Day 4

May 27, 2010

This morning, when I got to the clinic, Dr. E was preparing for surgery. Evidently, last night a sugar glider got its leg caught in its cage, and in order to break free it began chewing its leg off. This morning, the owner found the animal with a mangled rear leg. Dr. E decided the best treatment would be amputation. The surgery was very interesting for me because I had never watched a limb amputation surgery before. She carefully transected the muscles of the leg just above the knee, using stay sutures to keep track of which muscles were which. She then cut the femur, slightly higher than where she cut the muscles, in order to leave enough space to suture the muscle bellies together over the end of the bone.

By the end of the surgery, Dr. E had neatly sutured the skin back together over the tiny stump, and there was only a nice, neat line of sutures left to show for it. When the little critter woke up from his surgery, he resumed his frustrated chirping noises and recovered normally for the rest of the day. We checked on him every five minutes for the first hour and every fifteen minutes thereafter to make sure he didn’t begin chewing his sutures out, as sugar gliders commonly do after surgery.

As soon as the sugar glider surgery was finished, we began prepping a guinea pig for a mass-removal surgery. During the surgery, Dr. E discovered that the mass under the pig’s jaw was indeed an abscess, but after expressing it, she found yet another firm mass inside of the abscess. She decided to leave the incision open to help it drain and after consulting the client, decided to aspirate the second mass and send samples for cytology. The removal of the other mass, which Dr. E suspects to be a lymph node, will have to wait until the results come back from cytology, and until the client can consult with her husband about the price of additional surgery.

Just before lunch time, a family came into the clinic carrying a fawn that had been abandoned. It was obvious it had truly been abandoned because it had maggots feeding on its skin. Dr. Dan and Dr. E were just heading out for lunch, so they put me in charge of debriding the wounds and cleaning off the maggots. We used a topical solution of Capstar to kill the maggots and make it easier to flush them out of the wounds. When I finally got them completely cleaned out, I realized the maggots had made wounds that were about a quarter of an inch deep. We dressed the wounds with Silver sulfadiazine and flushed her navel with dilute chlorhexidine. The fawn was extremely malnourished, so we started fluids, made up a very weak concentration of goat’s milk, and fed the fawn via stomach tube.

We placed her in an incubator at 80 degrees and gave her cephazolin, an antibiotic, to get a head start on any infection she may have. Later, we took her outside to exercise, and when she urinated I realized she had a patent urachus. A patent urachus occurs when the tubes that carry waste urine away from the fetus in-utero do not close properly after birth. Therefore, quite simply, the fawn urinated from her urethra and from her navel. Dr. Johnson says this is likely due to the maggot infestation, and may possibly close up on its own or can be surgically corrected once the fawn is a little older and more stable.

After lunch, we had two ferret appointments. One had an insulinoma, which is a common tumor in ferrets. It is located in the pancreas and it produces extra insulin which can cause the ferret’s blood glucose to plummet after eating. This condition is basically the opposite of diabetes, but has the same outcome. It just occurs due to different causes. Diabetes is when there is not enough insulin, or the insulin receptors are not responding correctly, so blood glucose spikes and then drops. In the case of insulinoma, the tumor produces too much insulin, so it drops the glucose levels in the blood immediately. This particular ferret is well regulated for the time being. The other ferret had an adrenal gland tumor, which is also very common in ferrets. Adrenal gland tumors cause an over-production of cortisol, which can lead to Cushing’s Disease symptoms such as hair loss and a pot bellied appearance.

At the end of the day, Dr. E did a tooth trim on a rabbit, extracted one tooth, and showed me again how to do a nasolacrimal flush. As part of this patient’s check-up, we did a full blood panel (because it’s an older rabbit), a fecal exam, and a nail trim. This is all part of many rabbits’ annual visits.