Had an interesting and unexpected turn of events that caused me to spend a week of my four week elective rotation on the "ZEW" service. Z=Zoo, E=Exotics, W=Wildlife. I'm not highly interested in these critters, preferring horses, cats, and dogs instead, but find them fascinating all at the same time.
Were not exceptionally busy but had a couple of fun things to talk about. I drew blood for the first time ever from a snake. I was told it was luck of the draw (literally, pun intended) and sort of like hitting a cow tail vein. Got 0.4ml before the fountain stopped but no one else could get any either so I didn't feel too stupid! Did discover, however, that a 14 pound red boa can whip my butt at arm wrestling. Was helping to hold for someone else and he was totally beating me and I was using both arms!! Makes you learn a bit of respect especially for a hungry reptile!
Had two flamingos come in from a nearby zoo on different days. This story makes it necessary to take a quick tangential rabbit trail (not me, sarcasm intended) to give some more kudos to one of my old teachers. I'll never understand people and most especially specialists. Most of them get so hung up on their overinflated egos that they can't even admit they don't know something that they probably shouldn't know! I was so completely spoiled and thus ruined for all other specialists by one person who responded with "I don't know but why don't we look it up together" or "Here is where you can find that" or something along those lines to my endless questioning. So many just laugh and make fun of your questions which used to make me feel really dumb until I figured out that it meant they didn't know either and just didn't want to admit it. Does make you appreciate those really special super teachers that you are fortunate enough to know here and there (just not often enough!). Now, back to the story, I think you'll see the reason for the tangent without my pointing it out.
First flamingo had a tear of his lateral collateral ligament at the hock. Happened about 2.5 years ago and had been repaired, repair failed but the bird had made enough scar tissue to be doing well until something happened to re-injure the leg. Took to surgery and used two bone anchors like sometimes used to correct a cranial cruciate ligament rupture, tied the sutures together and basically recreated a ligament. The bone anchors were designed in an attempt to make the lateral suture surgery more successful by limiting areas of failure and easier. The basic premise is that a screw is placed in the distal femur rather than looping suture around the femorofabellar ligament then the suture that is already attached to this screw is pulled through the hole drilled in the tibial crest. Exact concept of lateral suture but a little different anchor. We placed one in the distal tibia and a second in the proximal tarsal bone then tied the suture in the middle. (I hope I'm getting the bones correct 'cause bird anatomy is a little confusing if you don't do it all the time!)
The second bird had bilateral angular limb deformities. We made small approaches on the lateral aspect of the proximal tarsal bone (same caveat!) in order to make an osteotomy (cut in the bone) allowing the bone to be positioned correctly. Then small ring external fixators were placed using K-wires for stabilization. Went really well and you could see an amazing difference in the clinical picture although the radiographs were less impressive. Way cool surgeries!
I'll now point out my complaint. I read extensively about both procedures the night prior to the surgeries and every single reference I pulled regarding surgery on a bird / flamingo's legs stated not to close the skin. As I understand it, their skin on their legs lacks the ability to stretch and expand like ours would (at least to an extent) therefore closure results in either tearing of the skin (dehiscence) or creating a tourniquet / compartment syndrome effect. The first bird did well except that the day after his foot was swollen and blue then the sutures tore and it resolved. Even after that, the second bird had both incisions closed. Apparently even a tiny amount of inflammation is enough to result in the tourniquet effect. I think somebody didn't read about birds... I also know somebody doesn't listen to those around because this was pointed out and ignored. I probably PO'd that somebody yet again. Oops. Maybe one day I'll learn to keep my mouth shut but I doubt it!
We also saw Andy, a kinkajou who belongs to a lady that has exotics and uses them for education. Andy broke out of his pen and got attacked by a dog several weeks ago and is now healing nicely. I did a rabbit dental, much like floating a horse's teeth but far less strenuous and I neutered a guinea pig. Usually, the ZEW service is pretty busy but we were a little slow this week due to the approaching holidays. This allowed time for me to exert my bad influence that somehow results in other people carrying out scathingly brilliant ideas that they would not normally even consider. (I don't know how I do it. Honestly, I don't even try; it just happens!) We got antlers and a red nose for one of the clinician's van, stole (er, I mean borrowed without permission) her keys, and decorated the van. We were planning to put battery powered Christmas lights and garland on another's motorcycle but he didn't drive it:( Pooey! Overall, a fun week which just goes to show that often the things that are unplanned are better than those that one plans in detail.
I'm on ER this and next weekend, cover the day ER shift on the 24-25, and am on anesthesia for the first few days of the week. I get vacation (HALLELUJAH) the week of New Year's and am heading home for some relaxation. The next week, and last of this rotation, I spend as an elective out-rotation at my alma mater. Will refrain from going into detail on this in order to protect the innocent... Then it's back to overnights but it's my next to last overnight rotation so I'm rather excited - I don't count the extra 4 nights that I have to do right at the end of the internship 'cause they'll be a breeze when I'm that close to done! Time is flying like mad and all too soon I must finish placing my ranks for residencies and then will find out if I matched or not. Probably won't have much time to write after this week and plan to drive out as soon as I am finished here on the 27th! With that, I wish everyone a very Merry Christmas and a Happy and SAFE New Year!!
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