Monday, 10 October 2011

Day 5: Camp September 2011

The early start was not as difficult as I had expected after such a long day yesterday. The adrenaline fuelled excitement of making sure our last day counted probably helped, although I was sure the tiredness would catch up with me next week. The street dogs were in their usual locations as we arrived at the meeting place for the last time. When we arrived at Giurgiu we continued with our mission of spaying all of the pregnant females in the shelter and Katy also embarked on a special project.
Katy with Tar boy
A dog had been brought in which was covered in tar. We nicknamed him Tar boy. His skin was becoming sore especially around the mouth. He was anaesthetised and Katy spent most of the morning cutting the tar from his coat using only scissors and bathing him in detergent. She did an amazing job as he looked a different dog afterwards. We could say the same about Katy as she had tarry blotches all over herself!

Before dressing was removed

What was under the dressing
We were hard at work when the dog catchers arrived with a small male with a bandage around his elbow. They asked if we would have a look at him. You could smell him long before you could see the dressing clearly. The dirty dressing was saturated with infected wound discharge and bone was just visible at the top. One look and we reached for the anaesthetic, the quickest way to provide a good level of analgesia and allow us to have a proper look at what horrors lay beneath the bandage. The dog was amazingly well behaved despite having such a painful injury. Once he was asleep we removed the bandage to find an open fracture of both the radius and ulna. The surrounding tissue was hugely swollen and infected. We loaded him up with NSAID’s and antibiotics and set to work preparing the limb for amputation. Sandra began the surgery with Aurelian assisting and demonstrating techniques for achieving haemostasis. The dog was entire so he was castrated as well. We were just finishing the procedure when the Shelter owner came to tell us the owner had arrived. He was initially not happy that we had removed his dog’s leg but once the problem was explained he was extremely grateful. The dog had been hit by a car four days ago and the owner could not afford veterinary care for him. He was lucky to have been brought to us.

Our team of Surgeons!

Before the dematt
With all three vets involved with the amputation Katy was free to continue her welfare work and was able to shave a very badly matted dog. The dog must have been so uncomfortable with those tight mats and looked much better afterwards. Hopefully a haircut of that standard should really increase the chances of someone wanting to give him a home.

We were so caught up in our work we almost forgot about lunch. We made some time for this and went to eat overlooking the river Danube. It was beautiful. The camp attendees were presented with their diplomas for making it through a tough week and we returned to the shelter to fit in a couple of final surgeries before it was time to pack up and return to Bucharest. Before we left we inspected our patients for the last time. It really gave us a sense of achievement walking down a row of kennels seeing each dog with a pink ear tag signalling they had been neutered and by us! Our totals for today were 4 males and 7 females which gave us a grand total of 58 neutering operations over the 5 day period (not including the other dogs we treated). Maybe not a huge total in the scheme of things but we are happy each surgery was performed with the utmost care and attention with techniques that would minimise any chance of post operative complications.

We headed back to Bucharest, Sandra, Lidia and Katy talking about how they can put what they have learnt to good use. Me, I was thinking about our next camp, what we could see and the amazing people we could meet.

Sunday, 9 October 2011

Day 4: Camp September 2011

Little did I know this would be a long but amazing day as I caught the metro to the meeting place. We were all tired but determined to make the most of our penultimate day of the Veterinary Training Camp. We were a well oiled team as we launched into our routine when we arrived at the shelter. Our previous patients were all looking good with the anaesthetic emergencies bright and happy, so all in all a good start to the day.

Dog with Glaucoma
We became very selective with the dogs we picked trying to make our choices count. As a result several of our surgeries were on pregnant females. The operations and anaesthetics went smoothly with Lidia and Sandra really demonstrating how routine surgery should be performed. We had also identified a dog with glaucoma and were able to perform an enucleation today, the second of the week.

The atmosphere was relaxed as we went about our work and we shared some interesting stories on topics ranging from small rodents to amazing inventions. It wasn’t just the camp attendees who were learning today.

Flank Spay
There was a great opportunity for Aurelian to teach a flank spay techniques. This is a technique which is adopted depending upon the patient and can be preferable in lactating bitches especially if feeding puppies. It is also sometimes chosen in deep chested dogs. Sandra quickly got to grips with the techniques and was able to see why this approach would be preferable in some cases.

Worming the puppies
If all of the surgeries did not keep us busy enough with an amazing 11 females and 6 males being neutered today plus the enucleation. Lidia, Sandra and Katy also set to work examining and worming a large group of puppies that arrived at the shelter. We made plans to bring vaccines for them tomorrow.

We were operating until after sunset using only lamps to work by in an effort to get as many dogs neutered as we could. As we were leaving the shelter, tired but satisfied, Aurelian got a call from Almavet a clinic in Bucharest. They had a complicated emergency case that they needed his expertise with.
Lidia Operating by Lamplight

We arrived back at Bucharest at about 9.30pm. Two cases were waiting at the clinic for us. The first was a 14 year old boxer with a pyometra, her bloods were fine so she was prepared for surgery which went without incident. The second case was a little more challenging and not just because it was happening at the end of a long day.

Penile trauma
The second case was major trauma to the penis, including a break to the os penis. The dog must have suffered extensive bleeding as he was pale and shocked. The decision was made to salvage as much of the healthy tissue as possible rather than opting for urethrostomy in the first instance. The physiological state of this dog meant his anaesthesia was just as challenging as the intricate surgery. Balancing fluid therapy, cardiac output and anaesthetic depth was a delicate minefield especially well after midnight following a long day. We are pleased to report the dog made it through his surgery as is doing very well. Further details and pictures of the surgery can be found on our facebook page.

We left the clinic in the early hours of the morning ready to grab a few hours sleep before our last day in Giurgiu. We had agreed to meet an hour earlier to make the most of the time we had left. As tired as I was I couldn’t wait to get started on the  work for the next day.

Day 3: Camp September 2011

Bucharest was decidedly chilly as we waited for Aurelian to collect us at our usual meeting point. It made a change after the heat of the last few days. We arrived at the shelter and settled into our routine of setting up the equipment, checking the patients and selecting the first dogs for the day. Our patients from yesterday were looking good, one male had been licking a little overnight but a repeat of NSAID helped to stop this.
Mesenteric tumour
Today was a day for surprises as a medium sized black female we were expecting to be spaying turned into an exploratory laparotomy when an abdominal mass was palpated after anaesthetic induction. The bitch had already been spayed and a mesenteric mass was located and successfully removed. The rest of her abdominal contents appeared normal and she recovered well. We would have liked to have been able to analyse the mass but this luxury was not available to us in this location. We were suspicious it may have been a foreign body reaction connected to her previous surgery and it reminded us of the purpose of the Veterinary Training Camp, highlighting the importance of good, careful preparation and sound surgical technique.

Close monitoring catches problems early 

We were also unlucky enough to have two anaesthetic emergencies. A little black female and a large old male. He had a pronounced heart murmur and was in fairly poor condition. We were suspicious he may have heartworms which is relatively common parasite in Romania. These cases highlighted the importance of close monitoring and the advantage of having IV and airway access via intubation. We were able to identify deteriorating peripheral pulses and progressive bradypnoea and bradycardia and act quickly with IV administration of an Alpha 2 antagonist, Atropine and doxapram. We did not have an oxygen source but was able to ventilate manually with an ambu bag. Both patients recovered successfully, a credit to the team who remained calm in a stressful situation.

The team hard at work!

Uterus with small Incision (Sandra Patzner)
We have passed the halfway point of our camp and have been working so hard that Lidias fingertips have become numb from breaking ovarian ligaments but we all agree there is nothing as satisfying as the sound when it snaps! Yet again the day had gone so quickly and it was time to drag ourselves away from our work and make the trip back to Bucharest, satisfied with the 3 males that were castrated today and 9 females spayed.

Day 2: Camp September 2011

Female with demodex

Another beautiful day dawned again in Bucharest. We met in our usual location and today were able to recognise the small group of dogs that lived near to Piata Unirii and identify their small territory. We were slightly quieter today as Monday had caught up with us. It is surprisingly tiring getting used to working with different drugs and in a new environment but all this was forgotten as we arrived at Giurgiu shelter. The group went to check our patients from yesterday as I prepared the theatre for today’s surgeries. 
We were pleased to be able to treat a little female who we noticed yesterday had demodectic mange. We are hoping her skin may have improved enough by the end of the week so she will able to be spayed but suspect this is not likely to happen.

The dog’s wounds all looked perfect with no redness or swelling. All except for the very first female who had somehow managed to remove her intradermal skin sutures. We were very disappointed but set to work debriding and resuturing the wound ensuring her pain relief and antibiotic cover was repeated.

One of the biggest surgeries of the day was a heavily pregnant bitch spay. It was emotionally as well as surgically challenging.  The bitch was already in poor condition which was likely to deteriorate if she had to feed and raise a large litter of puppies. That litter would then go on to produce more puppies so in a years time approximately 50 more dogs could be roaming the streets with more puppies on the way from that one female (assuming they were lucky enough to survive). Sandra operated efficiently to remove the distended uterus and was able to put to good use the Millers knot which she had perfected yesterday. This is ideal for surgeries which need good knot security. Within an hour the bitch was recovering well and we were confident she would quickly improve in condition and go on to lead a happier healthier life.

Sandra Removing the Uterus
Millers Knot
The afternoon was just as exciting due to a little dog we named Uno. He had a tumour of the nictitating membrane likely to be a melanoma and the globe itself was affected requiring enucleation. He was an unlucky little dog in that he was unilaterally cryptorchid as well, but his luck certainly changed as Sandra carefully removed the affected eye and searched for the hidden testicle under Aurelians careful and exacting guidance. His anaesthetic went smoothly thanks to Katy’s close monitoring despite not being able to access some of the indicators of anaesthetic depth with Unos head being covered in drapes and vets!

Our totals for the day were four males and six females as well as the enucleation. Sandra and Lidia were becoming more confident but careful surgeons with the techniques they were developing and Katy was really using her background knowledge demonstrating both care and skill with her patient preparation and anaesthetic monitoring. Again I did not realise how long the day had been or that I was really tired until we got back to Bucharest but I still couldn’t wait for what the next day had in store for us!

Wednesday, 5 October 2011

Day 1: Camp September 2011

It was looking like it was going to be a really hot day as I rode the Bucharest metro to meet our eager veterinary training camp attendees in the huge bustling square, Piata Unirii. We watched the crazy Bucharest drivers as we waited for Aurelian to pick us up for the 45 minute drive to the town of Giurgiu. I was excited about the small group we had joining us on this camp and was sure we were going to have a lot of fun.
Left to Right Lidia Nistor, Katy Orton and Sandra Patzner

As we settled into the journey we got to know a little better the people we would be sharing out skills and experiences with over the next 5 days. We were joined by two vets and one student VN. Sandra Patzner, a vet originally from Namibia now available as a locum based in Warwick, UK, Lidia Nistor, a Romanian vet from Botosani and Katy Orton a Student VN at Harper Adams University College, UK.

The journey passed quickly despite a slight scenic detour at the start and we soon arrived at our destination. Giurgiu is a small town near to the river Danube on the Romanian border with Bulgaria. Dr Petrisor Stefan (a.k.a Pepe) was waiting for us at the shelter with all of the equipment. We worked quickly in the little porta-cabin to set up our theatre for the week so we could go and meet the dogs we would be helping.

Giurgiu Shelter
You could feel the excitement in the air as we picked up the bottles of anaesthetic agents and a selection of syringes and needles and went out into the sun to meet and select the first dogs for surgery. We agreed on a pair of friendly young females and after a brief discussion on international differences in muscle choice for IM injections our dogs were asleep and ready to be prepared for surgery. Each dog was placed on IV fluids, intubated, clipped and scrubbed ready for spaying. The vets selected their instruments, draped the patients and we were ready to begin our first surgeries of the week.

The Team at Work: Katy Orton, Pepe Stefan, Lidia Nistor and Ruth Osborne
The concentration in the small room was intense as Aurelian and Pepe began to impart their surgical knowledge and the nurses got to grips with injectable anaesthesia. The morning’s surgeries went smoothly with the time passing by so quickly. After a fantastic lunch at a small restaurant in the town we got back to work. Despite it only being the first day we had already settled into a routine and we were working well as a team. Jokes and banter were beginning to flow freely as we became used to the new environment and drugs that we were using.

We were pleased with the start we had made on our first day with six females being spayed and two males castrated. The vets learned several new techniques and were ready to start perfecting them in the morning. We got back to Bucharest tired but satisfied with what we had achieved and already thinking about the dogs that we wanted to work with the next day.
Post Surgery