Monday, 4 December 2017

Oncology and what I learnt as a vet nurse

Recently my eyes have been well and truly opened to the world that is Oncology.




Prior to this, I had a sketchy knowledge and experience of oncology, I mean most general practice nurses have encountered say Vincristine or invasive lump removals etc. But I really found my knowledge was limited to 'Oh bugger it has Mets in its chest' - outcome Euthanasia. To an occasional purple topped Cytoxic sharps bin, to the grading of cancerous lumps. What I'm getting at is, we refer these cases, it's as basic as that. We refer them because there's is someone more specialised than us to deal with them, and let's face it.... it's never a great outcome right!?

First things first my attitude towards cancer has now changed dramatically, although some things remain - yes most patients do die and yes everything has cancer. But what's changed has my knowledge of the different types, the treatment regimes and the fact that some pets have such a huge response to treatment and it really can prolong their life.
I was in a very lucky position when I got the opportunity to take on a temporary role in an oncology department recently. It gave me an insight into this world that I hadn't previously ventured and more importantly I learnt loads :).

Oncology isn't as I naively thought just about Chemotherapy. I got to experience Radiotherapy and the use of a Linear Accelerator, one of only approx 5 in the country that currently treat your pets and delivers high energy x-rays (electrons) to a tumour. I got to see the immense amount of planning involved in these Radiotherapy treatment plans including planning CT and mapping out of a tumour.






From a nursing point of view, I learnt how specialised this role can be, how sometimes isolating it is away from the other departments. But overriding all of this I loved how much difference you can make to the clients and their pets. Sometimes these cats and dogs are coming into the department 2/3 times a week, or sometimes staying in as inpatients and you can build a real rapport with them. I gained loads of favourite patients :). These clients will normally do anything for their pet and are obviously very invested, which can lead to higher emotions that normally experienced in general practice and they are very heavily involved in the planning of treatments. They are also some of the loveliest clients I've met :)

Chemotherapy regimes was another area I gained knowledge in, all the different drugs available. Health and Safety and the handling of these drugs and the strict protocols. I was surprised at how well most animals tolerate these drugs and how calm the majority of them are when having to sit on my lap for 20mins whilst we slowly infuse them into their cephalic vein.

12 years I have been nursing for now, but I love that in this career you can still learn loads and change your attitude overnight. I learnt loads and would highly recommend going on rotations like these if you can get them to help keep your knowledge up to date or just gain completely new experiences. Now back in general practice I feel better armed and not as dismissive when it comes to cancer.



Sunday, 29 October 2017

Fears Of A Veterinary Nurse - Take Three - Bites

Ahhh I hear you say, finally she's writing another Fears Of A Veterinary Nurse :) Am I right?


So it's time I speak about the worst offender of them all - The dreaded Animal bite.
I had naively thought that after a 12 year career I was doing pretty well, that was until this year! 

Slight disclaimer here, scratches are just as bad and I've encountered a fair few of those over my career in fact my best one liner is 'I'll never get a career as a hand ware model anymore!' I know I'm sooo funny :p. I've had plenty of nips as well. 

Anyways as usual I digress;

My first ever bite in practice - was courtesy of a small....hamster. Don't laugh they can be bloody painful, and for anyone that's also been in this situation you will already know that they don't let go easily. This is where the little hamster flick as it's commonly known can come into play....and get you into trouble. Luckily for me the hamster was already wrapped in a small hand towel at this point, so it was I was able to prize it away from my finger. That bite came on pretty early in my career, in fact perhaps in the 1st year.... but it was so long ago and I'm getting old now and can't remember dates hehe.

My Second Bite - This one I definitely remember well. I had recently qualified and it was late on a Thursday afternoon. It was this time a cat, I was restraining it for a IM injection of triple combo.... I mean let's face it anything with Ketamine is going to be. Somehow whilst restraining the cat, actually what am I saying cats are notorious for being Houdini's! Anyway the cat basically managed to turn its head in my restraint grip and bite down on the base of my thumb....you know that nice chunky fat pad bit. It didn't bleed too much, but I knew it had gone deep. I gave it a good clean and thought no more of it until the next day I remember seeing the tell-tale pink line tracking towards my wrist! Oh joy I thought! Queue hopping in a car to the A&E walk in centre, where I received a very glamorous iodine dressing, oral antibiotics and told to strictly keep my hand elevated.... ummmm no driving then. I also left with a pen line marking where the infection had reached and told if it went beyond I won't need IV antibiotics in hospital.... LOVE MY JOB ;p!
 - On one plus it did get me out of that weekend on call, I mean come on I can't do a lot with one hand in the air hehe.

Now I'm going to fast forward here (well A I don't want to bore you) and because whilst in the in between periods I had received various nips, mouthing, scratches and other less dramatic cat bites there was one biggy that I had avoided. That was until this year... the year of 2017!

My Third Bite - Well this was a turn up for the books and to be fair I think I'd done bloody well to have avoided it for 12 years. It was time to pop my cherry for the notorious DOG BITE! And oh boy I didn't go for half measures!
I was called into a routine PTS appointment, I was told by the Vet that the dog was lovely but had already been sedated so it should be an easy one - at this point alarm bells should have rung but in I went. The owner was as expected very sad, the dog one very large ROTTWEILER. Still it was going well, we competently placed the catheter. The owner was giving the dog a cuddle and the vet asked if he was ready. At that point I leaned in slightly and went to place my hand at the back of the dogs elbow to stop it moving on injection. Just as I was moving in the dog suddenly and completely out of the blue turned and lunged at me. I managed to jump back but couldn't retract my entire hand in time as she sunk her teeth into my right hand thumb! Wholly Hell!! Without trying to cause a scene I can't remember too much of what happened next, dog wise I just remember trying to pull my hand out of her mouth whilst jumping back. Then managing to get to a sink in the room where my now gushing thumb was in a contained space. I grabbed some paper towel and politely made my excuses to leave - as the owner was saying 'Oh yeah sometimes she can be funny' - UNNbelievable. By now my adrenaline was pumping and I was actually pretty shook up, I managed to make it to another room where a volunteer clearly saw the colour of my face - sat me down next to the sink where I continued to flush the wound with tap water and grabbed a first aider. Whose initial response was OH SHIT that's a deep one - not helpful. Small bonuses I got a free hot chocolate out of it and a chocolate fish yay. Anyways next step a lift to the emergency room - being in a foreign country which doesn't have an NHS really opens your eyes and makes you appreciate England a lot more. Anyways after a small wait, the bite was flushed out by the nurse, dressed and then placed in a sling (slightly overboard me thinks) and queue some oral antibiotics oh and a tetanus shot. Then I was signed off from work for a few days, and luckily work covered the bill.


Got to say that one shook me up quite a bit and even now I'm slightly more fearful of dogs than I once was which is a shame.



My Forth Bite - And second of 2017, what is with this year!? 12 years no dog bites then two in the same year...ohhh shoot I've given away that it was a dog. Oh well. It was still pretty spectacular. Set the scene dog just been anaesthetised, by an anaesthetist who liked to intubate the patient a little on the light side. Oh who am I kidding the dogs were still moving and I was always saying perhaps a little more propofol!? Anyways the dog got tubed and we moved it onto the table however when she went to attach to the circuit I realised the tube was pretty short and was very far back in the dogs mouth. She couldn't connect it so I tried to help....just as the very awake dog decided to chomp down....on my finger! Same hand this time my index finger. And because it was partly anaesthetised
the dog didn't open his mouth. Queue me trying to physically pull my finger. Once out I once again ran to a sink where the finger was now pissing with blood, hibiscrub time and lots of water. This also involved a first aider, accident form, cold compress and then a trip to A&E for it to be cleaned, dressed and be given some antibiotics. I mean at least no tetanus shot as of course I'd had one 4 months previously :p



All in all it's been a brilliant year nursing hehe. My opinion has never changed I'd much rather receive a cat bite over a dog bite any day! HAHA happy nursing, and remember your scars show your life's journey, mine just shows a lot of animals along the way :)




*Hibiscrub - Chlorhexidine
*PTS - put to sleep

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