- Posted on July 14, 2014 8:45 pm
Today’s Diary Entry is sponsored by Wildlife Feeds by Spikes World
This morning I sat my anatomy final, I am emotionally and mentally exhausted and last night asked my twitter followers to help me through. This they did wonderfully and I drew enough strength from it to get my through my exam today with a D. When you consider how much is needed to be memorised and for so many species you can understand why I am happy with that. Also I have decided that I would rather have practical skills and understanding than straight A’s with just book learning.
After this I popped my head into clinic to see what was happening, surprisingly it was busy with two guinea pig castrations booked in. I ran anesthesia for the first castration surgery and then assisted in the second surgery which was pretty cool.
After this as I was about to leave a member of the public dropped in a duckling with fishing line coming out of it’s mouth. Now this is the first time I have seen it here and so I decided to stick around.
We quickly anaesthetised to inspect the mouth and see if we could find the hook, we could not see it in the mouth cavity, and taking a quick look with the endoscope I could not see it in the upper part of the esophagus. Because of the way the esophagus is a elastic tube you normally also need to also introduce air to see further which we do not really have the facilities to do. So it was decided that our next step would be to get xrays to see exactly where the hook was, it was lunchtime so xray was closed which meant we had to wait an hour for this.
When doing xrays it is really important to do both a ventrodorsal (laying on back) and a lateral (laying on side) image as this will let you use your imagination to put them together to get a 3D image. The one on the left below is the lateral image taking from the side, and the one on the right (which also has my measurements for planning the procedure) is the one with the ducking on it’s back (you can click it to see a bigger version).
From the xray you can see that the hook is inside the thoracic cavity (the space between the start of the ribs and the diaphragm) – and if you look at the xray on the right you can see the ribs visible on top of the hook. Now during surgery on the thoracic cavity is very challenging at the best of time so we wanted to avoid this. The easiest way to go and get the hook was through the mouth, so one of the doctors here attempted to slide a tube along the fishing line to see if he could dislodge it whilst I prepared the endoscope.
Now I do not know where they came from as I had never seen them before, but I found a pair of grasping forceps (well biopsy forceps originally…) on a rigid attachment for the endoscope so I decided to give this new toy a try. The doctor had failed to get the hook out using the tube so it was time for my performance.
We used isoflurane (a gas anaesthetic) with the duckling so we had to remove the mask to do anything which meant we had a limited time we could do anything before the duckling started waking up and the mask had to be put back. Because of the previous attempt to get the hook out using the tube there was some air trapped inside the esophagus which made visibility better for me and I followed the fishing line down to the hook. Now on the xray it didn’t look it had a very big barb so I made the decision to try and remove it from the lining of the crop which was successful with no bleeding observed. I then caught the point and started to bring it back up the esophagus, near the mouth the hook slipped from my instrument however I was able to grab it again and remove it completely as below with fishing line attached.
All of this took me under 90 seconds to do, and as I brought the hook out the duckling started to wake up. I was a little bit surprised at how quickly I had managed to do something I’ve never done or seen before. We do have a recording system for the endoscope but I was so focused on getting the hook out of the duckling that I totally forgot about this until now though I really wish I had a video of this to share. Instead here is a picture of the duckling with the hook and my new favourite instrument!
So with this I’ll leave you with a request that I am sure has been said a thousand times before…
The great outdoors is great fun, but please make sure the only thing you leave behind is footprints!Posted in categories: Vet School Diary