Small Animal Surgery

This was a 4 week rotation that was split into 2 weeks of soft tissue surgery and 2 weeks of orthopedic surgery.  The students that were on the rotation with me were Misty C. and Jacob N. (I forgot to get a group picture :( )I was on soft tissue first with Dr. Milovancev.  I had a total of 12 patients and 7 of them went to surgery and I was able to scrub in. The surgeries were really varied and I got to see many different procedures from pulling teeth associated with an oral tumor (epulis) to a septic abdomen. My favorite patient was a dog that had a huge spleen that took up 75% of his abdomen. He was a pretty good sized dog and when we took him to surgery to remove his spleen we were all surprised at the enormity of the splenic mass. We all tried to estimate just how much it would weigh during the surgery and afterward I weighed it and was shocked to find that it was 9 pounds! I had to adjust my patient's medications after his surgery because he was now 9 lbs lighter. He did well after we sent him home and the best news was that his splenic mass came back as a benign lesion.  We also had a lot of brachycephalic dogs come in for corrective surgery to help them breathe better. Brachycephalic means short head/face and example dog breeds include English Bulldogs, French Bulldogs, and Pugs. These dogs often have difficulty breathing and require surgery to make their nostrils bigger and shorten their soft palate to help them to breathe better.

The entrance to one of four small animal OR rooms.

Scrubbing in for surgery was fun. I was really nervous at first but I grew to enjoy and look forward to it. Scrubbing in entailed putting on a cap and mask, scrubbing your hands and arms for 5 minutes and then  putting on a sterile surgical gown and gloves. Most of the time I would just oserve the surgery and help retract things (legs/body wall etc.) for the surgeon. Occasionally Dr. Milovancev would let me try my hand at things like cauterizing blood vessels and he taught me how to use a ligasure device that cauterizes and cuts at the same time. This device was used to remove the spleen from the patient described above and it was pretty nifty. I would also use scissors to cut the suture tags for the surgeons, I got to lavage tissues with saline and a bulb syringe, and I was allowed to suture the skin on several of my patients. I tried to always be prepared and knowledgeable about the surgical procedure because I was sure to be quizzed about it during the surgery.

One of the owners sent me a thank you card with a picture of my patient and she expressed her appreciation for how I took good care of her dog while she was in the hospital. I didn't get this card until I had already moved on to the orthopedic surgery part of my rotation but it sure made my day to know that someone appreciated my hard work.

Thank you card from a client. :)

Orthopedic surgery was much different but was also a good experience. Dr. Warnock was the surgeon on clinics while I was doing the ortho rotation. I saw 20 patients on this rotation and scrubbed in for 3 surgeries. There was a lot more re-check appointments with follow up radiographs (x-rays) to assess bone healing. I felt like ortho was busier with less down time to work on paperwork. Often I would leave around 7pm to go home and eat while working on paperwork or studying up for procedures that would be going on the next day. The residents were great though and helped the students out where they could. I got to practice doing orthopedic and neurologic exams and I feel more comfortable doing them after finishing this rotation. 

Things that were in my pockets or on my person at all times during this rotation.

On ortho, I scrubbed in on two fracture repair surgeries and one TPLO. The TPLO procedure was really neat especially because I had never seen one before. This procedure is done to treat a ruptured cranial cruciate ligament in the knee joint to change the weight bearing surface of the tibia and make the leg functional. Dr. Warnock let me handle the arthroscope for a minute which was pretty neat. The scope is used to assess the integrity of the cruciate ligaments and the meniscus in the knee joint before starting the TPLO surgery. I got to drive the scope around the knee joint with her help and I got to take pictures of the inflamed joint. She also let me drill a hole in the bone and place a screw in the TPLO plate. It was so cool! The picture below shows an x-ray of a dog leg following a TPLO procedure. 

This image is from the web. X-rays after a TPLO. I was able to place the 2nd screw from the bottom in my patient.

My other surgical patients both had a fracture of bones in their front leg. One was an older dog with a fractured ulna and luxated radius (aka Monteggia fracture), the other was a young puppy with a fractured radius and ulna. I got really adept at applying modified Robert Jones bandages on both of these patients while they stayed at the hospital. I also learned the awesome healing properties of Manuka honey as we applied some to a few bite wounds and they started healing well. Both of these patients got their fractures fixed with a plate and screws and an omental graft. The omentum is an organ in the abdomen that is often used as a graft due to it's ability to provide good supply and therefore increase healing of the fracture. The older dog was not spayed and since we would be going into the abdomen anyway to retrieve the omentum the owner asked us to spay the dog at the same time that we repaired her fracture. I was able to do most of the spay and that was pretty neat and went well. 

My patient's spay incision. I closed the skin with a ford interlocking pattern.

My skin sutures in a little puppy leg after her surgery. A cruciate suture pattern.

One of the many bandages I applied while on the ortho rotation.

Overall, I enjoyed this rotation but I definitely was burned out by the end and was ready to return to a sense of normal life. The time I spent at the hospital was about 60 hrs per week. I had a total of 32 patients thought not all of them had surgery or were hospitalized. Most days I was eating and drinking on the go as I was walking to the pharmacy or in between seeing patients or while I worked on paperwork. Comfy shoes were a must as I was on my feet most of the day. Students were responsible for 7 am and 7 pm patient care for any hospitalized patients even on weekends so sleeping in on weekends was out of the question. I also discharged several patients on the weekends so I would go in later during the day to discharge them as well. I learned so much and enjoyed the variety of things that I got to see and do. I got better at communicating with clients about their animals and I grew to enjoy calling them with daily updates when their pet was staying in the hospital. Most of the people I talked to were so appreciative and it made me feel good to let them know that their pet was in good hands and doing well.

Magruder Hall @ 7 am

Magruder Hall @ 7 pm Same Day.

 While on this rotation I figured out what I will research for my Senior Paper. I had several patients on the ortho service that had orthotic braces. These braces help with mobility by providing support for injured limbs. They are sometimes used as an alternative to surgery or in conjunction with surgery. I find this topic in vet medicine very interesting and we didn't cover it in our school lectures so I decided to pursue a senior paper topic about orthotic braces and their uses in veterinary medicine with my mentor Dr. Warnock. I'm very excited about this topic and though my Senior Paper isn't until March my goal is to work on it now and get as much done as I can.

An Example of an orthotic brace stabilizing the knee joint. Image from the internet.

Other things of note: 

- It was surreal to see the new 1st years starting school and remembering when I was in their shoes four years ago! I can't believe I am a 4th year vet student and I graduate in June.

-  My date is set to take the NAVLE on Dec 5th. This is the national licensing exam that all vet students must pass in order to practice veterinary medicine in the U.S. It is a 7 hour computer based exam that covers everything learned in veterinary school. 

- My next rotation will be 2 weeks of overnight shifts. One week in the large animal hospital followed by a week in the small animal ICU. Wish me luck with staying up through the night and sleeping during the day.