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Wednesday, October 29, 2014

Learning to DIY, or How I Became A Mechanical Engineer In Veterinary Medicine

Most people don't realize just how slim the budget and narrow the profit margin is in almost every veterinary practice.  When something breaks down we can't always afford to call in a professional to fix it.  Often we have to muddle through and try to figure out how to do it ourselves.  It may take longer than would someone who actually knew what they were doing, but it is a lot less expensive.

When I was growing up working for a local vet, this happened commonly.  I remember our clothes dryer breaking down many times.  It was a standard household one because the vet couldn't afford an industrial model, and it wasn't designed for the daily grind we put it through.  The drive belt would break, the heater would die, and other things would go wrong.  I was 16 years old and my boss asked me to try and fix it.  I had never done anything like that before, but I've always been bold and confident, and decided to see what I could do.  I discovered that dryers really aren't that complicated and only have a few major parts.  Sure, it took a while to figure out how to put on a new belt, or how the get the heating element out.  But by simply jumping in and doing it, going slowly as I took it apart and paying attention to where parts connected, I was able to do it myself.

As I got into vet school I realized that there were actually many similarities between living bodies and machines.  One time during my veterinary training the brake light on my car went out.  My dad used to be a mechanic and was a regional sales manager for a major car company, so I knew he could help me figure it out.  He got out his voltage testers and started going down the wires trying to find the short or break.  As we did that it suddenly dawned on me.  "Hey, this isn't any different than isolating neurological damage in a dog!"  In my mind the wires were nerves, and we had to figure out where the nerve signal failed.  I remembered my lessons in testing reflexes in different parts of the body, and based on the responses determining where the damage was.  Once that clicked in my brain it was easy to get into finding the right wires as I equated the electrical tests to neuro exams.

Just recently our dental machine suddenly stopped working.  Our first dental of the day went fine, but during the second one we lost any power to our scaler and polisher.  It was a Saturday, so the technical support line for the machine was closed.  We had four other dentals scheduled and I didn't want to cancel those as well as the ones for the next several days until we could get in touch with someone to trouble-shoot the problem.  So I took my medical training and started looking at the machine.  

There was a compressor, which was like the heart, and there were electronics, like the nervous system.  I checked the circuit breaker, which worked fine.  All of the electronic parts seemed to work, and it looked like we just weren't getting any air pressure into the system.  I checked the tank pressure, released some, and waited for the air pump to build it back up again.  Okay, that worked, so the "heart" was in good condition.  The problem must be in the line somewhere.  And that's like anatomy!  It then became a matter of following the "vessels" (air lines) from the compressor to the rest of the equipment.  As I did so I noticed that one connection seemed loose.  A little fiddling with it and I realized that a clamp had been bumped loose, disconnecting one of the tubes.  As soon as I connected it properly everything worked fine again.  The "blood" (air) was now able to go from the "heart" through the "vessels" and into the "limbs" (hand pieces).  I fixed it!

Despite the title, I'm really not great with mechanical things and am nowhere near the skills of a true engineer.  But I've picked up a lot of skills over the years out of sheer necessity and by relating it to my medical training.  I've been pleasantly surprised at how my knowledge as a doctor can give me analogies to help me understand non-medical concepts.  I've used the same principle to try and explain diseases and injuries to clients in non-medical ways.

Monday, October 27, 2014

Steampunk Pirate Hook

In my last post I showed off an ice hook I made for a costume my daughter will be wearing.  To continue the theme let's look at something I made for my own costume.  We're doing steampunk versions of characters from Peter Pan.  My wife is Tinker Bell, I'm Captain Hook, our daughter is Wendy, and our son is Peter.  I'll post pictures of the finished costumes at a later time, but for now I wanted to show off the hook I made for my costume.

I started with two inexpensive plastic costume pirate hooks.  One simply for the base that goes around the hand.  The other we found at a seasonal Halloween store and bought it because it had a more elegant design than typical hooks.  Definitely had a Victorian/steampunk look to it.

So then the question becomes, how to make it "steampunk"?  One of my favorite places to shop for cosplay is our local Habitat For Humanity store.  This is a thrift store, but they also have leftover hardware from when they make homes for low income people.  For making steampunk costumes you'd be hard-pressed to find a better store.  In this case I found a door handle mechanism that had just the right mechanical look and was a little worn, creating a great aged effect.  

Then it was just a matter of spray painting the base, gluing the pieces together, adding a gear in an appropriate location, and some copper coils to enhance the look.




Making things like this is a great creative outlet for me and is actually pretty relaxing.  One of the best parts is trying to figure out how to modify existing parts and pieces, re-purposing things in ways that were never intended in their original design.  When I go to thrift stores and flea markets, I've gotten in the habit of looking at objects and how they might be altered or added to in order to create something new and steampunk.

Friday, October 24, 2014

Frozen + Pirates = Ice Hook

Like most pre-teen girls, my daughter is completely obsessed with the Disney movie Frozen.  This movie is responsible for her favorite color going from pink to blue.  She has seen the movie over 20 times and could probably quote the entire thing from beginning to end without making any mistakes.  I don't have a real problem with this as I think it's a good, enjoyable movie with good messages about love, family, and being true to who you are.  Since my daughter is rather quirky and unique, I think it's important that she embrace her individuality and not feel like she has to follow the crowd or any particular trend.

We're getting ready to go on a Halloween cruise on a Disney ship.  Anyone who has read my blog for a while know how much my family likes costumes and dress-up ("cosplay") and that my wife is a skilled seamstress who has a small custom costume business.  On Disney cruises one night is always "Pirate Night", where guests are encouraged to wear their best pirate gear to dinner and around the ship.  She needed to make new outfits for our kids, but my daughter wanted to dress like Elsa from Frozen.  My wife compromised and was able to take a basic pirate costume pattern but use material similar to that worn by the main character in the movie. 

While this was great, and made for a unique outfit, I started thinking of other ideas.  Elsa creates an outfit and entire castle out of ice.  If she was a pirate, what else might she create?  What is something we typically see on a pirate? 

A hook!   But even better.....an ICE hook!

But how to make one?  Would there be something online?  Of course there would be!  The Internet has everything!!!

Honestly, it didn't take long to find what I wanted.  Apparently professional photographers buy or make fake acrylic ice cubes, because real ice cubes melt quickly under the heat of the lighting and it's hard to get good, consistent shots.  After looking at a couple of websites I thought it would be pretty easy to do.  And it was.

I started with a plastic pirate hook from the dollar section at Target.  I cut off the hook and wrapped aluminum foil around it to form a mold.  I wanted to use aluminum foil so that the resulting hook would have a texture like ice.  Once I had the foil shaped, I removed the hook and had a nice mold of it.

The next step was using clear acrylic craft beads.  I preheated my oven to 375 F, as some of the websites described.  Next, I placed the mold on a baking sheet and filled it with the beads then left them in the oven to melt.  It happened more slowly than I wanted, so I increased the temperature to 400, and then eventually to 425.  As the beads melted they filled less of the space, so I kept adding more beads until they filled to the top of the mold.  Once it was done, I took everything out to cool.

While it was cooling I took the base and spray painted it turquoise to match with the color of the rest of her outfit.  Once the paint dried I put everything back together.




My daughter was absolutely ecstatic!  She didn't know I was making it and then I called her in to show it off.

This was surprisingly easy to make, and cost a grand total of less than $5.

Yes, this is what I do when I'm not being a veterinarian.

Tuesday, October 21, 2014

A Tale Of Three Uteruses....Why You Should Spay

**CAUTION--Graphic images from surgery.  Proceed at your own risk.**


Recently I had a rather interesting day.  I had three dogs in to be spayed, but each one was a completely different situation.  And I realized that the comparison between these dogs was a good discussion on why you should have your own pets spayed.

Let's start with the first one who was a six month old healthy German Shepherd mix.  She weighed around 58 pounds (26 kg) and had not gone through her first heat cycle.  The surgery went smoothly and there were no problems.  Here is what her uterus looked like once it was removed.


For those who aren't used to seeing these things, the tubular structures in the center of the "V" are the horns of the uterus, with the ovaries at the top of the photo.  The fatty material extending past the tubes and towards the sides is the connective tissue surrounding the uterus.  Pay attention to the scalpel, which is provided for scale.  That becomes very important in a minute.

The next patient was a pure-bred German Shepherd, also at six months old.  This patient was in the middle of her first heat cycle, but the owner didn't want to reschedule so we went ahead and did the surgery.  This dog was 46 pounds (around 21 kg) and her uterus was about three times the size of the first one.  Here's what it looked like post-operatively.


It may not be obvious when you first look at the photo, but look at the scalpel handle for scale.  This uterus is several times thicker than the other one and though you can't see them there are much larger surrounding blood vessels.  Doing a spay on a dog in heat takes longer, uses more suture material, and carries a slightly higher risk of bleeding.  Even so, it can be done safely and this dog also recovered without problems, though the surgery took me over 30 minutes rather than my typical 20 minutes.

The last dog was an 11 year old shih tzu who weighed just under 14 pounds (about 6 kg).  She had developed a life-threatening uterine infection that required immediate surgery.  This is called pyometra, and involves an infection of the uterus so severe that the organ fills with pus and can kill the dog if it ruptures.  The only treatment is usually to do rapid surgery and remove the offending organ, though this is a high risk procedure since even handling it can result in a rupture, spilling pus into the abdomen.  Thankfully this surgery went smoothly, but the uterus was obviously abnormal.  Compare this one to the other two.


Again, go back and look at the other photos using the scalpel for scale.  This uterus is very obviously swollen and discolored.  And if that's not gross enough, here is what it looked like when I opened one section.



All of that nasty fluid was inside the uterus!  And it could have been prevented by spaying her at a young age.

So let's recap the situation.  The largest dog had the smallest uterus and the smallest dog had the largest uterus.  All three came through their surgeries with flying colors and all three were doing great on their post-op recheck 10 days later.  But the dog who had not gone into heat yet had the lowest risk of all of them, so the other situations, especially the last one, could have turned out much worse.

Let's also look at the cost differences.  The first surgery was routine and ran around $350.  Since the second one was in heat and that takes longer, it ended up being around $430.  The pyometra case was over $800.

Do you see the lesson here?  It's better for your dog and for your wallet to have the spay done before their first heat cycle.  Do yourself and your pets a favor and have them spayed by six months old.

Saturday, October 18, 2014

Removing A Hamster's Ear Tumor

I like to see "exotic" pets and therefore I do things that most other vets won't.  I'm certainly not the only one, but I know that not many of my colleagues would do surgery to remove a hamster's ear.

This little guy came in with a growth on its ear that looked pretty nasty.  It was growing quickly over a week or so of rechecks and the decision was made to try and surgically remove it.  By the time we got to this day it was beyond just a tumor and had encompassed most of the ear, including the canal.  I quickly realized that I wouldn't just be removing the mass from the skin, but removing the entire ear.

Here's what things looked like before the surgery.  He was heavily sedated and this was just before the surgery.



Here he is while under anesthesia.  When dealing with pets this small we sometimes have to get creative.  There aren't tracheal tubes small enough, and the face masks for anesthetic gas are too large to fit.  I've learned to place a latex exam glove over the end of the mask and then make a small hole to place the patient's face so they can breathe in the oxygen and anesthesia.  That's a pulse oximeter on his leg, which measures the heart rate and blood oxygen.  It actually worked really well through his leg.


And here he is after the surgery with the mass removed.



I know it's a little hard to see here, but the surgery site closed really well and other than the missing ear there was no deformation of the face or head.

This is what the mass, ear, and ear canal looked like postoperatively.


He recovered well that day, then came back 10 days later for a recheck and to remove the sutures.  Unfortunately I didn't take a picture then, and now I wish that I had done so.  He looked great and was showing no bad effects of missing an ear.  It was a completely successful surgery.

These kinds of cases make the job really interesting!

Wednesday, October 15, 2014

In Your Pet Food But NOT On The Label

There was an interesting recent article that looked at ingredients in pet foods and whether or not there were things found in the food that wasn't on the label.

"In order to see whether mislabeling occurred, the researchers tested 52 products by extracting DNA and testing it for the present of eight meat species: beef, goat, lamb, chicken, goose, turkey, pork and horse. In the end, the researchers found that chicken was the most common meat species found in the pet food products. Pork was the second most common, followed by beef, turkey and lamb. The least common was goose, and none of the products tested positive for horsemeat.

Of the mislabeled products, 13 were dog food and seven were cat food. Of these 20, 16 contained meat species that weren't included on the product label, with pork being the most common undeclared meat species."

This may seem a little shocking to some, but honestly it doesn't really concern me for most pets.  Most of these ingredients are probably trace amounts, meaning that rather than a big chunk of chicken being thrown in there would be some residual bits on the equipment.  So I wouldn't be concerned about this for my own dogs.

The concern is for pets that might have food allergies or other sensitivities to ingredients.  This study is exactly why dermatologists don't consider any over-the-counter foods to be sufficient for a diet trial to rule out allergies.   Let's say that a dog has a beef allergy.  In order to prevent a reaction you pick a food that doesn't have beef on the ingredient list.  So your dog shouldn't react, right?  Well, maybe, except for the fact that there is a good chance that there are trace amounts of beef in the food anyway and even a small amount could trigger a reaction.

If your pet isn't allergic to food ingredients, this is a non-issue and really isn't news.  But if your pet is known or suspected to have food allergies, please listen closely to your vet when they recommend a very specific diet.  There is real science behind the recommendation.

Sunday, October 12, 2014

Hit By Car: Broken Leg And More

One of my long-term clients brought their dog to me for a broken leg after being hit by a car.  She had let the dog, an older poodle, outside when the dog wandered too far and got into the road.  A car hit her but didn't stop.  The dog was limping and the leg had an obvious break, so she brought her in.
On the initial exam the dog was breathing heavy but was alert and stable.  There was a bad fracture in the middle of the left tibia, something that I could tell just on palpation.  Surprisingly there didn't seem to be any worse injuries and I was hoping that it was just a broken leg.  In order to assess the damage and see what would be needed for treatment we took some x-rays.

Here's the leg.  This is a bad fracture, but not irreparable.  A splint/cast alone probably wouldn't stabilize the bone well enough, but a pin or plate would result in a very good chance of healing and normal use for the rest of her life.



This is the point where instinct and training take over.  With just the exam I could tell that the leg was broken and there weren't obvious injuries otherwise.  So it would make sense to take radiographs of the legs.  However, a thorough doctor will be aware of other possibilities.  And just to be on the safe side I took some views of the chest.



Notice the haziness in the area of the lungs between the heart and the spine.  This should be much more black, representing the air in the lungs.  Also look below the stomach in the abdomen.  You'll see some hazy, mottled objects running along the direction of the body.  These are feces in the colon and they should not be in that location.  At this point I knew what had happened, but I took the last view.


Even if you know nothing about reading x-rays, I'm sure you can tell that the right side of the chest is just "off".  What's going on?  Those are abdominal contents in the right half of the chest.  Feces within the colon show how that part of the intestines is now within the space normally occupied by the right lung lobes.  Notice the air-filled (blacker) object on the right-hand side of the image at the last ribs?  That's the stomach.  Follow it to the right side of the body and you'll see a finger-like projection pointing "up" into the chest.  This is not normal, and represents the pyloric region of the stomach, which should empty into the upper small intestine. That part of the stomach is now going into the chest.  And lastly, look at that oval whiteish object in the center-left of the chest.  That's the heart, and it's being pushed from the center until it is touching the left wall of the thorax.

This is a diaphragmatic hernia, and was the reason I decided to view the chest.  When there is a hard, sudden impact against the body, the force can push the air and organs against the diaphragm, causing it to "pop" like a balloon. The diaphragm is a muscle, so this results in a tear and hole in the structure.  The inside of the chest has negative pressure in order for the lungs to be able to inflate without pressure around them.  That small vacuum helps to suck abdominal contents into the chest.  Once the diaphragm ruptures it's pretty simple for liver, stomach, and intestines to move through that hole. 

A diaphgramatic hernia is much more serious than a broken leg.  This dog had difficulty breathing because at least half of its normal air space was taken up by abdominal organs.  It should be obvious that she couldn't live well this way.  That being said, I've known cases where a hernia of the diaphragm goes unnoticed for a long time because the dog compensates for its breathing.  This is not an ideal situation, so surgery is always strongly recommended.

I've done this surgery, but it's a very risky one.  It involves opening the abdomen pulling everything back into the proper place.  This allows the thorax to have exposure to outside air, collapsing the lungs.  You have to forcably breathe for the patient and remove excess air from the chest afterwards.  Depending on the size of the herniation it can be difficult to pull the liver back into the abdomen.  There is also a very important nerve along the diaphragm that can be damaged, resulting in paralysis of the breathing muscles.  The surgery carries a lot of significant risks, but not doing it is even riskier.
In this case the owner didn't have good options.  She simply didn't have the money or credit to do any kind of surgery, let alone the thousands of dollars it would have cost to repair the diaphragm and leg.  This little girl ended up being euthanized so that she wouldn't suffer.

Not all traumatic injuries are obvious on first glance.  A broken leg is bad enough but it's not a life-threatening injury.  Please be careful with your pets.