I think I just need to unload. Chanel, Portuguese Water dog, had cancer in the chest. Owners elected to go forward with surgery rather than euthanise, so the surgeons did a left lung lobectomy and right chest wall resection (cutting out part of two ribs in the process). Procedure along with post op healthcare estimated to cost $10K. Treatments were pretty straightforward, she wasn't like some critical cases I've seen on fifteen different fluids with a urinary catheter and nasal tubes. Those are horrible. But she was just the chest tubes. They'd placed a nasal oxygen line because she didn't seem to be oxygenating well after surgery, but she was just on fluids and Fentanyl post op, with the usual course of post op antibiotics every eight hours to prevent infection. They pulled a lot of air and fluid off the right chest tube the first night she was down (some 165 mL air, 260 mL serosanguinous fluid), but it dropped off rapidly after that. Yesterday we pulled both chest tubes and the nasal oxygen line as we were getting minimal amounts of fluid/air from the tubes and she was oxygenating well according to the pulsoximeter (a machine which will be the death of me, since it's so finicky and dogs don't usually like clips hanging to them from their inner lip). She's probably gone home today. She ate really well for me last night, this chicken/salmon wet food. At first she wouldn't eat when I simply put it down, but when I held the bowl up and scratched her ear and told her what a good girl she was, she ate it all and even asked for seconds. Was urinating outside when I got there, off her Fentanyl CRI and on oral pain meds (Tramadol, Gabapentin) as well as oral antibiotics (Simplicef, I think). She made a full recovery. Yesterday was great to take care of her, she was low maintenance, but the day before that it was that transition period where she's awake and aware enough that she knows what's going on and was probably anxious/slightly painful (had her on a really high rate of pain meds, so hopefully not too much pain) but not alert and awake enough that she was urinating outside, eating well, etc. I had to move her from being ex-caged (where we set up a pen and the patient lies there and we go inside the pen to do treatments) to going back in the cage properly, since she was starting to twist up her line and everything. But otherwise, a full recovery and a happy story. I thought she'd have to be in hospital much longer, but overall she was only there three/four days post-op. Zoe, boxer/pit mix, stage four renal failure. She was a sweet dog, but owners visited constantly for several hours at a time, which made it difficult for me to give her treatments, especially since two nights ago, I had four pretty involved cases that I was drowning in. Usually with my case load, I'm able to help out getting assessments and bringing animals to the back, doing treatments on them or setting up. I was just engulfed in my four cases that night. Zoe has always been on the lean side, owners struggled with her sensitive stomach issues, she had a history of reactions to medications. They brought her in for lethargy and inappetence, the rDVM found that she was azotemic with super high kidney values and referred to us. She was an ER patient for two days, where owners didn't want treatments to be done or certain diets fed (even though we were feeding her a low protein prescription kidney diet to help with her kidney issues! owners wanted to feed only homemade chicken and rice, which was completely not recommended because of the protein content) and visiting for hours would prevent her from being effectively dioresced. It was extremely frustrating. Then finally they elected to get a consult with internal medicine to get to the bottom of things. Abdominal ultrasound revealed some mild changes in corticomedullary structure but nothing to explain the renal failure, suspected an infection (for example, Leptosporsis). So they switched her from ampicillin sulbactum antibiotics to doxycycline and enrofloxacin to cover a wider spectrum and hit the possible infection aggressively. They would have her on continuous fluids, if owners wanted to visit it would have to be with IV stand (which I did, further complicating the whole night for me), put her on a renal diet, add aluminum hydroxide to her regimen along with IV metronidazole to address sensitive stomach issues. She was also put on vetastarch for decreased ALP (? I think?) values. They also found she had abdominal effusion, so started having me catch all her urine to measure ins/outs of fluid, worried that the effusion was due to the kidneys not producing enough urine that she'll soon be overloaded and go into heart failure. She also had high blood pressure throughout so put her on amlodipine to address that. The case changed hands from ER to IMED right during my shift, but IMED is only there during the day so I was her tech for swing shift, and I was the one to had to do all these new for her because she was getting three different antibiotics (Doxy takes 1 hour to administer, Baytril 20-30 minutes and Metro the same) and all that stuff. We also pulled for cortisol to test Addison's, since her resting cortisol had been low. Anyway. She went home yesterday, IMED did discharges, put her on a ton of different antibiotics (oral forms of the same ones I named above) including a regimen for administering subcutaneous fluids at home since her renal values, while slightly improving over the days she was here, didn't show the improvement doctors had been hoping for. Ironically enough, a dog with the exact same symptoms as Zoe came yesterday, and I took her case also. Renal failure, inappetence, lethargy, high blood pressure, the same type of boxer/pit mix too. Her name was Roxee, but in her case the owners reported that she had been diagnosed Lyme positive two years ago but hadn't been treated, so the doctors suspect it's the Lyme disease attacking her kidneys. She was immediately put on Doxycycline to address possible Lepto and Lyme, aggressive diorescing overnight, given Amlodipine to address high blood pressure. Owners were super nice, they asked me questions which, given all my experience with Zoe, I was able to answer. Luna, a cat with untreated Diabetes Mellitus. Her BG on presentation was like 640, they put her on fluids and gave 1/2 unit regular insulin (shorter acting) and her BG responded appropriately each time (unlike another case I had once, where a dog would go from hyper to hypo glycemic all over the place, not able to regulate his blood glucose at all with even the smallest doses of insulin). She got an abdominal ultrasound, where they saw the pancreas looked really bad, but she was eating a diabetic diet (DM) really well so they suspected it was too painful (yet). Owners declined doing a pancreatitis workup, they decided to switch her to long acting insulin so that she could be sent home. Her case wasn't super difficult, I feel like, only thing was that she had to have blood glucose checked every four hours and that day, I'd had to do all the treatments for Zoe and also aspirate the chest tubes on Chanel every four hours so I was running all over the place. A lot of people helped me with Luna, another tech named Mari had had her the day before so she would help me with treatments. We got blood from ear sticks, which worked really well. She ate the DM wet and dry super well. Generally a sweet cat, BGs were a little on the high side when I left last last night (314 was the last reading I took) but held on giving insulin since wanted to switch to a regular two times a day schedule. She went home, was also discharged by IMED yesterday. Kiko, older dog, Papillon mix, had an abscess in his left hind that continuously oozed fluid. They'd lanced the abscess the night previous where a lot of stuff came out, and it just continued to come out throughout the day and in my shift, on and on. Dog wasn't eating, was getting cold/warm compresses on his leg, edema massages to prevent the ooze from sitting static in his extremities, antibiotics. He was on vetastartch (I don't remember why) and fluids with KCl added (potassium was low). Generally recumbent and lethargic during my shift, owners came to visit and he was completely uninterested in eating for them. He was there yesterday when I worked, then left.. I don't know if he went home. Owners were considering euthanasia because he was so dull and listless, not seeming to recover despite the three nights of hospitalisation and antibiotic treatments. I don't know what happened. Sweet dog. Edema oozed so much red pus when I would do the massages. It was gross. Addy, a really old lab who came in from another vet hospital for severe urine scald. It was horrendous. Owners had been out of town, boarding her at a facility when they took her to the other hospital for "hot spots." Shaving revealed that her entire hind was covered in urine scald. She was recumbent, unable to walk/get up, a lot of muscle wasting in the hind, so who knows how long she was sitting in her pee at that boarding place. Shaving revealed it was all up and down in both hind legs. The owners, when contacted, didn't want any diagnostics done, only to keep the dog alive, but we put her on a Fentanyl CRI, fluids with KCl, Cefazolin (antibiotic). She wasn't really interested in food, but she ate a little chicken and baby food. The main problem was keeping her dry. She would continuously leak urine, so they tried to place a urinary catheter and failed, but she expressed very easily so they did instead. I would rotate her every four hours and express her in the process, then put down new pee pads and place a pee pad between her legs to keep her dry. We'd put ointment on basically the entire hind, since all of it was affected. I know that I was able to keep her as dry as I could during my shift, but the urine scald didn't look like it was much improving. It was still pretty red, though it looked less raw, and starting to scab over. Owners are supposed to come back from vacation or whatever today and see the condition of their dog. They asked about taking her home and home care, but I told them it would take a lot of dedication. She's painful but not eating, so giving her oral pain meds would necessitate pilling her. She's unable to walk at all, even with a sling, she would knuckle on her hind limbs so if she urinates, she has to be moved immediately. It's unlikely that she'll drink much water so keeping her hydrated properly would be a problem at home. Honestly, the dog was in such a bad state that I hope they euthanise. It was horrible, the condition she was in. Someone was mentioning that it's not something which happens overnight. And yes, the urine scald is the fault of the boarding facility, but the owners clearly didn't address her weight loss, muscle wasting, general quality of life as she got to this point. Dakota, young Siberian husky with a lot of bruising on his left hind limb, presented with petechia on his abdomen which turned into more bruising over time. His liver values were elevated. Owners didn't want to do much but see if the bruising would go away on its own, elected to basically monitor him and hold on fluids, doing much diagnostics, etc. They had called last night telling me that he'd gotten a Rimadyl injection (carpofren) in that leg, and they were doing research online and were convinced that this was the cause of all his symptoms, and wanted to make sure the doctor knew. I admittedly get annoyed with owners who go online and decide to do Dr. Google research and basically tell the doctor the diagnosis. I mean.. the doctors I work with are good at what they do. They've seen a lot. I relayed the information to the doctor, who said she had already taken it into account and that Rimadyl toxicity doesn't present to the extent that it did for Dakota. I mean, the entire leg was bruised, down to his abdomen, penis, scrotum, into his belly, and the liver enzyme levels were extremely high. My main frustration with him last night was that he wouldn't urinate outside despite the fact that his bladder was huge and he hadn't peed in two days, and we needed a urine sample. Of course he urinated in his bed. I was able to suck up a sample of urine from the pee pad overflow, but it didn't show anything special-- a lot of bilirubin, but nothing else. wouldn't eat all day either, owners told us that he's actually a nocturnal eater. Had to pill him for his meds. Generally a nice dog, though. Ellie, mass removal on her face, hound mix. She woke up rough from surgery so they gave her Dexdermitor and brought her down, then put her on a hydromorphone CRI. She was out. Super sedate, not really responding to stimulation. She was on 3mcg/kg/hr, but I asked the doctor to low it to 2mcg to see if it did anything. Her temperature continued to drop and her heartrate was 44, so I asked to lower it again to 1.5mcg. That finally did the trick, temp went back up and her resting heartrate was 70, which is normal, and she was responsive to outside stimuli. By the end of my shift, she was awake, able to walk, ate a bunch of z/d (hypoallergenic diet, she's allergic to chicken and grain so they feed her a salmon diet at home) and ate her oral pain meds in food, so discontinued the hydro at midnight. Abby, foot laceration, Bernese mountain dog, female intact. She was a bit crazy, not trained at all, had to be sedated just to do a physical exam. Doctor did a laceration repair. I can't keep writing anymore.
