I feel like I'm under a world of stress these upcoming two weeks. Today was our poultry final (thank God that class is over, hope we all passed). Wednesday is our Critical Care final. Friday is our Ruminant and Small Animal Surgery finals. Monday is our Radiology final and Tuesday is our Large Animal Surgery final. Tuesday afternoon is our white coat ceremony (which signifies our transition from a third-year-classroom-student into a fourth-year-clinical-rotation-almost-doctor), Sunday is Easter and Monday starts clinics!
Plus, we have a case presentation due, and ICU case to turn in, a handful of online quizzes due at random times, and surgery responsibilities this week and next week. PLUS, I am trying to catch up on emails and plan my visit for home in a couple of weeks and plan our trip this weekend for the wedding in Michigan (right before finals... GREAT).
Anyway, I had my third spay yesterday on a sweet beagle that reminds me of our 18 year old family dog, Gypsy. She is about 2, has clearly had puppies before and happened to be in heat. Surgery was very uneventful compared to my pregnancy surprise four weeks ago, which was nice, so I took it as another opportunity to better my surgical skills. I located the linea like a champ and found the left uterine horn on my first attempt.
The only odd thing to happen was bleeding from "external" structures - which was coming from outside of the body, such as the ovarian artery after the left ovary and uterine horn were exteriorized - so we just clamped the artery since we were removing the structure anyway. Our surgery tech walked by and asked if she was in heat (which she was) because of all the blood on the drapes and offered to bring more sponges, but we just replied "It looks MUCH worse than it actually is!" And it did - there was no blood in the abdominal gutters, no blood anywhere IN the abdominal cavity - we only used four gauze squares for the whole surgery, but it just looked like a mess on the drapes.
All-in-all, a successful surgery - patient woke up a little cold (98 degrees), but was conscious and wanting to move around after we tried to warm her with the heating blanket and towels, so her and I took a few laps around the surgery ward to increase her temperature. She said hello to a few groups and by the third go around, her temperature was 99.7 and increasing, so she got to go back to her run and sleep for the rest of the day.
I always breathe a sigh of relief when I check on my patient a few hours later and they are doing well. Then I check again a few hours after that... and again early the next morning, and so on. I just want to make sure my animal survives :)
I was on a high after finishing surgery and I studied for the rest of the morning and afternoon. KJ and I got lunch on campus (Chipotle for me and hot dogs for him) and we chatted for awhile, prolonging our break from studying for poultry. Around 5:30, I decided to go home to let the dogs out and feed the zoo. I get home and Jazz doesn't meet me at the door which is VERY strange. I see her trembling in fear on the couch... so I know she did something wrong. I see little black plastic remnants on the floor, which look like a plastic bag was ripped to shreds. I wondered what she had gotten into this time as I tried to read the writing on the plastic, but it looked to be written in German. I then happened to glance down the hallway and see a HUGE (20+ in diameter) pool of BLUE vomit with blue chunks. At that point, I saw a cardboard box sitting on the floor that was missed a corner (eaten by Jazz) which contained an opened bag of blue paintballs
I immediately rushed over to her and checked her mucous membrane color and CRT (capillary refill time) - those indicate perfusion and oxygenation. She was pale, slightly tacky, and CRT = 2.5 to 3 seconds. Her abdomen was significantly distended and hard as a rock. I checked the cardboard box with paintballs again - the bag was mostly full, so she hadn't consumed that many of them. Plus, she had vomited - another good sign.
(What did I learn about paintball toxicity in toxicology? Didn't we just learn about this in critical care?)
So, I freaked out. I called the animal hospital immediately, talked to Dr. MD and she suggested I call Dr. SH, since she used to work at the ASCPA poison control - I couldn't get a hold of her, so I call my friend JA, who worked as poison control over the summer and is super smart - she told me that paintballs are an osmotic and cause hypernatremia along with other signs. Jazz and I jumped in the car and drove to the animal hospital where they calmed me down and gave subcutaneous fluids and ran electrolytes (specifically checking her sodium level).
At this point, Jazz had really perked up, her color was great, CRT less than 2 - so I relaxed a bit. Her electrolytes were normal and she handled the visit like a pro. I decided to study at home for the rest of the night to keep my eye on her (obviously, I wasn't about to leave her so she could try to kill herself again...) - but I lose massive focus when I study at home. I finished going through my poultry notes, typed up my surgery report and waiting for Kyle to call so I could pick him up (he was still studying at school, even though he offered to come with me to the animal hospital and all at - I didn't think it was necessary for both of us to lose out on an afternoon of studying, especially since I'd already studied more than him for the exam).
All in all, a very long, exhausting and stressful day.