Life as an RVT: Puppy Anesthesia Challenges..

By Rhianna Depew, RVT…

'Puppy'-PDA-1

Dr. Steven Cole, our board-certified cardiologist, approached me and asked a very delicate question. “How do you feel about doing anesthesia on a two-week-old, tiny puppy?”

“Puppy” as she was aptly called, since she hadn’t acquired a name yet, was a cute and cuddly, and very fragile Burmese Mountain Dog neonate that was already having cardiac issues at her young age. She had patent ductus arteriosus, or PDA, which is a congenital vascular communication between the aorta and pulmonary artery. This is normal for humans and animals in the womb, however in some cases, this vessel fails to close normally at the time of birth.

If left untreated, a PDA can cause severe cardiac enlargement, and eventual congestive heart failure (fluid in the lungs), or pulmonary hypertension (high blood pressure in the lungs).
In fact, most dogs with an untreated PDA do not survive the first few years of life. Because of how tiny she was, she wasn’t a good candidate for the typical, minimally invasive technique with catheters. Instead, Puppy needed open chest surgery in order to accomplish the PDA ligation; but that also meant a lot of risk, and a whole host of potential complications.

Dr. Cole knew I loved challenges, and was always up for our most difficult cases, but this one was different—a suckling neonate under general anesthesia is extremely high risk. But we were determined to do everything we could to help this puppy, so I started planning ahead. I thought about this small, delicate puppy every day leading up to the procedure, as well as the night before. She kept me awake, going over every detail and making mental checklists of everything I needed to get her safely through her risky life-saving surgery.

That morning I woke up early and wanted to make sure I arrived at the hospital ahead of schedule to start planning and preparing. This was the smallest heart surgery I had ever assisted with. She would need the tiniest versions of all the equipment we normally used. Tiny catheters, tiny endotracheal tube, tiny, tiny doses of medication and anesthetic drugs. I calculated all the “what if” emergency medications ahead of time and went over and over again everything we needed. I went over to Puppy’s cage and scooped her up. She fit into the palm of my hand and had the typical clumsy movements of a newborn. She was incredibly soft, and made the cutest little squeaky puppy sounds.

She fit into the palm of my hand and had the typical clumsy movements of a newborn. She was incredibly soft, and made the cutest little squeaky puppy sounds.
I gave her a kiss and held her up to my cheek and told her that she was going to do great, and that there would be plenty of days of running through grassy parks, toys, and treats in her future. Then I placed her back in her bed of cozy blankets so she could get some rest before her big procedure, and so that I could go triple check that everything was in place.

When it came time for surgery, we prepped the puppy before we put her under anesthesia and had every warming device at our disposal to keep her temperature up. I gave her micro doses of anesthetic to get her sleepy, placed ET tube in her trachea to control her breathing, hooked her up to the anesthesia machine and patient monitor, listened to her little heart beating on the monitor, and gave her some tiny breaths.

Then, I remembered to breathe, as I was holding my breath with each step taken to prepare Puppy for her big procedure. We were on our way.

Our board-certified surgeon Dr. Jana Norris, along with Dr. Cole, arrived into the OR, and we wasted no time getting right to it. The room was silent. We were all hyper focused in our tasks at hand: to accomplish this procedure and get this puppy out quickly and safely. Dr. Norris’ skilled hands were each the size of the entire patient, and they worked precisely and efficiently around the puppy’s tiny heart and lungs. I continuously watched between my monitor, the patient and the doctors, monitor, patient, doctors, monitor, patient, doctors—trying to stay a step ahead at all times. You could cut the tension with a knife, and I don’t think any of us had taken a full breath, then….

Dr. Norris assured everyone in the room with a confident “I got it.”

Puppy was doing great under anesthesia, and knowing the mission was accomplished, I could feel some nervous tears welling up. We finished the surgery and gave each other well deserved verbal high fives. I brought our tiny patient into recovery and stayed by her side until she fully woke up. Within a couple of hours she was back to being her cute and wiggly self, and wanting to be bottle fed.

Puppy was able to go home a few days later and recently came in for a recheck with her beloved cardiologist. She’s doing very well and is expected to grow fully to her Burmese Mountain Dog size and live a long, happy life. Puppy will be a constant reminder that preparation, precision, dedication, and team work, are all crucial to saving an animal’s life. For now, Puppy will continue to steal our hearts and bring joy to the hospital with each and every visit.

Dr-Norris-Dr-Cole-Rhianna-Depew

From Left to right: Dr. Jana Norris, Dr. Steve Cole, and Registered Veterinary Technician, Rhianna Depew.

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Dr. Annie Lo: A Cut Above the Rest…

Dr-Annie-Lo

We are thrilled to announce that Annie Lo, DVM, DACVS is now a board-certified veterinary surgeon. Dr. Lo, a California native who grew up in San Francisco, received an undergraduate degree in Molecular and Cellular Biology from the University of California, Berkeley in 2000, after which she extended her studies with research in human hematology.

In 2009, Annie completed her Doctor of Veterinary Medicine degree at the University of Illinois, going on to complete a small animal surgical and medical internship at the University of Pennsylvania, where she stayed on as a Small Animal Surgical resident.

Today, fully entrenched in the Department of Surgery at ACCESS Animal Specialty Hospital in Los Angeles, she is a highly regarded doctor, with interests in minimally invasive procedures (laparoscopy, thoracoscopy, and arthroscopy), surgical oncology, reconstructive wound surgery, emergency surgery, urinary tract surgery, and various orthopedic procedures. Dr. Lo enjoys reading, gardening, and crafting. She has a special interest in origami, and utilizes her penchant for precision to create beautiful paper flowers.

We want to congratulate Dr. Lo on such an impressive accomplishment!

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The Surgeon with the skull collection…

Jana-Norris-DVM-DACVS-ASFVJana Norris, DVM, DACVS joined our San Fernando Hospital in January 2013 to head up our new surgery department, though her road to veterinary surgery had quite a few twists and turns in it. Jana grew up as a child actor working in theater and received her Bachelor’s degree in Fine Arts from USC. After working as an actor for a few years, she literally “woke up one day and didn’t want to do it anymore”. We sat down with Jana to find out what led her to ACCESS Specialty Animal Hospitals.

How did Dr. Norris decide she wanted to work with animals?
When she was acting, her dream was to land a sitcom and make enough money to move to the country and live around animals. Jana decided to cut out the middleman and go right into veterinary school.

What is her favorite animal?
The Octopus. Why? “They can change color depending on their mood, they are the smartest invertebrates, able to learn a task in a single trial and remember it for the rest of their lives, and they can fit through a hole the size of their own eyeball!”

Why surgery?
Jana has always been into fixing things and finding out how they work. As a child, she used to like playing with tools, and even took apart the TV and phone, much to her parents’ dismay. She really enjoys “the structural approach to disease”. The chronic, inevitable decline of patients is too emotionally taxing, whereas surgery is repairing the issue at hand. Jana sees surgeons as “the cowboys of the hospital”; they’re able to come in, take a patient, and fix the problem they’re presented with.

What are the most challenging procedures Dr. Norris has ever done?
“Any critical care patient is stressful, because you know that there is a risk that what you’re about to do to help them has the potential to be unsuccessful, but they will not survive without your treatment.”

What is her favorite procedure to do?
Dr. Norris is heavily influenced by her past, enjoying ‘putting things back together’. In her words, her favorite procedures have to be “fracture repair and skin grafting & reconstruction!” The procedures are the same as they are with humans, and Jana enjoys being able to be creative with both art and structure to reestablish form and function with the surgical procedure.

What is her “bread and butter”?
“Cruciates! They are so well researched and such a common injury. We have excellent outcomes with the right approach, and when done correctly, have a 100% success rate.”

Why California?
Jana lived in California for 17 years before moving to the East Coast. She eventually ended up in Philadelphia, where she worked at the University of Pennsylvania with her then future husband, ACCESS Cardiologist Dr. Steve Cole. She loved California and what it had to offer, so after marrying Dr. Cole in Switzerland and having their reception at the Mutter Museum(!), Jana and her new family moved back to the sunny scenery of California.

Wait… they had their reception at the Mutter Museum?!
They sure did! Dr. Norris has a fondness for things many people would consider…unusual. She has a collection of 40 skulls, both human and animal. The smallest skull she owns is that of a vampire bat, and the largest bone structure is the entire spine of a calf. She even has a fully articulated canine skeleton in her living room! When she was a pre-vet student at Santa Monica College, she supervised a dermestid beetle colony. The dermestid, or carrion, beetles are used to clean bones as they are the most effective tool to clean the bone while also preserving it.

So, she has a skull and bone collection. What else is she into?
Dr. Norris’ home is quite the showcase for out of the ordinary collectibles. In addition to animal and human bones, she also has an array of vintage medical equipment and posters. Her collection includes decades old handheld Oster clippers, speculums, and glass syringes that are seen as pieces of art in her house.

What is her most prized possession?
“My father’s medical kit from the 1940s.” Dr. Norris’ Dad, Dr. Norris, is a Rheumatologist and gave his black doctor’s bag to Jana. Inside you’ll find a stainless steel emergency tracheostomy kit. It’s basically a Swiss Army Knife with tools used to stab, cut, and intubate a choking patient.

What’s her favorite dish?
“Beef tenderloin, rare, with my mom’s white spaghetti”. Dr. Norris also loves to cook and her Rum Cake is her specialty. She makes a ton of them around the holidays, as her family and friends are constantly requesting her delicious dessert!

Dr. Norris is one of over a dozen skilled and interesting doctors at ACCESS Specialty Animal Hospitals, and we are so grateful to have her on our team. She brings a fierce dedication, wealth of knowledge, and passionate enthusiasm to each day she works and is available Tuesday through Friday.

Jana-Norris-DVM-DACVS-at-work

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Gordo up and outside…

09/19/2014 – 4:15pm

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Following surgery yesterday afternoon to repair his leg, ‘Gordo’ is doing well. So much so, he was able to catch a little time outside today with Bonnie Riehl, a Veterinary Technician at ACCESS Specialty Animal Hospital – Los Angeles.

According to Dr. Kim Carey and Dr. Annie Lo, the surgery went very well. Gordo had an FHO (femoral head ostectomy) which is where the ball of the ball and socket of the femur is removed and scar tissue forms in place of the ball. Patients that undergo this type of surgery are typically able to recover well, and with good post-operative care and management are soon able to run, jump, and play like normal. Gordo who manged a good meal after his operation, remained affable and very affectionate, capturing the hearts of many the doctors and technicians. Yes, he’s one tough little guy!

Dr. Carey and Dr. Lo are optimistic about Gordo’s recovery, and look forward to seeing him during his recheck appointments.

Stay tuned for updates…

#gordo #savethewhitedog

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‘Gordo’ out of surgery…

09/18/2014 – 5:35pm

Good news. ‘Gordo’ is now out of surgery, which according to ACCESS veterinary surgeons went well. Dr. Lo will shortly be providing a statement to the press where she’ll provide more information, and we’ll be sure to post further updates as they unfold.

Once again, thanks to so many people who called, emailed, tweeted and texted good thoughts for this little guy. And for the many who so generously opened their wallets and purses to assist Gordo’s owner, well, what can we say, but “we love you all”.

ACCESS-Specialty-Animal-Hospitals-Surgery

#gordo #savethewhitedog

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Update on ‘Gordo’…

09/18/2014 – 1:15pm

Gordo is currently going into surgery where Dr. Carey and Dr. Lo will work to save his little leg. Surgery time will be around two to three hours, after which we will post an update.

The below image is of Dr. Carey and Dr. Lo briefing the media and addressing the amazing outpouring of support for the little guy. #gordo #savethewhitedog

ACCESS-Specialty-Animal-Hospitals-press-confrence

Los Angeles News | FOX 11 LA KTTV

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ACCESS in action to help save ‘Gordo’…

More on this story soon.

But for now, here is a photo of “Gordo”, the little dog injured during a police chase in Los Angeles.

Thankfully, he could not be in better hands than those of ACCESS Specialty Animal Hospital surgeons, Dr. Kim Carey and Dr. Annie Lo.

See more at: NBC Los Angeles (plus more information on this story can be found this morning on the web).
#savethewhitedog ‪#Gordo

Gordo #savethewhitedog

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He’s still got eight lives.

Kittie-Pie-2

Looking a little ‘down-in-the-dumps’ is Kitty Pie, a sixteen week old Persian cat who tumbled from a 4th story window. Examination by his primary veterinarian revealed, besides a hurt mouth, that he had fractured his metacarpals, which in us humans are the bones located in our palms.

Kitty Pie was referred to Dr. Annie Lo at ACCESS Specialty Animal Hospital – Los Angeles, who with the owner, decided surgery was the best option to treat his mouth, along with having his metacarpals splinted and bandaged by our Surgery team.

Now, with one of his nines lives lost, we’re sure it won’t belong before he is back to himself, and with no doubt, having a lot more experience as to when to leap through open windows. 🙂

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We know how it feels…

We take care of every patient at ACCESS Specialty Animal Hospitals as though they were part of our own family. Occasionally though, our staff members experience medical emergencies with their own pets which reminds us how it feels to entrust others with the care of our furry family.

Kali-Surgery-PhotoThis is exactly what happened to Kristen, a surgery assistant to Jana Norris, DVM, DACVS.

Kali, her dog, wasn’t eating, had vomited a few times, and just didn’t seem like herself, so just in case, Kristen brought her to work.

It’s a good thing she did. A physical examination, blood test, and an ultrasound by Dr. Elana Hadar revealed an enlarged and very inflamed kidney that was near failure. At that point we knew what had to be done: she needed her kidney removed, and it needed to be done quickly.

Kristen responded to the news as a loving and worried pet owner and not as an employee. She felt confident all would be well, but struggled to keep back the tears and needed a hug. So instead of her usual role of being part of the surgical process – helping owners admit their pets into the hospital, prepping animals for surgery, and assisting the surgery team – Dr. Norris and the rest of our staff insisted that they would handle everything.

So Kali was prepped for surgery, protocol was set, and the team at ACCESS San Fernando Valley swung into action.

Good news! It wasn’t long before Kristen was told that the surgery went very smoothly, and the prognosis for Kali’s recovery was excellent. Kali, who had won the hearts of all who cared for her, recovered quickly and comfortably, and continues to improve at home, looking and acting better than ever!

Go Kali and Kristen!

We know that you love your pet – your companion and your friend. We also know the stress and worry that comes along when they are sick, and we know the pain and heartache when tragedy strikes. We love our pets and would do anything for them, which is why we take care of every patient as if they were our own, because we know how much you love them.

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