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



Thursday, March 13, 2014

Tales From The Trenches: Sedation

On Monday we had this adorable calico Oriental shorthair kitty come in for inappetance of a couple of days' duration. She was about 5 years old. We took abdominal radiographs and ran basic bloodwork (CBC and chemistry) and everything was unremarkable. I was working on her along with Dr. J, one of my favorites of our staff doctors.

Not Tabitha
The cat, whom I will call Tabitha, was a stellar patient throughout all of this, completely chill about all of the poking and prodding. I have a soft spot for oriental type kitties (who am I kidding...I have a soft spot for ALL cats!) and couldn't help giving her extra attention during the entire process. Within minutes she had a fan club in our ER.

Dr. J was stumped at not being able to figure out what was wrong with Tabitha. He kept returning to her mouth: logic said that if everything else was fine, the cat was probably not eating because her mouth hurt for one reason or another. Tabitha did not like having her mouth examined but held it open just long enough for Dr. J to observe that the back of her tongue and throat were not quite normal. 

He stepped out of the ER to ask the kitty's owners for permission to sedate Tabitha so he could take a closer look at the back of her mouth. I took the opportunity to pick her up and snuggle with her while waiting for Dr. J to return. Not only was she super cool to work with, she was also one of those cats that loves being held.

The owners acquiesced and we gave her an injection of dexdomitor and midazolam. 

I'd say about 70% of cats freak out when sedatives first kick in: they become agitated and sometimes may even try to bite in their confusion over this alien sensation taking over their bodies. I can't say I blame them-I'd probably be in that camp if I were a cat and didn't understand what was happening. Part of my job is to keep them quiet and calm while the sedative takes full effect. Sometimes wrapping them in a towel like a kitty burrito (aka swaddling) or gently covering their faces can make a huge difference (a lot of sedatives cause pupil dilation, which causes light hypersensitivity; they'll see halos and trails around lights. Think when you have your pupils dilated at the ophthalmologist's office.)

High kitty is high
And then you have the other 30% of cats: the ones that actually like the sedative! These never fail to crack me up. One of my favorites was a kitty back in FL whom the doctor decided to sedate to do a more extensive physical exam: he was harmless but quite wiggly. I had a bad feeling about sedating him and honestly didn't feel it was necessary for what the doctor wanted to do, but techs follow orders and I quietly did as I was told. We gave the kitty his drugs and then waited for them to kick in. Since they were given IV, it wasn't long before they took effect. I saw the exact moment when that happened. I swear the cat got this expression of "WOW!!" He started looking curiously around him, up at the lights in the ceiling, the windows, our faces. He actually put his face right up to mine and when I drew back, he reached out for me with sheathed claws, just a soft paw, touching my cheek and still trying to put his nose up to mine. "Wait, wait! I want to see you UP CLOSE!" His expression was one of sheer fascination. And then he started to get mouthy: he wanted to put everything in his mouth. Not to bite, just to have it in his mouth. It was freaking hilarious. This cat was getting an absolute kick out of being high. At this point the doctor realized that this particular cocktail of drugs was not going to work for this particular cat: if he'd been wiggly before, there was no keeping him still now that he wanted to touch and taste and see all the things while on his vet-induced trip. He was like an out-of-control raver! Chuckling, we put him away in a cage with tons of bedding to let him sleep off his drugs. He was back to normal about 30 minutes later.

Tabitha was of the second camp.

Dexdomitor is a hard-core sedative that also has pretty strong analgesic properties and is great for use in young healthy animals because it will really knock them out without the loopy side effects that most other sedatives have. (It can really drop their heart rate though, which is why it should be used with caution or avoided altogether in geriatric patients.) It also has the advantage that it is completely reversible: one injection of the antidote and the animal is often awake within 15-30 minutes.

When the drugs took effect, Tabitha leaned back on the table and got this awesome look of, "Oh maaaan!"... And then she was out.

Dr. J was able to look in her mouth and discovered that the papillae at the back of her tongue were quite enlarged. Her left tonsil was also large and irritated. We couldn't see anything wrong with her teeth (cats get feline resorptive lesions, comparable to cavities but a million times more painful; not surprisingly, they are often enough to cause a cat to stop eating) and honestly had no idea why the back of her mouth appeared so angry.  Dr. J decided to send her home on pain medication and antibiotics for the irritation in her mouth and recommended a follow-up with Tabitha's regular vet.

I gave the kitty her reversal agent and held her while waiting for her to wake up so she wouldn't get cold (most sedatives will drop a patient's temperature as well).

She was as awesome waking up as she had been going to sleep. She slowly opened her eyes and looked around, slowly moving her head and focusing on her surroundings. I could tell she was having a hard time remembering where she was and couldn't help giggling because she looked so much like a person waking up from anesthesia.

At the sound, she turned her head and looked up at me. I saw the instant when she recognized me as the person who'd been working with her previously. "Oh hai!" she seemed to say, and her entire expression softened. I couldn't help giving her a kiss on the forehead at that moment.

Shortly afterwards, Dr. J took her back to her owners.

I'm not sure why, but that instant when Tabitha recognized me just stayed with me for the rest of my shift. It wasn't just the fact that she'd recognized me, it was the change in her expression from one of slight anxiety at not remembering where she was to one of utter relaxation when she recognized me. You know you're doing something right when you can make an animal feel like that in a scenario that might otherwise be terrifying.

This is why I love my job: because of the positive difference we can make in a patient's life, no matter how small that difference might be.


6 comments:

  1. I believe some people are born with a natural and deep compassion. I believe that other people (far fewer) are born with the ability to sense the emotions of others, be it people or animals. It does not surprise me AT ALL that you are one of those people. Not only does it show in your work, it shows in your riding and in your art.

    Just another reason to admire you.

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    1. That kitty just made my week. It's one thing to get that look from your own pets; it's extra special when you can get an animal that's not your own to feel that comfortable. :)

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  2. I am with Karen here - you obviously have a gift. Your story made me *sniff* a bit because I know just what you mean by an animal's expression softening when they see/recognize you. It's just the best feeling. :) I make no claim of that happening when I was a Vet Asst., but I've known it often enough with my own pets and even those of friends. Nothing like making an animal happy!

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    1. I know right? That kitty totally made my week.

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  3. We use telezol to knock them out at the s/n clinic. Most cats just sort of doze off with zero reaction, though some get agitated during the recovery process.

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    1. A lot of shelters and old school vets use telazol, but you don't see it in most GPs nor pecialty practices anymore because there are a variety of sedatives and analgesics now that are safer to use. That said, when I did my clinical rotation at the Broward Humane Society, they did use telazol without a problem in dogs.

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