Thursday, July 8, 2010

7/6 - Day 2 in the Hospital: Necropsy and the End of Derm

As you may have noticed from the previous post, I do not think much of dermatology. It’s fun seeing all the cute little puppies that have puppy pyoderma, but seriously, most of it’s just gross. Our clinician just goes between cases and talks to the owner, takes a look at the affected area, and tells the tech to take a scraping or do a culture, and then explains what the owner said to us. (The owners typically talk to the clinicians in Tamil, one of the languages spoken in India.*) After that, we typically move on to another case.
Since derm doesn’t get cases until around 8:45, we had some time to kill that morning so we went to Small Animal Medicine. Best decision ever. We got to see two really interesting cases: a dog with end stage distemper and a chicken with Newcastle disease.
I’ll discuss the distemper case later.
The Newcastle was in a chicken:

Note the puffed up wings, slouched posture, half-open eyes. It was also super lethargic, wouldn’t stand when held by the wings, wouldn’t put weight on its legs individually or together, had a super nasty vent, and the crop was empty. In laymen’s terms: sick bird signs (not eating, and feeling so icky that it didn’t want to or couldn’t move)
Newcastle, in the US, it typically seen in low pathogenic strains, where it’s referred to as PMV-1 (paramixovirus – 1). However this is the exotic form, which is very common here in India. The doctor prescribed an antibiotic to prevent a subsequent infection (or one that was already brewing) and that was that.
Then we went to derm, which was the same old thing.
demodex suspected, scraping negative, fungal culture collected, abx for suspected 2ndary infection
puppy pyoderma
same dog as above
quick escape from derm for an ekg:sinus tachycardia, chronic kidney disease, mild ascites, 2degree hypertension.
(from above dog)

At one point we were rescued by Dr. Subbiah, to attend a meeting about World Zoonoses Day. The parasitology department, I think, put together a set of demonstration stations so that people and school children could learn about zoonoses. We got to meet with some of the Indian vet students studying here and Dr. Subbiah quizzed some of them on zoonoses. We certainly couldn’t have answered his questions, so I’m glad he wasn’t grilling us.

We looked at some of the displays and then headed back down to derm to readily await 11:30 when it closed.

Remember that case I mentioned before, about the skin issue and the giant tumor – and we only looked at the minor skin thing… well, here’s some pictures.

Finally, we finished with derm and went home to lunch.
puppy pyoderma

After lunch was awesome!
The dog that came into small animal medicine earlier with advanced distemper had been euthanized (he had horrible muscle twitching, which would have developed into seizures and eventually just died a horrible death within a few days otherwise) and we got to see the necropsy. I’ve compiled a video (about 5 minutes in length) which shows the dog’s symptoms as well as the necropsy. However, it is VERY GRAPHIC. Watch at your own risk. If you’re a medical-type person this is just up your alley.
Necropsy is such a different animal here. First of all, it’s in a room that is very open. And by open, I mean that it has open windows and open doors all leading to the outside.
It has fans, not AC. And attached is a walk in fridge/freezer. However, due to the consistent power failures here, I’m not sure how fantastic that fridge is...
When we went to see the necropsy, the power was out, so there was NO AIR CIRCULATION and the room was OVER 85 DEGREES, had no air circulation, and didn’t have any working lights. Outside, it was about the same temp. We started with the necropsy and the tools they used were kinda scarry. There was this big knife – possibly made of solid iron – and this big curved thing that kinda looked like a mini Arabian sword from alladin – you know, with the curved tip? Also, bandage scissors and suture scissors were used for some of the smaller things, like sample collecting.
So we put on bouffant and face masks, making us even hotter, and proceeded to watch the necropsy. It proceeded in the usual style: examination of the exterior of the body, removal of limbs, opening the thoracic cavity, removal and inspection of organs, etc. Then it finally became so unbearably hot THAT WE MOVED OUTSIDE. We set up a table, put a board (with the necropsy blue background), on the table, and just kept on truckin’. When we needed a new organ from the room, the professor doing the necropsy called to one of the Indian vet students doing his internship there to fetch the appropriate part from inside.

At one point I noticed a crow had flown into the room through an open window and then landed on the necropsy table. The professor saw I was looking and sent his student into the room. THE CROW HAD EATEN THE DOG’S ADRENAL GLANDS. We were supposed to be taking samples from them and making impression smears of them too... It’s a good thing crows don’t get distemper.
We went organ by organ and did GI last. When the doctor cut open the small intestine, that drew about a million flies – which was super gross. We had a good 20 or so on the guts on the table at several points.
Finally, we needed to examine the brain, so we went back inside so they could remove it from the head. At school, we use a bone saw to get through the cranium, but not here. Remember that alladin-esque thing? The assistant used it to bash in the skull and crack out the brain. It was extremely violent.

Here’s the video if anyone’s interested. It’s mostly still photos with explanations is subtitles, but the beginning shows the temporal twitching and involuntary leg movements in end stage distemper and there’s also a clip of the skull bashing. It’s a very educational video – about 5min.

Flash forward to that evening: more shopping. Three of us really wanted to find material to get salwars made so we went to a store called Textile India. They had an ok selection, but the guy didn’t really understand what I was asking for when I said what colors I was looking for. I ended up not finding anything nor did val. I just don’t want something super sparkly or flash, and unfortunately that’s what many people wear in India. But, I have seen plenty of people wearing things less sparkly, so I think I’m just not looking in the right part of the store. We went with Pumadi, a senior student at the vet school who will be coming back with us to school for a 6-week internship.

After an exhausting evening, I passed out pretty early – basically right after dinner.

*The state that Chennai is in is called Tamil Nadu – they speak Tamil here. In other states in south india, they speak different languages. Everyone, however, should have a grasp of English since all school is taught in English starting from elementary school. When we speak English though, they can’t understand us all the time... because of our American accents.

More about diseases discussed in this post: - distemper, merck -newcastle, merck - distemper, wiki - Newcastle, wiki

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