adventures of beck

Friday, May 05, 2006

Shattered Leg, New Dreams

Today, first, I got a tick that I think came off a cute shepard puppy. The tick is now hanging in my office and I am going to identify it later, and possibly create a "summer risks" bulletin board including things that can come after you and your dogs and cats. That will be neat.

The rest of the day was spent observing and somewhat assisting an amazing surgery on a cat named Bradford, who is a stray, that appeared to have been struck by an automobile. Bradford had some amazing films (x-rays) and even a casual observer could see that his femur had been shattered- both longitudinally and torsionally. It was pretty ugly, but he was a real nice cat even though he must have been in horrifying pain. We had no idea how long it had been since he had been hit. I was nervous about watching a surgery, and watched from a bit of a distance at first, but once I realized that the insides of cat leg appear enormously like raw chicken breast, I came to three conclusions: 1. I'm glad I grew up a meat eater, around raw things and grills. 2. I can totally handle surgery. 3. I'm not sure I find chicken appetizing anymore.

In any case, surgery was awesome. I got to see him drill bone with a hand drill, put a pin in longitudinally, down the marrow, remove scar tissue that had formed (so much scar tissue that he said had he known it was this long since the injury, he would have referred them to an ortho-surgeon, and if they hadn't wanted to do that, Bradford the Cat would have lost his leg, which wouldn't be a big deal, and was a back-up plan anyways.) Then I got to see him wrap wire around. Wire goes through the bone (drills holes first), and then wraps around half of it-otherwise it would act as a tourniquet and cut off bone circulation. The more impression-making parts to me were the initial cut, the digging through the muscle, the scraping of bones, the removal of scar tissue, and the way surgery is by no means a tender, gentle act. It is literally like changing the tire on your bike- you have to apply a lot of force! This is because when a bone breaks, the muscles have free roam to tighten way way up. This makes it hard to get the bone back to it's original position, and frequently, that leg ends up shorter than the others. Bradford will also limp on his leg for life, because the formation of scar tissue locks down the range of motion he will have. His leg won't hurt though, it just won't move as far. Again, you fight a battle with keeping the animal breathing and yet under anesthesia. You test things like blink reflex, capillary refill time, etc. If he starts licking his nose, or twitching, then you push another .1 ml of anesthetic from the syringe that's plugged into the port on his IV. (I got to do this a couple times) Not every animal gets an IV during surgery, lots of times we just have a syringe taped to their leg, plugged into a vein. I think longer, more traumatic surgeries get IVs, and so do deydrated animals.) The anesthetic, at least in part, was Pentathol, which is I think the same stuff they use to put animals to sleep. Now, when an animal is undergoing surgery, the amount of anesthetic you need is based partly on the amount of pain that the surgery causes-this is because the body responds to pain, even if your cerebral cortex has no idea what is going on. So during spays, the dog twitches or snuffs when you grab it's uterus and move it around, or cut it out if the anesthetic is too light. For Bradford the cat, he showed the most signs of waking up when the doc was yanking his bones around, trying to get them to line up (not a very easy task.) He even licked his nose and lifted his head (like twitched it a little.) At first, this seemed terrible to me, and I had trouble with it on other animals. By now, I'm learning to appreciate more the signs of perfusion, lack of shock, good heart rate, good breathing, and signs that the animal is toughing out the trauma more than placing emphasis on how the animal might be feeling. This takes work, to put myself in an objective frame of mind, but luckily, thinking of the mechanics and biology is just as fascinating for me as is animal behaviour and emotion. Occasionally, I would start to imagine that it was my leg that was being worked on, and I had to stop myself, and say to myself, "Do you have furry ears? No. Do you have a tail? No. Do you have whiskers? No. Then you are not this cat. Your leg is not cut open. And you do not like cat food." This talking to myself with the little joke at the end let me step back out of the cat's shoes, and back into the vet's shoes. The little joke made me relax and smile, and then I was back interested in the bones and the muscles and the blood. The surgery itself was a very interesting and difficult one, which I was very very lucky to have been able to observe, especially up close, with such a nice veternarian to whom I could ask the occasional question that he was happy to answer. I even got to open some sterile packs to give him some instruments, which I treated with the utmost care and concentration. I really enjoyed anticipating his next move (in my head), though I was wrong a lot, I enjoyed the times that I was right. I think that some of my mechanical experience will cross over to be helpful in surgery. Guess all that playing around with Dad's tools and rolls and rolls of bell wire when I was younger might actually come in handy! Even more fascinating to me still, though, is the process of surgery, that has not yet become mundane to me, and there's still a little magic left in putting an animal under, and that still makes me uneasy. I don't know how the drug works, so it makes me feel weird to watch. The first knife cut is also a little disturbing, a strange violation of another creature, but once cut open, I am definitely good to go. Stitching up, too, is also odd, one because it involves a needle, but two because I think I am anticipating the transformation from lump of bloody fur back to animal who purrs. Even so much as moving my gaze from the incision to the animals head (where vitals are monitored by holding a hand near the nose to feel breath, and blink reflex is watched for) creates a strange sensation of a split mentality- like "cat-leg-cat-leg-cat-leg" and I know firsthand the difference between seeing a whole patient, and seeing a trauma of a body part. I know too, why it is so difficult for a surgeon to have a kind bedside manner- it is pure cognitive dissonance.

After the surgery, I got to help with creating the splint- by wrapping thick gauge wire around a skippy peanut butter jar (to create the perfect width circle for this kitty!) The splint is the best of both worlds -not complete immobilization (which creates cast disease (lots of scar tissue)) and limited movement (which allows the bone ends to join again.) We also took anothe xray to be sure that the pin was in the right spot (it had to be adjusted slightly-read "jammed further into bone with brute strength.) Luckily the cat was still really out of it, though we were no longer pushing anesthetic and were instead allowing it to start waking up. It is interesting to treasure pink-looking gums more than a happy cat. The cat was in fact, probably in a lot of pain as it awoke. We cleaned up the blood on it's fur and around the incision (did I mention we shaved the cat's leg, and it's IV site?) with hydrogen peroxide- the cleaning solution of choice for blood. Then kitty went to a surgical recovery cage with a heating pad, and a towel for warmth (to prevent shock.) The before and after x-rays were amazing. And Bradford seems to be doing great.

This is so cool.


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