Sunday, 1 October 2017

Abscesses - Cats, Rabbits and why us nurses love them!

To this day I have yet to meet a veterinary nurse that does not like abscesses, so why the heck not dedicate a whole blog post to the things!?

Wow to it being October already, so many things have happened this year already! However I thought I'd reflect back on a cute kitten I met late last year so here he is: 

The best abscess I've witnessed to date and played an active role in was in practice last year. A poor little ginger kitten came in to see us with a suspected broken hind leg. The leg was so swollen and hot, I'm talking the entire leg. We did some x-rays but hurrah the leg was in fact just dislocated. Whilst prepping the kitten for the x-rays I felt a tell-tale scab on the leg so suggested afterwards that we clip it up. My hunch was that the kitten had been bitten by something and shook and perhaps the swelling we were feeling was in fact an ABSCESS!!

As the kitten was already sedated at this point, the vet let me take the lead in clipping and cleaning the leg and looking for any wounds. Sure enough there was one and so I asked if he'd be happy for me to lance the swelling. Yesssss! Now I had a feeling this was going to be good but nothing could prepare me for how good. I called a few people over and using a scalpel blade lanced. WOW, I kid you not (and I wish to this day someone had filmed this for YouTube) the abscess was under that much pressure that when I broke through the capsule and squeezed the pus was only centimetres away from hitting the ceiling. I have never seen that quantity of pus fly that high. Luckily no one was hit by it :p. But wholly, that poor kitten must have been in so much pain having that quantity of infection trying to get out. As soon as I had squeezed the majority of it out and cleaned it some more, you could now clearly feel the hock dislocation and the two bones grating in a way that they just shouldn't.

Although not ideal for the infection, we did have to then splint the leg and re x-ray to make sure it was in the correct position. This poor kitten would need quite a few bandage changes and heaps of aftercare but I was so pleased that it wasn't a break or in need of amputation. The kitten in the pictures is the actual one for once, as I fell a little for the cute guy!

It's pretty common for cats to have a few abscesses in their lifetime. They're normally caused by being in a fight with another cat, the bacteria from the other cats mouth penetrates and festers under the skin and causing the infection secondary to the actual puncture wound. Swelling can develop 2-5 days after the fight, other signs can be a fever, the area is hot to the touch, limping and or a smell (if the abscess has already burst.) These do require treatment and being seen by your vet and they are pretty painful. Normally they will require pain meds, antibiotics and or lancing and flushing of the wound. 

On a side note other abscesses that we all love are of the rabbit variety - cottage cheese. Rabbits are notorious for getting abscesses, be in the dental kind or bite wounds inflicted by other bunnies or even tear duct ones. They can be much harder to treat that in other animals due to the actual pus being much thicker like toothpaste/cottage cheese.

This means that even once you lance them, they don't tend to drain very well by themselves - many require surgical intervention to remove the entire capsule of the abscess. 

I can't really explain why nurse's and or vets tend to love these things. Perhaps from a nursing point of view it's something we can get really involved in - hands on if you will. Perhaps its because you can see the problem obviously and you can treat it right there and then and see the instant results. Perhaps it's just because we're a weird breed that like the sight and smell of puss. Whatever the case I've never met a nurse that doesn't like the things ;p! 

Wednesday, 20 September 2017

Veterinary Nursing Rocks....Sometimes

My week started like any other, I was assigned a ward. I already listened to the daily rounds, but I must admit bar a few bits I was off on a daydream somewhere else. So I collect my tools don my gloves and get to work. Spoiler alert, always listen to rounds! As I went to put a lead on a very large boxer cross bulldog not only did she let out the deepest growl, she also turned around and lunged for me….thankful for the buster collar she was wearing I backed slowly well lets be honest I ran from her kennel. However always up for a challenge I tried once more, more of a lasso to avoid getting to close, however despite the tug on the lead she was not budging and her growls only got worse. Fine keep the lead I thought I’m going for backup.

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That was my first experience of Lilly

I later learnt that she was the dog I vaguely remember hearing about in rounds. She required three of us to remove her from her kennel and she required some top up sedation to be able to do anything with her.

You see I couldn’t hate Lilly, I mean I can’t hate any animal but I really did feel for her. You see she had a bladder tumor that was affecting her badly, not only causing some incontinence but also extra growths and tumors on her vulva. They were super sore, and as a woman I at times wanted to cross my legs as she went for a wee, the stinging must have been unbearable.

However the vets were doing their thing and despite it not being my main ward for the week I made it my mission to check in on her daily and see how she was going. Day two she went for debaulking surgery, which wasn’t heaps of success however they did manage to remove some. She was on a pain relief CRI and fluids but required a lot of nursing time to keep her clean and avoid urine scolding. However this isn't easy in an aggressive dog that not only is flat from the drugs but also probably at the height of her pain tolerance. Despite this we all put a lot of work into her, some nurses she preferred. For some unknown reason she’d taken a real dislike to me, even when nurses had her out and I heard the growling from the down the corridor, it always seemed to intensify when I entered the ward to check they were ok.

On Wednesday we once again sedated her in the morning to be able to tend to her sores and manage her pain. It was on this day I finally managed to get some cream onto her vulva and hopefully offer some relief to her. In the afternoon we finally got her out of the kennel and out for an actual walk, don’t get me wrong there were a lot of growls and displeasure from her end, but a success none the less.

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Friday, although this wasn’t again my main ward we were short staffed so I helped out. Lilly was due to go home later today and when we took her for a walk (on as backup just in case) I could see such an improvement. Also from the extra padding I’d applied to her hock the day before around her catheter site – the IVFT had now been removed and the bandage sore had disappeared J
Lilly hadn’t really had much of an appetite all week, despite this I cooked her up some chicken again and being wary placed it in her kennel. I sensed a change in her and I thought right lets give this a go. So slightly nervously I picked up a piece of chicken and offered it to her. Me the one nurse that she had really hated decided to offer a dog that kept giving me the eye my fingers. She tentatively took the piece of chicken, so gently. Just a fluke I thought but no, I fed her piece by piece. Until then I regretted cutting up the pieces smaller to make it easier for her to eat… I can’t now offer her the tiny pieces as it brings my fingers waaay to close to her mouth and she was in fact still eyeing me up. Ok well here goes, I scooped up the chicken in my hand and keeping it as flat as possible offered her the palm of my hand – not only was she the most gentle dog Ive hand fed but she also ate every last piece. Yesssss success! And this is why I am a nurse, the dog that wanted to kill me on Monday was literally eating out of the palm of my hand by Friday. Now yes I have no doubt she was in less pain, had got used to us and probably knew she was on her way home but….just that extra time you send building a bond with animals makes such a difference.

Now at this point I’d say I played it cool… but that’s just not me. I had a grin on from ear to ear and went and told all my fellow nurses, even the ones that were having a shite day! Yayyyy nursing rocks sometimes.

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