bladder prolapse

pivotal-moment  asked:

E and 4 please :)

Once upon a time, even before Dr Ferox was a new graduate, she was a vet student and for her chosen career was required to spend time shadowing other vets.

One night I shadowed a vet on call out in the country, at the beginning of peak calving season. This was about as busy as you’d expect it to be.

4am, frost on the ground, I was called out to help the vet, a new graduate herself, with a dairy cow who had prolapsed her uterus. Dairy farmers are up early.

For those who have never considered a prolapsed cow uterus, picture this if you will.

700kg of bovine is a big walking wall of meat. The farmer had kindly tied her so she’s down and can’t run away, because running is probably the worst thing she could do.
Hanging behind her is the uterus. Picture something the size of a large garbage bag, the sort you could crawl into if you wanted, pink and slippery hanging out of her vagina down to her feet, almost dragging in the mud. She can’t urinate while her uterus is taking in the moonlight, but she can defecate and she has already done so all over her uterus, which her tail has smeared evenly across the surface. It has nobly bits about half the size of your palm, because cows do. They’re useful for the placenta to attach on, but in this situation serve simply to act as little pockets for the shit to pool in.

The first thing we have to do, in the freezing cold, is lift the thing off the mud. It’s bloody heavy and slippery, taking three of us to lift it onto a plastic garbage bag. Now it’s off the mud, but still needs a clean.

Cold water is the only thing for the job. It’s all we’ve got in he the stockyards, and with any luck the cold will make this massive swollen pink uterus shrink for the inevitable attempt as shoving it back through a relatively small hole back into the cow.

We of course get drenched cleaning the thing, kneeling in the the mud straining to manipulate this monstrous uterus. Time is against us, as the arteries that supply this huge garbage bag of muscle can stretch, but only for so long before they rupture.

We hoist up the plastic the uterus rests on, hoping gravity will help us shove the thing back through the vagina, one tiny handful at a time. It’s insanely heavy, and I’m holding most of this weight whilst sitting over the cow’s back. I’m freezing and fatigued, and I have to be bright and intelligent tomorrow. The vet is desperately trying to get this thing back inside the cow, wanting to make a good impression in her first calving season.

We realise shortly that the bladder has prolapsed too, but must have been small, because it has now filled to a size bigger than my head. It would be impossible to push it back in whilst full, so ewe have to try to drain it.

We put an 18g needle into the bladder through the prolapsed uterus wall. Urine spills forth into the mess we’re already in,but at least it’s warm.

Do you know how long it takes several litres to drain through an 18g needle? Too long. It was marginally faster when we put in 8 of them. The thing looked like a pin cushion, but eventually shrunk enough to try to get it back in.

Do you realise how much deep cold fatigues you muscles? We were exhausted. 6am was creeping closer as we tried once more to lift the impossibly heavy sack of meat and push it, handful at a time, back into the cow.

This is a slow process when gravity is against you, and the uterus just does not want to sit in the abdomen where it’s supposed to be.

To be honest, we were losing anyway when the cow took a turn for the worst. She must have ruptured a uterine artery, because she died before we could put her to sleep. We were slow. The penetrating cold and fatigue made it difficult to even stand. What we were covered in need not be mentioned, but there were at least three different types of bodily fluids.

We were basically dead women walking. We had tried so hard and still lost the cow. Didn’t matter than most uterine prolapsed are only the size of a basketball by the time they see a vet, not the whole damn organ, we had failed and felt like death.

The farmer was surprisingly good natured despite our hopelessness. He ushered us through the dairy to clean our equipment and ourselves. Then he did something to bring us back to life.

He turned on the hot water.

Hot water is a blessed treasure on farms. It was so wonderful, words cannot adequately express. In our fatigue and hopelessness it was such a wonderful light to get us through until morning. Such a simple thing, that was so kind for us.

He’d subsequently tell the practice owner that he was impressed with how hard we tried, even though we didn’t succeed.

Moral of the story: small acts of kindness make a big difference.

sunshineovertime  asked:

Could you tell me more about what Ob/gyns do? I know I don't have a lot of information on these things. But I have a lot of interest in delivery, prenatal care, treating things like PCOS, fertility. That kind of stuff.

OB/GYNs:

  • take care of you while you grow a baby (prenatal care)
  • treat your pregnancy complications (high risk prenatal care, maternal-fetal medicine)
  • help you get baby from point A (uterus) to point B (outside world) (managing labor and delivery)
  • prevent you from growing a baby (contraception, abortion)
  • figure out why you can’t grow a baby (infertility workups, fertility treatments, treat sex hormone disorders, PCOS, etc)
  • make you bleed (treat irregular periods, do surgery for PCOS, fix imperforate hymens, etc)
  • make you stop bleeding (hysterectomy, uterine ablation, medications for heavy periods)
  • make you stop hurting (surgical or medical treatment of ovarian cysts, endometriosis, etc)
  • find or prevent cancer (pap smears, mammograms, colposcopies, LEEP, CKC, endometrial biopsies)
  • treat cancer (hysterectomy, lymph node dissection, vulvectomy, medication management of GYN cancers)
  • help you pee better (Fix bladder prolapse, fit pessaries, treat pelvic floor dysfunction)
  • help you stop peeing / pooping (fix fistulas, treat urinary incontinence)
  • fix your hot flashes or stop your beard from growing (hormone therapy)

Granted, some of these things are done by OB-GYN subspecialists like those who work in GYN-Oncology, Urogynecology, Maternal-Fetal Medicine, or Reproductive Endocrinology and Infertility. But all of them start out as OB/GYNs. I probably left some things out, but these are the most common things at least.