I was supposed to do a spey today, but because my patient has a zillion problems, it was cancelled last night. However, when I arrived at school this morning, anaesthesia had already given my patient her pre-meds and was about to take her down to the surgery theatres. Two students told me the vets had decided she would definitely not have surgery, but the clinicians themselves were nowhere to be found. Que confusion, and anaesthesia becoming very unhappy.
The unfortunate thing about the morning is that the clinicians have this habit of all disappearing right when you have the most questions. Usually it's because they do rounds, and you can see them all standing there discussing the in-patients, but can't interrupt. But occasionally they all disappear for meetings, and it's always the worst timing possible. So today when I had no clue what was going on with my patient, it was very unhelpful that I couldn't find a free clinician to even tell me if the surgery was going ahead or not.
Eventually, I confirmed that she has other problems to worry about, behaviour issues not being the least of them, and we would investigate the UTI rather than doing the spey. She got transferred to a medicine student, but since I no longer had anything to do that morning, I followed her around and did all the stuff anyway. Since she was already sedated, the vet wanted to use a quick ultrasound to perform a cystocentesis (jab the bladder with a needle). I mentioned in my post yesterday that this dog is a giant wuss, but I completely underestimated that fact. Just putting the ultrasound probe against her belly caused a riot of screeching and whining and struggling. To an outside observer, it might have sounded like we were stabbing her to death. And just a reminder, this is a heavily sedated dog.
There was some confusion about when, exactly, she had been sedated, so vet #1 said we should give it another half hour for the meds to hit their peak effect. Vet #2 got around to it in about an hour, and as it turns out, the sedatives were given much earlier than either vet had realised, and now completely worn off. I went to get her out of her cage, only to be greeted by an alert, tail-waggy-but-whiny puppy.
They zonked her out again, and this time gave her an extra large dose, considering what happened last time. Vet #2 mentioned that it was twice what he would normally use.
Unfortunately, zonking them out relaxes all their muscles, so as soon as the nurse lifted the dog out of the cage so we could get a urine sample, the relaxed bladder emptied itself all over the blanket. Vet #3 made a frowny face as she felt the now-empty bladder. Crap.
Well, maybe there's enough still in there that the imaging people can get a cysto sample using the proper ultrasound.
We wheeled our patient down to imaging, where an actual ultrasonographer was waiting, and fortunately, this time the dog was out like a light. A tense couple of minutes followed, as the ultrasonographer poked his needle into the bladder over and over again to no avail. You could see on the image just how thick the bladder wall was. The needle was pushing against it, but not breaking through into the organ itself. He redirected, poked in quickly, pushed in slowly (even to the point that you could see the needle going through and pushing on the far wall), used a different needle--still nothing. Finally, by some miracle, on what may have been the last attempt, vet #3 pulled the plunger and urine! She handed me the syringe and said, "Guard this with your life."
We then typed up the forms for the lab, and I got sent on a Quest: bring these items to the pathology lab!
That's pretty much the end of the story, but to tie things up I should mention that when we checked the results later, there was a lot of bacteria. We put her onto a course of antibiotics and sent her home.
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