopedics class. Just writing this blog has helped me calm down, finally being allowed to use the creative part of my brain for a few minutes. Most of all though, its the people I sit with every single day. The Smalls', Jones', Chells' that make me laugh because they are willing to be so goofy just to get me to smile.
This morning I will leave you with a quote and important information from the very entertaining Dr. D in neurology. "The Manx cat is an abomination." We laughed at first but apparently Manx cats, who are born without tails, have what is called sacro-caudal dsygnesis. This means that they are born with a range of malformations in the spinal column. Many will die in utero and those who are viable will not be sold by breeders until they are 4 or 5 months old and the full manifestation of their disease is realized. So don't buy one because we shouldn't breed animals like this. Its not responsible.
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