Reading up on reptiles... - Veterinary Practice
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InFocus

Reading up on reptiles…

Nikki Cumberbeach steps up to a challenging case involving a 17ft python with a tumour, and finds herself rising to the occasion.

ONE OF THE REASONS I LOVE
MY JOB
is that you never quite
know what one day is going to bring.
However, we all have certain things
that we dread having to be involved in,
and I am no exception.

I seem to have perfected an
unflappable exterior over the years in response to
whatever is
thrown at
me, but that
does not
mean I’m
not quaking
in my boots
and trying
hard not to allow my stomach to reveal
the true extent of my fear.

This emotion is often transient
and once our training kicks in in the
emergency scenario I am fine; however,
recently I found myself in a situation
in which it was not transient and my
training and previous experience were not going to kick in as I had none.
What was the situation? A 17kg python admitted for a tumour to be
removed from its jaw. This was most
definitely out of my comfort zone. In
fact, if I am going to admit a phobia,
this is as close as I get.

Ever since I can remember I have not really
liked
the way
snakes
just are…
I think
seeing
The Jungle
Book
as achild and being rather haunted by Kaa
the snake has made me feel that out
of any creature, snakes are the most
untrustworthy and should be feared.

So not only do I not like snakes, but
any information I had learnt about
them at college while training had been
stored in the “won’t ever need to know ‘cause I won’t be going there” brain
vaults.

Time to ‘man up’

Well on this day I had to. As head
nurse, with my only other allies at this
particular time being eager students, I
couldn’t crumble – I had to “man up”.

I should have been more prepared
– I’d known that the practice principal
had an interest in snakes and I’d meant
to at least read something, but in the
excitement of starting a new job there had always been something else I
should be doing. So, stomach churning
and after a hasty toilet break I ran
upstairs to consult my trusty library.

Wherever I have worked I have
always brought my books with me. As
a clinical coach it has always proved
helpful when trying to appear like the
guru of all knowledge to your students.
A quick flick through Veterinary Nursing
of Exotic Pets
by Simon Girling started
to make me feel a little less like a rabbit
in the headlights.

This confidence ebbed away when
the box appeared and the combination
code belt securing the lid was released.
My boss had already got some
injectables ready – we were going to
be using a medetomidine/ketamine
combination, and he was injecting, but
help was required for the restraint.

Luckily at this point one of the
other vets appeared and helped at
the head end, while I and one of the
student VNs held the more caudal
end.

The feel of the snake was so
different to what I expected that I
started to feel my stomach churning
ebb away and my curiosity started
to get the better of me. To feel the
strength of the muscles was quite
something.

Total recall

Memories of lectures at college about
snakes broke out of my brain vault
and I found myself remembering
how their organs are placed and how
you shouldn’t grip them too tight as bruising releases myoglobin and
causes damage to kidney filtration
membranes, at which point I loosened
my grip.

The snake was returned to her
box for the drugs to take effect and
we prepared for the surgery. I was
feeling rather proud of myself for
helping restrain the snake and slightly
embarrassed by my reluctance and
now subsequent excitement at the
prospect of something new.

It took a good 20 minutes for the
injection to take enough effect for
us to be able to remove the snake
and place it on the theatre table to
intubate. At this point it seemed I was
at the head end and feeling con dent
that as a non-venomous snake this
wasn’t such a bad place to be.

I held the head behind the occiput
and used my thumb and middle finger
to support the head laterally with my
index finger placed on top of the
head. My boss proceeded to intubate.
Intubation proved easy – the glottis
was immediately visible – and once
this was achieved, we were able to
start maintaining anaesthesia using
IPPV (two to four breathes per
minute) and sevo urane gas.

The snake’s temperature was
maintained throughout using a
combination of heat pads carefully
insulated and a bair hugger. In such
a large snake the heart rate could be
auscultated using a stethoscope –
re exes proved harder to monitor, but
as it happened the snake helped us out
by exhibiting what I later learnt was
the Bauchstreich response – where
ventral stroking of the scales cranial
to caudal produces movement in the
body wall, which helped us tailor the
anaesthetic depth, between 3-4%
sevo urane throughout the procedure.

The procedure was performed to remove the tumour on the jaw
and once surgery was complete we
concentrated on recovery. Atipamezole
was given as a reversal agent, and the
sevo urane turned off. Oxygen was
given for a further minute at only two
breathes per minute and then removed.
The anaesthetic plane had been light
throughout the surgery and the snake
recovered uneventfully.

This experience has since meant I
have made a concentrated effort to
read up on my reptiles and although I
feel con dent about the bigger snakes,
I’ve heard it’s those smaller ones you
need to watch…

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