"And, when you want something, the entire Universe conspires in helping you to achieve it." -The Alchemist, by Paulo Coehlo

Monday, March 11, 2013

Speaking of Bruises...

Today just sucked all around.

I spent half the morning wrestling with a 110 lb Labrador who had a pneumothorax, and who was also regurgitating...we had to place an NG tube (nasogastric-through the nose to the stomach) to empty the stomach before anesthetizing him for an MRI to see where his lungs were leaking air. Why did we need to empty his stomach? Because with the regurgitation, there was a very high risk of him regurging while being induced, which could complicate matters further with aspiration pneumonia. You do NOT want a patient with a pneumothorax to end up with aspiration pneumonia to boot!

A pneumothorax is when air gets outside of the lungs, but stays within the chest cavity. It is common in trauma cases, such as bad hit-by-cars, but can also occur spontaneously, like with this patient. A pneumothorax is very dangerous because it creates increasing pressure on the lungs to where the patient can die from them collapsing-he won't be able to inhale.

Now that you know that, tune back into the above scenario. We had to wrestle with this dog. He had received whopping doses of 3 different sedatives, and was still shaking his head and trying to paw at his face every time my supervisor, who is another very experienced tech, tried to insert the tube into his left nostril. We finally had to give him a small dose of Propofol (the Michael Jackson drug) to knock him out 75% so we could quickly get the NG tube inserted and sutured in place. This whole process took an hour, because we were trying so hard to not stress him out. Why didn't we just knock him out entirely to begin with? Because patients need to be able to swallow so the NG tube will end up in the stomach where it's supposed to. If they are too sedate, they will lose their reflex to swallow.

NG tube in a cat. This was the best photo I could find, so you could see how it goes into a nostril, and is then sutured to their face. I can't say I blame our patient-I would've done the same!
We sucked out all the fluid we could from his stomach (about 15 mls, not much at all) then had to take the big boy to Radiology so we could take a placement radiograph, to make sure the NG tube was correctly in the stomach (not too far out nor too far in). It was definitely in, but it had curled around inside the stomach-we had to undo the sutures and partially pull the tube out, then stitch it back into place.

This turned out to be impossible. By then, all the drugs we had given the dog had started to wear off, and with one quick swipe of a front paw, he was able to yank the entire tube out. You have no idea how incredibly frustrating this is, especially on a critical patient like this one. You don't want to have to mess with them like this and stress them out, possibly endangering them further!

The doctor gave the okay to stop. She decided they would just have to be extra-careful during induction and place the NG tube then. It wasn't worth continuing to stress the patient out.

My arms, chest, and shoulders are going to hurt tomorrow.

That was the most eventful part of the day. We had 1...ONE...emergency ALL day. It was a 12 hour shift, and only ONE emergency! I was tearing my hair out with boredom.

I flew out the door at the end of my shift. I had brought a change of clothes, so I could go straight to the barn to ride!

I got to the barn, changed, and met Alex halfway as he was bringing Lily in from the field with the other horses. I saw it before he said anything-she was off.

After this frustrating day, I was upset. I took Lily down to the outdoor to lunge her so I could try to identify which leg was bothering her. She had an equal head bob to left and right, and it seemed to be her right front. She was acting like an absolute retarded nut. The arena had been dragged and the jumps moved. The same jumps she's seen every single time I've ridden her out there, but today she was blowing and snorting at them, and trying to run away from them! Yep, you guessed it-of course she's in heat! I HATE when she gets like this.

And of course looking at her in the setting sun, I could see the outline of her ribs and the backs of her shoulder blades. All the muscle I worked so hard to put on her, all of the weight I put on her-gone. Gone in 3 months. MONTHS of beet pulp, grain, going out of my way to find extra tasty, good quality hay; the haynets; the supplements; the rice bran oil and the vitamin E oil...It took me a good 6 months to get her looking the way she did back in July (see sidebar on the right). And it's all gone.

I took Lily out of the arena, and had her trot around me on the concrete. There it was-she was dead lame on concrete, and it was definitely her right front. I texted my farrier, who can't come out to our barn until Friday, and I decided to treat it as an abscess.

But first, I found Alex and asked him about increasing Lily's grain ration yet again. They had increased her Low Starch ration as originally requested, but I asked him to add more hay stretcher and also a daily pound of rice bran pellets.

I put Lily on the cross ties in the wash stall. It was wet, and when I picked up her hoof to stick it in the soaking boot, I saw it:

A nasty little bruise on her inside heel (to the right of the photo). I soaked her foot in the boot with warm water and Epsom salts, and brushed her again while waiting the 15 minutes for it to take effect. She was uper-fidgety on the cross ties, going back and forth and not holding still. I have to distract myself when she does this because it makes me insane. If she didn't know how to stand still, it would be a different story, but she knows-she just chooses not to when she's hormonal and/or acting herd-bound.

Finally the 15 minutes were done. I put her in the cross ties in front of her stall and packed her hoof with Magic Cushion, the put her up for the night. Alex had put bute in her grain for me, like I'd asked. I told him to keep her on it until Thursday.

It is frustrating. This mare was lame for a single day in South FL, the one time that her puncture wound really bothered her. That was the only time she'd been off in a year and a half of owning her. In the 6 additional months since we moved, she's been lame 3 times. There are 3 other horses with abscesses right now. Mud season sucks.

I'm just really, really upset right now, and it doesn't help that I only got 3 hours of sleep last night. While I love the longer days of Daylight Savings, I hate losing that hour of sleep. That one hour time difference really messes me up for the first month after the change. Last night was a classic: waking up every 2 hours thinking it was time to get up, then finally waking up at 3:00 am and not being able to go back to sleep. This scenario happens every year. We didn't have this in Puerto Rico-over there it's Daylight Savings year-round. I've been doing this little back-and-forth routine for 8 years now, but I still think it's the dumbest thing ever. I mean, why? It doesn't even make sense! Who wants a night that comes even earlier in the wintertime, when people are already suffering from SAD from lack of sunlight?

I'm off to bed. I'm whining. Sorry guys.

1 comment:

  1. Hate to say it, but mud and wet is a very big part of this part of the country. I know horses have a hard time adjusting to it - I've heard rumor of people trying to bring horses over from West of the Mississippi for endurance and never getting them as sound as they were originally. I don't know how true this is or how it would apply to a FL horse.

    Our horses are on 40 acres +, I guess its what you referred to as "rough" board where if I want anything done I do it. D and Steve put round bales out as needed, but the horses are on their own otherwise. We all convene for vet days to split the farm call if its yearly vaccines or something, but other than that we're on our own. But - even with all that area for 6 horses to be on there is still mud and goop around the gates and hay feeders. It'll be gone by summer, but it still exists right now.

    Per your other issues - no bueno. Noooo bueno. I hope you can find answers or a better situation soon!