fluid therapy

Fluid Therapy Routes in Chelonians
  • Oral - regular bathing, succulent melon/cucumber, syringes (not as effective as stomach tubes)
    • Regular bathing once/twice per day in shallow warm water for 10 minutes - stimulates reflex urination and defecation, and water is drawn into cloaca and absorbed
  • Stomach tube - not ideal for repeated fluid administration
    • Placement: pre-measure tube, lubricate, open mouth, run tube along roof of mouth, flush after each use
    • Maintenance: 0.5-2% bw/day in divided doses
    • For significant dehydration: 2-4% bw/day
    • Using water and liquidised vegetables
  • Oesophagostomy tube - same as stomach tube
  • Epicoelomic - rapid absorption, easy to do, less complications
    • Placement: through cranial inlet of shell laterodorsal to head and neck, immediately dorsal to plastron and below/into pectoral muscles
    • 1-2% bw/day in divided doses
    • For critically-dehydrated patients
  • Intracoelomic - less reliable absorption
    • Placement: surgically-prepare, into prefemoral fossa, avoid bladder trauma or respiratory space compression
    • Up to 3% bw/day in divided doses
  • Intraosseous
  • IV - only for severely debilitated emergency treatments or anaesthesia
  • Subcutaneous
    • Into prefemoral fossa or btwn neck and front limb
  • Type of fluid - unsure, Hartmann’s not ideal b/c of high risk of lactic acidosis (half-strength Hartmann’s could be used) - ideally take bloods to measure osmolality

I’ve always had a passion to create and a love for painting. When I hit a bout of depression I started using painting to help me get back on my feet and my me feel like myself again. As a result, I started The Ellen Lane, a place where I could display my art and sell it so it doesn’t sit around my house with no one admiring it.

This particular painting is for sale and it’s one of my favorites.

Click here to check it out and my other works as well!

It’s #spooniestrongselfiesaturday and I don’t feel strong at all. This has been such a rough few weeks because basically my doctors are choosing not to help me so my health is just going to keep getting worse and worse. Last night I started looking at more house-friendly wheelchairs. I’m so pissed off that I’m likely going to spend thousands of dollars making my home accessible for me all because my doctors think fluid therapy is a joke despite it being the one thing that gives me a semi-reasonable quality of life. Just so frustrated and exhausted and ready to give up.

Treating Sludgy Urine in Rabbits
  • Express sludgy urine by manul expression or catheterisation and flushing under sedation/GA
  • If perineal scalding is bad: clip away soiled matted fur, clean with chlorhex, apply topical cream (zinc oxide, petroleum jelly, Fuciderm [steroid!])
  • If not eating: IV fluids in hospital, then supplemental feeding with Emeraid at first, then move to more high fibre foods (Oxbow, 20ml Recovery formula up to 5x/day etc.)
  • Prokinetic
    • Cisapride (5-HT4 agonist) - acts on colon only, synergistic with ranitidine
    • Ranitidine (H2 antagonist) - act on proximal GI tract and colon
    • Metaclopramide (dopamine antagonist, 5-HT3 antagonist and 5-HT4 agonist) - acts on distal oesophagus, stomach, and duodenum
    • Domperidone (D2 receptor antagonist) - acts on stomach and small intestine
  • Analgesia (buprenorphine, meloxicam)
    • Check liver and renal parameters before long-term meloxicam
  • Antibiotics based on C&S
    • Enrofloxacin/marbofloxacin, TMPS - treat long enough to cure cystitis
    • Oral penicillin is toxic!
  • Other supplements
    • Biolapis (electrolytes, probiotics, prebiotics, rehydration) - 1 sachet mixed with 50ml water giventhroughout day
    • Cystophan 1 capsule once/day
  • Treat underlying cause! (essential since recurrent problem)
    • Vs osteoarthritis: meloxicam therapy, may need to use tramadol if very painful and unresponsive to meloxicam
  • Induce diuresis using IV, SC or oraly fluid therapy or increase water intake (feed wet leafy green veg, sweeten the water)
  • Provide clean dry bedding
  • Increase exercise to encourage urination by providing big outdoor enclosure
  • Increase amount of phosphorous in the diet (phosphorous retention increases urinary calcium excretion)
  • Reduce amount of calcium in diet (avoid high Ca foods like kale, broccoli, turnip, Chinese cabbage, watercress)
Come Back Down Part 8

Characters: Jensen Ackles x Reader, Aunt Maggie, Mike

Summary: Jensen spends more time at the hospital with Y/N.

Warnings: Cussing, sexual tension, attempt at humor

Tagging some great people, thanks for the support and comments!: @jotink78, @dancingalone21, @perpetualabsurdity, @maileann, @daydreamingintheimpala, @gecko9596, @gemini75eeyore, @winchesterprincessbride, @sandlee44, @exploratiionist, @arryn-nyx, @littledarlinhavefaithinme, @tiffanycaruso

Sometime on Day four, Mike made an appearance and he wasn’t too happy. He caught up with me on one of my many trips to the coffee machine. It was truly awful coffee, but it filled the hole. The moment he’d walked through the front sliding doors and zeroed in on me I knew I was in trouble.

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I am normally so so happy when I see that other spoonies are getting good care, especially if it’s something like fluid therapy and a port because I know how valuable that can be. But right now I am just so bitter about it all. I just don’t understand how me deteriorating this much is okay by my doctors. I’m just so frustrated and bitter right now. Normally my anxiety rules my life but right now it is a mega case of depression.

Let’s talk fluid therapy:

I was never the math whiz in school but now that my patients lives depend on my math, I suddenly wish I had paid way more attention. Reviewing the calculations often is a good way to be prepared for emergency situations. So here goes.

Say I have a 4 day old Holstein calf with diarrhea and a progressive decrease in glucose. I want to add dextrose to her fluids to help supplement her so she doesn’t become hypoglycemic. Question is, how much dextrose do I add to my fluid bag?

The formula needed for this problem is:

C1V1=C2V2 

Where C is concentration and V is volume. We can actually determine the answer pretty easily if we remember this formula: My final volume (V2) is a 1000mL bag of saline. The concentration of dextrose I want to end up with is a 12.5% solution so C2 is 0.125. The bottle of dextrose I have is a 50% solution, so my C1 is 0.50. To determine how much of that 50% dextrose solution to add to my bag, I simple need to plug in those numbers and solve for V1.

C1V1=C2V2

0.50 x V1 = 0.125 x 1000

0.50 x V1 = 125

V1 = 125/0.50

V1= 250mL of dextrose!

This calculations may seem easy but it can throw you for a loop if you’re not used to using it quickly and efficiently! Don’t forget to hone your math skills because not knowing the diagnosis for a patient may kill it eventually but miscalculating drugs or fluids can kill it a heck of a lot quicker. Practice good vet math!

Hyperemesis Gravidarum is a real pregnancy condition and not just ‘extreme morning sickness’.
Vomiting can cause starvation acidosis and women can need fluid replacement therapy as they are unable to eat.
This can affect baby and development. Also nutrients are not getting to growing fetus.

If this is happening to you contact your midwife asap.
Pregnancy doesn’t have to be suffering.

You guys in an hour I have my phone call with my CFS/Fibro doctor. She is the last hope I have to get back on fluids. She’s the one that prescribed the fluids, but my PCP was the one who ordered the PICC (and they were SUPPOSED to order my port as this doctor and my EDS doctor agreed, but they decided to deny it). If she can’t help me basically I’m going to be stuck in bed for months until I can get in to the new PCP. It is so excruciating and exhausting getting from my bed to the bathroom, much less trying to get anywhere else in the house. I have new arm crutches coming today that hopefully will be more help than my cane. But regardless, I really need her to be able to help me. I know she supports my fluid therapy, I just don’t know if she has the abilities to order a port.

8

Even my father (who has no idea about my gender things) said I looked like a boy from one side and a girl from the other when he saw this hair. Add in a couple of selfies I like, and a two pictures of the old me (and what I think my family want to believe I’ll one day go back to)

Still… iffy who I tell about being gender fluid. A lot of people just put it down to my diagnosed DID, and it just being male alters. But I know it’s not.

Happy trans day of visibility everyone.

 And to all the trans alters out there, your gender identity is just as valid as any body else’s. xx

Scar(let) - Gender Fluid (She/her, he/him or zie/zem anything goes, really)

Canine Parvovirus, from a vet who treats it.

The early years of my career were spent in a rural Australian practice. I saw a lot of canine parvovirus from poorer socioeconomic areas, and by ‘a lot’ I mean up to 5 per week in Summer. 

There’s no way to sugarcoat parvo. It’s a nasty, highly infectious, highly durable virus with a near 100% mortality rate if not treated. Conventional hospitalization and treatment in early to mid cases can provide up to 98% survival though, which is why I laugh at ‘alternative treatment’ spruikers who want to prey on your vulnerability and make you buy their book with new ‘magic cures’. The difficulty is that treating it is expensive.

Canine parvovirus attacks stem cells in the dog. For most dogs, their must abundant stem cells are in their gut lining. This means their gut lining stops replenishing, producing foul, copious, watery and bloody diarrhea as their intestinal lining falls away. This is as horrendous and painful as it sounds. There are also stem cells in bone marrow and severely affected dogs will find those attacked as well, worsening anemia from blood loss and causing immunosuppression. In very young pups it will attack stem cells of the heart also, as though these pups didn’t have enough to worry about.

The virus itself is highly contagious. It’s also very durable, and by that I mean the virus survives in soil very well, potentially up to 20 years. This means that if there has ever been a parvo dog in your backyard, your soil is probably contaminated. It can also be spread by foxes and cats, so good luck keeping those off your property too.

It takes 3-7 days from infection to first clinical signs. People would often buy a healthy looking puppy only to have it come down with parvo a few days after it arrived home. Usually it was not vaccinated.

I want to make it very clear that vaccines do not cause parvovirus. The actual, live virus causes parvovirus. It’s common for an infected puppy to be brought to the vet on the first day with its new family, before it starts showing clinical signs, only to then become sick 3-5 days later. When you’re a vet in this situation, vaccinating the puppy becomes a race against time. You want to vaccinate them before they get a chance to be infected, but not before their mother’s immunity has faded. Generally the risks of having a parvovirus vaccination are less than not having it. This is especially frustrating when the pup has already been out in highly contaminated areas, like dog parks or the beach.

And when the poor little pup, or the young adult dog, does come down with parvo, hopefully its owners brought it in early instead of wasting two days researching ‘cures’ on the internet before coming in.

Treatment is expensive. Parvovirus dogs need to be in isolation to stop every other pup that comes into the clinic from potentially becoming sick as well. They need lots of fluid therapy, pain relief (those guts hurt), gut protectants, antibiotics (bacteria cross the damaged gut into the bloodstream too easily) and anti-nausea medication. Sometimes they need intravenous nutrition, and you know its bad at that point.

There’s no cheap miracle cure for canine parvovirus. A canine plasma transfusion is the closest I’ve found, because it contains antibodies from a vaccinated donor, as well as proteins the patient needs. A plasma transfusion can have a pup going home 48 hours later. The trouble is, it costs about $300 wholesale for only 200ml.

Vaccination is the only way to prevent canine parvovirus. Vaccinate the mother before she gets pregnant. Vaccinate every dog that comes onto your property. Vaccinate adult dogs to keep them from shedding. Keep pups away from likely contaminated areas until after their 16 week vaccine, especially in known parvovirus hotspots. Vaccinate pups as per your veterinarian’s directions. Don’t buy them if they’ve not had at least their first vaccine, no matter how cute they are. 

Parvovirus absolutely sucks and I would happily never see it again, despite the enormous vet bills it generates. I now work in a higher socioeconomic area where people have generally listened to their veterinarian’s advice and vaccinated their pups and adult dogs as recommended. I haven’t seen a parvovirus case in 18 months in general practice, and only two in emergency. Vaccination makes a huge difference. 

I’m not trying to sell you anything, unlike every other ‘miracle cure for parvo’ and ‘what-your-vet-wont-tell-you’ salesman. This is just free advice, and my sincere condolences if you’ve ever found yourself with a parvo puppy.