#vetandready

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Veterinarians’ spouses will get a kick out of this description of how to feed their vet and keep them happy… ;)

[vetandready]

Thank you & Instagram

Welcome new followers! Let me know if you have anything you would like me to blog about that is vet related. And thank you to anaspiringvet for including me in your master veterinary blog list!

For a few days I will open my Instagram privacy to accept new followers. Find me vetandready to see more island and vet related pics!

[vetandready]

Word of the Day

Sphygmomanometer - (pronunciation: SFIG-moh-me-NOM-eh-ter)

Say that three times fast...bonus if you know its use in veterinary medicine (resist temptation to Google it)!

[vetandready]

Old Things New: Surgery Report

Written Summer 2014

I'm in my final semester here at Ross University. This is my last semester of pre-clinical training and coursework, including four classes and an intro to clinics (which I feel is preparing me well for my actual clinical rotations beginning in August at Louisiana State University). 

I have already done my first surgery, which was on day four of the semester, a castration on an island dog. I have also worked as the anesthetist for another patient, my SOAPing group's sheep, nicknamed Grits, for his epididectomy and castration. And, this week I am going to be doing a spay on a sweet little island dog that I met earlier this week. 

With each procedure I complete, I am responsible for doing a pre-op physical examination on the patient, which I then transfer into a written SOAP. I also have to do all the preparation - studying and understanding the actual procedure, including anatomy I will be working with, along with any complications that may arise. Furthermore, I write a discharge letter for the client, and do all the client communication to make sure that the patient is adequately prepared the night before the procedure (ie. food taken away the night before). The final part is the surgery report, which basically outlines the entire procedure from start to finish, including all little details. 

I figured I would share the surgery report for my spay, even though it is prior to the procedure taking place. I wrote a rough draft of what I expect to do and after the surgery, I will amend it to fit exactly what I have done!

First, the patient's hair was clipped on the ventral abdomen from the xiphoid to the pubis and (at least 7cm from midline). The shaved skin was then prepped by scrubbing using circular patterns from the incision site moving towards the periphery. The scrub was alternated from chlorhexadine to alcohol three times, finishing with chlorhexadine solution and allowing for maximal contact time between the antimicrobial and the skin. After the surgeons were gloved and gowned they placed four quarter drapes on the patient, at the xiphoid cranially and pubis caudally and covering the mammary glands laterally.  Four towel clamps were placed on the towels and skin to hold them in place. A top drape was then placed, and four towel clamps were secured to the drape and the underlying neck of the previous towel clamps. A fenestration was then cut in the top drape using suture scissors to match the underlying borders made by the huck towels.

The primary surgeon confirmed with the anesthetist that Cefazolin had been administered and that the patient was at an adequate plane of anesthesia before making the incision. The incision was made through the epidermis, dermis and subcutaneous tissue on the median raphe starting about 1 cm caudal to the umbilicus and extended about 5cm caudally, using a sliding fingertip grip technique. The incision was continued until the linea alba was visualized. While the incision was being made, the thumb and forefinger of the left hand was used to keep the tissue spread laterally to minimize bleeding from smaller cutaneous vessels. A pencil grip was used to incise through the subcutaneous tissue on both the cranial and caudal end of the incision. A gauze 4x4 square was used to control subcutaneous hemorrhage throughout the procedure, where necessary.

fascial border and then the scissors were placed perpendicular to the incision to begin blunt dissection at the visualized margin. The scissors were then placed parallel to the incision and the subcutaneous tissue was cut away from the fascia to complete the dissection. The linea alba was grasped with the Adson tissue forceps at the cranial aspect of the incision and tented away from the abdomen. An overhand scalpel technique was used to make a single stab incision through the linea alba with the blade facing away from the abdomen. The incision was extended using the adson tissue forceps to tent the linea alba high out of the abdomen and guide the scalpel blade in a sliding technique along the length of the skin and subcutaneous incision (about 5 cm in length).  Confirmation that the incision was completely through the linea alba was done by opening the incision to readily view abdominal contents (the omentum being seen first). The spay hook was inserted with the hook facing the body wall.  It was advanced to dorso lateral midline and rotated 180 degrees pulling to ventral midline to expose broad ligament fat. The surgeon then used her fingers to take the fat from the spay hook and search medially to find the uterine horn. The horn was traversed cranially to the left ovary. A mosquito hemostat was placed on the proper ligament of the ovary between the ovarian bursa and the uterine horn. The surgeon then identified the burs surrounding the ovary, the pedicle, and the suspensory ligament. Slight digital traction was placed on the ovary with the dominant hand, while the suspensory ligament was strummed with digital pressure and broken down at the most cranial aspect of the ovary with the non-dominant hand. A window was then opened parallel to the blood vessels using the Carmalt hemostats, dorsoventrally, leaving 1-2 cm of mesometrium cranial to the window and from the pedicle.

A modified triple clamp technique was used, placing a Carmalt hemostat about 1.5 cm 0 PDS suture) was placed in the most proximal crush, and the respective Carmalt was removed as the ligature was being tightened with continuous moderate pressure. A transfixing ligature was then placed about 0.5 cm distal to the first ligature, while the respective Carmalt was flashed to ensure a secure ligature. The tissue directly distal to the Carmalt was then transected using a scalpel, through the window with the blade facing away from the abdomen, and cutting towards the surgeon. The surgeon extracted the ovarian bursa to confirm that no ovarian tissue was left behind. There was none seen and the entire ovary was intact, so the surgeon then placed Adson forceps distal to the ligatures in an avascular area to secure the pedicle, the Carmalt was removed, and the pedicle was then retracted slowly into the abdomen while the surgeon checked for hemorrhage from the pedicle. After hemostasis was confirmed, the pedicle was released.

The surgeons switched sides of the operating table, maintaining asepsis. The secondary surgeon then proceeded. The left horn was traced caudally to the bifurcation of the uterus, and then traced cranially along the right uterine horn to the right ovary. A mosquito hemostat was placed on the proper ligament, and the suspensory ligament was located and digital traction was used to break it down. The same modified triple clamp technique was used to clamp and transect the pedicle. The pedicle was checked for hemorrhage and then released back into the abdomen once hemostasis was confirmed and the duodenum was replaced back into the abdomen.

The broad ligament, dorsally and laterally to the uterine horns was broken down digitally in an avascular area lateral to the uterine arteries on either side. The uterine body and cervix were visualized. A triple clamp technique was then performed on the uterine body. A Carmalt clamp was placed about 0.5 cm proximal to the cervix on the uterine body. A second Carmalt was placed 0.5 cm proximal to the first clamp. And, a third Carmalt was placed 0.5 cm proximal to the second clamp. A circumferential ligature using a Miller’s knot was placed proximally into the crush of the most proximal Carmalt clamp. Two modified transfixing knots were placed distally, on either side of the uterine body, to include the uterine vessels and the uterine tissue. The uterus was lifted and the transection was made distal to the Carmalt clamp with the scalpel. The uterine pedicle was grasped in an avascular area proximal to the ligatures and the clamp was removed while the surgeon checked for hemorrhage and tension was removed from the pedicle.

Before closure, of the incision, the pedicles were checked again to confirm hemostasis. The colonic maneuver was used to retract the colon and jejunum so that the left pedicle could be checked for hemorrhage. There was none from this site. The duodenum, along with the pancreas, were retracted to check the right pedicle for hemorrhage. No hemorrhage was seen from the right ovarian pedicle. And, the uterine pedicle, between the colon and urinary bladder, was also checked for hemorrhage, and there was none. A simple interrupted pattern was used to close the external rectus sheath (with 2-0 PDS) using 0.5 cm bites on either side of the incision. The subcutaneous tissue layer was closed using a simple continuous pattern using 2-0 monocryl. The final knot was smurfed to the cranial end of the incision. An intradermal pattern was placed (using 2-0 monocryl). Using 2-0 vicryl, cruciate sutures were placed in the epidermal layer. Recovery was uneventful.

 ^^P.S. Reports are never this long and detailed anymore! It isn't a journal entry, it's a surgery report... LOL

[vetandready]

I'm so thankful that I have professors who care about me and cheer me onward to the finish line! Finals week at Ross consists of emails reminding you that you really are GREAT and the "finals fairy" leaving you extra change at the vending machine for a late night snack and peppermints on the desk to stimulate your brain (our profs really go above and beyond!)!!!

[vetandready]

From the RUSVM Associate of American Bovine Practitioners (AABP) club...check out this video for a little insight into what we do! I love going on palpation trips to our local farms to help them with pregnancy checking and the overall health of their herds!

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Theriogenology Class Competition

In class quizzes are done with clicker devices. Our prof decided to have us join a team for some good ‘ol friendly competition. The team names she came up with were:

Barbie Butts Vagina Divers Springy Vulvas

Let the games begin!

[vetandready]

The Dog With No Name

He was a quiet soul and one who tugged at the heart strings of everyone who walked hastily past him in the make-shift clinic which was set up in a dusty school house outside of Los Chiles, Costa Rica. His owner walked alongside him for 10 kilometers seeking veterinary care that he hoped would save his dog that day. The dog with no name hadn't eaten in eight days and upon further examination was in poor body condition with a large mass protruding from, and firmly seated in, his left neck region. He didn’t resist the hands that ran over his dull coat during the examination, and his eyes looked longingly toward his owner. There was no way for us to better his quality of life, and we informed the owner that the only thing we could do for him was to give him peace, by ending his life with dignity. I will never forget the sorrow, the hurt, the loss that I saw in his owner’s eyes…but I will also cherish the love that radiated from him in that last embrace with his four-legged friend, his little hero. For the man who lived in a home held together with bamboo trunks and tarps, who slept in a hammock at night, and cooked his meals over an open fire, this dog didn't save his life, but was his life. To the courageous, flea-bitten, dull-coated, thin, imperfect little dog, thank you for being this man’s personal hero up until the very end.