Post-Operative De-Escalation – Rachel Hughes
November 28, 2017
When I was selected to be a member of the chinook project, I was thrilled to be selected to be a part of which a wonderful program and have the opportunity to learn how to enhance my surgical skills, whether that be learning new suture patterns or tips and tricks to become a more efficient surgeon. This year, the Chinook Project was a bit different. Instead of the hours and hours of surgical experience, which was expected, we found ourselves with only two or three surgeries over the entire ten days we were up north. At first I was quite disappointed in this reality but the number of other veterinary skills I learned because of the lack of surgeries has proven to be quite the blessing.
I saw this as a blessing because with the few surgeries that I did have, I got to spend more one on one time with my patients from start to finish throughout the entire process. A major lesson that I learned while working in the North was the importance of recognizing fear aggression and the effects that pain and a rough recovery can have on the personality of an animal. One of my surgery cases was a mature dog spay on Daisy. When daisy first arrived at the clinic she was the most well-mannered and cuddly arctic dogs I had encountered up to that point. She was placed under general anesthesia for her surgery, which went very well. I had the opportunity to learn a new knot pattern, the Miller’s knot and several tips and tricks to improve my efficiency during a dog spay.
The ultimate lesson I learned from this case when the in the moments following turning off the isoflurane. This being my first canine spay up north, I followed the usual recovery process that we use at school. Providing a dose of hydromorphone post operatively, recovering the dog on the floor with their catheter in place and waiting for a swallow before removing their endotracheal tube. Never in my life have I seen an animal wake up from surgery so rapidly and be in such a state of dysphoria. After removing her endotracheal tube, Daisy jumped up off the floor and immediately ran for the door. Luckily team members were present to corral her back into a kennel and her incision was still intact, but now came the difficulty of removing her catheter. The once very kind and loving Daisy, was now in a kennel, recovering from a painful procedure, following the roughest recovery I have ever seen. Daisy was now a teeth bearing, infuriated dog who would not let anyone near the front of her cage. After hours of debating on how we were going to manage this very angry dog, Julie recognized that Daisy was displaying more kennel guarding behaviour than outright meaningless nastiness/aggressiveness. Following this, we were successfully able to coax her out of the kennel and immediately her personality reverted back to more normal.
There were many lessons I learned from this encounter with Daisy. 1) The way a dog recovers immediately from anesthesia can set the tone for how the entire recovery will be. 2) Recovery from anesthesia, for a time, can cause profound dysphoria especially following a dose of intravenous hydromorphone. 3) Being able to recognize kennel guarding and not necessarily deem the animal as being mean/nasty. Although her rough recovery from anesthesia most likely contributed to her overall rough recovery, being able to recognize that she was kennel guarding instead of being nasty was a key lesson learned. Recognizing that this was the issue, the management of the case went from, how am I going to get in the kennel to remove this catheter in a nasty/aggressive dog? To, I need to get this animal out of the kennel which is the key to her distress. This taught me to always look for all possible reasons why an animal may be in distress or displaying signs of aggression. Whether it be fear aggression, guarding behaviour or the effects that post-anesthetic drugs may have on the recovery of a patient.
Rachel Hughes, AVC 2018, traveled to Igloolik in 2017 as one of the student participants on the Chinook Project. As part of the experience, the students craft various pieces of reflective writing.