Portfolio of my Internship 2017

1. Rebecca Van Eaton
Internship
Schmidt
Aug. 5, 2017
Introduction
My internship was completed at the Fort Collins Veterinary Emergency and Rehabilitation Hospital
(FCVERH) on 816 S. Lemay Ave. Fort Collins CO, 80524. FCVERH was a place I walked into close to the
end of my second semester. At the time I did not know it would become an integral part of the education for the
Veterinary Technician program I am studying for. I remember the day I walked in to the Rehab side of the
hospital. I looked around and inspected every inch of the place. Out of the corner of my eye I saw windows
into other rooms. In those windows I saw my future, my dream. It was Dharma, a rather large Newfoundland
dog in a Hydrotherapy tank.
Many months later, my internship completed I have to look back on that moment. I was awestruck and
fell completely in love with something I did not even know existed. In the weeks and months to follow I hoped
I would get a chance to see what the Hydrotherapy tank was all about. I also wanted a chance to watch and
learn from highly skilled people who are currently working in the career I am endeavoring to be a part of.
I wanted to pick their brains and ask a million questions. I learned I could do just that; I only needed to ask my
questions one at a time.
I had a few setbacks and failures; I did the only thing I know how to do, I rallied.
I discovered I had retained more than I thought I had from the many hundreds of hours in class and spent
studying. I had reserves of personal strength and patience for other people’s shortcomings. I realized this job
would demand my full attention; there is no autopilot. I wanted to be immersed in every part of it. Laundry,
cleaning kennels and blood soaked surgery. I wanted to uncover the mystery of the Hydrotherapy tank. I did it
all. I learned what we do in the classroom directly translated to the surgery suite, and the emergency room
triage table. I hoped for an introduction to the world of Veterinary Technicians, what I got was a crash course
in the demanding world of animal nursing.
I got everything I needed for my internship and so much more.

2. Weekly Report
Week one June 8th
– June 10th
30 hours
Thursday, June 8, 2017 (1300 – 2200)
Today is my first day working at Fort Collins Veterinary Emergency and Rehabilitation Hospital. The
staff here is welcoming and friendly. I was introduced around and did the hospital tour three times with
different staff members, and each one had a new cubby or place to add to the enormous space. I think I have a
good feel for where things are in general and on a smaller scale where the restock is and where to find
equipment and specific things i.e.: syringes, fluids, liquid medications and pill form medications.
A Vet Tech named Amanda showed me how to digitally capture and enter a new patient in the digital
radiology computer. It was fascinating to see the ease of moving the radiograph images around and
enhancement. I also was shown how to manually set the KVp and how to collimate and adjust the light for
positioning. I observed Amanda as she took a history and did a TPR for a cat that had been brought in by the
owner because the cat had vomited three times that day. The TPR could not be completed because the patient
was growling and would hiss when any attempt was made to touch the body. Amanda noticed that petting the
cat’s head was ok. Any touching the cat’s back was not tolerated. Amanda was very keen not to push the
patient, and said she would talk with Dr. Wright who is on today.
Dr. Wright asked us to inform the client that she would like to take some X-rays and that it may require
some sedation, because the cat did not tolerate being handled. Amanda showed me where to make a patient
record in the computer, and how to fill out the patient paper record. There was a sedation order from Dr.
Wright. She asked me to look at the drugs the Dr. wanted us to use and to calculate a dose for one of them
called Butorphanol. Butorphanol is partial mu opioid. Example Calculation: 1 mL./kg, the patient weighs 5 kg,
= and the concentration 20 mg /1 mL. .
We went in to get the clients approval for the x-rays and sedation drugs. I watched Amanda as she went
over the charges and cost for each procedure, the client agreed to the patient care plan and we were allowed to
bring the patient back to the ER for x-rays. The cat was left in the carrier and had a towel over the front of the
body and the cat’s head was restrained. I was shown how to draw up the liquid medications. Dr. Wright gave

3. the injections and now we had to wait for them to kick in. Amanda asked me to set up the patient’s radiograph
with the views the Dr. ordered. I assisted in the patient positioning for a VD image and 2 lateral views. The
idea for the radiographs was to rule out linear foreign bodies. There were no foreign bodies. No evidence on
the x-ray for skeletal or obvious kidney issues. Dr. Wright palpated the kidneys for the patient with little luck.
At this point the Dr. asked us to restrain the cat for a cystocentesis. The Dr. tried three different times at
different angles to draw urine from the bladder, to no avail. I was very impressed when the Dr. asked one of the
vet techs named Dosia to give it a try. Dosia apparently is pretty good but even with help from the sonogram
machine she could not get a urine sample. At last Ame the lead vet tech tried, she too was unsuccessful. We
put the very unhappy cat back in his cage. He promptly urinated on a towel. Here is where Ame surprised me.
She quickly drew urine from the towel with a syringe and asked if Dosia and I would make slides, dipstick, and
a urinalysis in the chemistry machine.
Dosia quickly performed the dipstick and I pulled out the refractometer because I know how to perform a
specific gravity! This cat was severely dehydrated with specific gravity over the marks on the internal scale. I
assisted Dosia making the urine slides and staining them. We used the quick diff solutions and allowed them to
dry. Unfortunately there was not much to see, accept a lot of bacteria, which probably came from the stain. We
moved on to the chemistry panel we ran in the chemistry machine. Here was a hardware problem; the machine
need cleaning and a mandatory self probe operations check. This took a very long time to sequence.
In the mean time, I decided to help the other tech clean floors and cages. The cleaning protocol was
easy to follow and it got done before the chemistry machine was. It was very slow, so I decided it would be a
good time to break for lunch. When I came back, Ame asked me to go up to the front desk to start the other half
of my shift for the rest of the day. I met Cody and Jenny. Jenny walked me through phone calls. This place is
not a regular clinic with scheduled appointments, we get emergencies with owners who are upset and scared.
Your job is to listen and to always stay clam and keep cool. The people on the other side of the phone are
usually crying or screaming and confused.
Keep your voice at a low consistent monotone to soothe the client, and then ask direct questions. Never
give quotes over the phone only that we charge $118.00 Monday through Thursday and $158.00 on Friday
through Sunday and $158.00 after 5 pm everyday. For the fist few hours, I watched as Jenny entered two
clients and checked out only one. She told me about how the flow moves in the clinic and where the paperwork
is filed and who gets what copy of what. I asked if I could do anything on the task list for closing out the shift
up at the front desk. There was sweeping and trash, so I got a broom and went to work. Ame touched bases
with me before she left for the day. She quizzed me on the hospitals’ TPR normals. For future reference, they
are Temperature for both canine and feline 99.60
- 102.50
, Feline pulse 140 -220, Canine pulse 60 -140,
respirations for both 12 – 40. You can imagine my confusion! I kept my school normals to myself.

4. I think a good first day.
Friday, June 9, 2017 (0730 – 1730)
This was a quick turn around, but I was ready to get going. As I came in the Dr.’s were doing
“Rounds”. Ame said this is an excellent time to listen, learn and observe. This is the change over where
patients change hands with the new Doctors coming on shift. One patient was leaving this morning, and a
second was a staff member’s dog. I asked if I could clean kennels. I followed the protocol posted and it took
me a while. As I was finishing up two more animals had been brought in and so I asked Dosia if I could help
with the blood work on a dog that has been staying here for a few weeks. He was hit by a car and had extensive
damage to his pelvis, it was shattered three weeks ago and put back together by the good staff at CSU. The dog
was brought here for his lengthy recovery.
Dosia showed me how the blood work is done here. I assisted in any way I could. She made blood
slides and asked if I would do duplicates for myself. I tried several times; I am not vey good at making blood
slides, my monolayer was to small and there was virtually no feathered edge. She showed me how to prepare
the blood for the CBC machine and how to set it up. She also showed me how to run the Blood Gases machine
and of course the chemistry. The CBC machine was asking for a mandatory probe cleaning and we had to use
control blood from the refrigerator to complete this task. This took a very, very long time as the normals kept
coming back low.
Ame was called in to assess how to proceed. She said this is a new machine and to keep running the
control blood until we get all the numbers in the normal range in black. I ran this control blood but continued to
receive low numbers, I called Ame back and she made a call to the manufacturer for assistance. By this time a
few patients had come in and been checked out, I had missed a lot. I felt frustrated because I wasn’t helping
anyone really. I remained patient and moved on to observing Shelly and Emma while they were entering
medications for the dog that was hit by a car I had mentioned earlier. I think they were concentrating pretty
hard and I felt bad asking if they would explain how they were doing the drug calculations. I did learn
something though; I over heard the lead rehabilitation tech talk about something called Shockwave. It is an
electrical impulse that makes microscopic cracks in the bone. This sends a flood of white blood cells to heal
and repair, this bumps up the healing process of actual damaged bone in adjacent areas too.
I broke for lunch and came back. Ame needed to make some changes on my schedule. It was still slow
and so I picked up a mop and got to work on the back hall. When I finished, I had missed two animals that came
in and Ame wanted to speak with me. She put it as kindly as she could. We really appreciate the cleaning, but
you are here to learn how to take care of animals, not clean floors and kennels, you need to be able to multitask
and budget your time on things that you need to learn. She seemed disappointed and wanted me to make some
changes. She said that I was spending more time writing things down instead of doing things and that I might
learn better from doing. I felt disappointed in myself too. She quizzed me on the hospital’s TPR and I could not
recall, she was encouraging, she said no one knows everything. Be patient with yourself and put down the

5. pencil and get in there! We talked for quite a while about why I chose this place. She said you seem like the
kind of person that likes schedules and routines, why did you knowingly pick a place like this?
I said that I am used to getting things the way I like. I do like routine and lists, and schedules. That is
the problem, at some point in my career; someone is going to upset my little world. I need to know how to do
what you guys do here, multitask, prioritize and triage. It’s important to know how to do these things and there
is only one way to learn, sink or swim. I told her I would put down the broom and pencil and get my hands on
animals. When I left, I was pretty tired and I felt like an idiot. I felt defeated and just a bit out of my element.
She said that too. At home I thought about what she said. Can I do it though? Breaking this bad habit is the
only thing that matters right now. I cannot move forward if I don’t. I decided to rally. Rally, Rally, Rally. I
can do this; I’m a big bad Marine.
Saturday June 10, 2017 (0730 – 1730)
This morning I guess I brought my “A” game. When I walked in there was a Chihuahua that had come
in for Xylitol toxicity. He was in pretty bad shape. Kelsey and I monitored the TPR and tried to get him to eat
some food we prepared. Ame asked me to observe and help her draw blood from his catheter with the three-
syringe technique. She told me that we would be drawing blood from his catheter injection port. She showed
me how to turn off the fluids and clamp the T-port closed. Because this dog was so small she used 1cc syringes.
We put on gloves and swabbed the injection port of the T-port (catheter hub) this is where we will get the
sample blood from. She inserted the 1cc syringe and very slowly began her draw; she asked me why was she
drawing so slowly? I said because this dog is so small, you could easily collapse the vein. She filled the syringe
and capped the needle. She said with the next syringe we will get the sample we came for. The first syringe of
blood may have artifacts in it, or fluid from the IV. Next She performed the same technique of slowly drawing
the blood into the 1cc syringe.
She got her blood tube and let the blood from the syringe pour into it. I labeled it and we set it to the side. Now,
she said because this dog is so sick, and small we are going to give back the extra blood from the first syringe.
If we are taking blood often for tests this could have an effect on his concentration levels and blood chemistry.
Kelsey asked if I would come with her to walk the dog and see if he would eliminate outside. He was
very weak and really was not interested. We brought him back and were checking his IV, when he decided to
get very cozy with me, so much so that he was practically in my shirt. The next part is pretty gruesome.
He began to defecate bloody diarrhea all over my arm and shirt. I just let him; he seemed afraid and was
shaking. When He was done Kelsey, got him into another cage and began clean up of the mess in his cage. He
continued to present with bloody diarrhea in his cage and we had to change the bedding four more times. At
some point, it stopped and he was exhausted and fell asleep.
The next animal to in was a golden retriever with known neurological problems that had just had a
seizure. She was panting very hard and very fast. I was asked to restrain and give flow by oxygen. I watched
as the team worked to get her vitals and blood pressure. This dog wrapped her paw around my arm and drew

6. me close and pushed her head into the crook of my shoulder. The team was trying to get her BP it was very
difficult. From my vantage point there were four people including myself working on her. It took several
minutes to accomplish, but the team finally got her BP, TPR and blood drawn. All the while she drooled
heavily into my long sleeve shirt. Everyone seemed pleased and the dog was put in a blanketed cage for
monitoring.
The next dog had been brought in while this was going on. A Healer ranch dog, in for a bandage change
on the left leg. This dog was a biter, so she was muzzled. I had the job of holding the towel over the face, but
still allowing a way to breath during the procedure. I watched Dr. Pell as he peeled back and cut away the old
bandages and how he gently inspected the torn cruciate injury. He began the process of rewrapping and I
remembered How Kara had taught us how to this same procedure in surgical nursing. The Dr. had done the
exact same procedure perfectly!
The hospital seemed slow after this, so I broke for lunch and came back. There was another golden
retriever in, he needed to be restrained for and ear cleaning and inspect for any problems. Ame asked if I would
assist and gave me pointers on the order of which ear the dr. will look at first. He will look at the left ear (good
ear first) so you need to be on the right side of the dog. One arm over the back and across the chest, the other
hand across the length of the bridge of the nose and hold it or point it in a downward angle. This went
successfully, so we changed positions and he inspected the right ear and said no real problems in either ear.
Later I observed Ame and Dosia doing a chemical dilution on the Chemistry machine. I helped a little
by getting the control blood for Dosia and finishing the technique when Ame got called away. As the day was
winding down Ame began a TPR class in the ER with me. We spoke about lung quadrants and sounds
(auscultations) that can tip you off to what might be going on. Crackling in the cranial right lobe could be fluid
in the alveoli. We moved through each one and what these sounds might indicate. She asked if I knew what
CRT stood for and to give her the colors and meanings of the colors. Luckily I knew them, most of them.
CRT, capillary refill time: Blue gums -cyanotic, lack of oxygen-hypoxia. Brown gums –Tylenol toxicity. Red
gums - Septic, high fever. White - overhydrated too much fluid.
So the day ended with a teaching moment from Ame about all these things. At the end of my shift she pulled
me to the side and said she liked what she was seeing and to keep it up. She also said to listen, slow down, and
ask my questions ONE at a time, but to ask them! A much better day she said.
I agree, glad I decided to rally instead.
Feedback Date
Jun 14, 2017 0759
Week 1
Rebecca,

7. Q. I would look at the math for your Butorphanol again, this seem very high... Are you sure it was a 1 ml dose
and not 1 mg? 5 ml’s for a kitty seems very high.... How much volume did you actually draw up? How did you
draw this up?
A. 5 kg cat, 1 mg/1 kg of Butorphanol, concentration is 10 mg/mL
5 kg X 1 mg = 5 mg dose 5 mg X 10 mg ⇒ 5 mg X 10 mL = 5 mL = 0.5 mL volume to
1 1 mL 1 10 mL 1 10 mg 10
It was drawn up in a 1 mL syringe. I was not allowed to draw up the medication.
Q. How did you restrain for the x-rays and cystocentesis?
A. Amanda asked me to only observe for the x-rays because I do not have a dosimeter badge. The cat was put
in a trough, in dorsal recumbency and all the legs were held out and away from the body. The cats’ back legs
were held wide apart and the Dr. used ultrasound guidance to find the bladder, which she did successfully.
Q. What was the specific USG and what is normal?
A. Unfortunately no one remembers what this cats’ USG was, but I did get some normals for the hospital. Dr.
Wright gave me these numbers, she said they use 1.010 I was reminded of Dr. Lombard’s affection for this
topic and thought about what USG is. Urine Specific Gravity (USG) is the evaluation of the kidney’s ability to
concentrate (remove water in excess of solute) or dilute urine (remove solutes in excess of water). This
evaluation is of the kidney’s tubular reabsorption or lack of reabsorption. I remember her numbers well, for
cats: 1.001 – 1.080 is normal and the usual is 1.035 – 1.080. For dogs: 1.001 – 1.070 is normal and the usual is
1.015 – 1.045. Dr. Lombard would be proud!
Q. How did you stain the slides?
A. This hospital uses Sedistain. Take 2 mL of whole urine, place in centrifuge and spin down. After spin,
compare to a Urine dip strip. Back to the spun down sample, pour off the supernatant and pipette the pellet, use
one drop per slide, make 2 slides. The slide with no stain just put a cover slip on and examine under the
microscope. Use one drop of the Sedistain on the slide first, the add one drop from the pellet and place the
cover slip on and examine under the microscope.
Q. What disinfectant did you use to clean kennels and why?
A. This hospital uses Lemon – Quat. Lemon – Quat is an example of a quaternary amine based disinfectant.
This kind of disinfectant binds to and is inactivated by organic material, so the kennels were cleaned before
disinfection. Lemon – Quat will take care of gram negative and gram-positive bacterial and enveloped viruses.
It is normal for the first week or so to do more observation, hang tight :)
Q. Did you get to observe the shockwave?
A. No, but I will get to, and I will have some cool information on how it works.
Q: You can do this! You have official been introduced to the tech world with bloody diarrhea congratulations.
Look at white mm color again...think shock :)

8. A: Yes, I looked again at what I wrote and indeed, white gums are indicative of shock, because there is a loss of
blood circulation. The body is trying to shunt blood away from extremities and to the body core and organs.
Q: This is a good first report and I can see your day in your writing. Keep it up just add detail. Tell me how you
restrain and tell me more about some of the cases...why did the dog have bloody diarrhea? What was the injury
for the bandage change, a cruciate injury didn't tell me much? Was it a surgical site or wound? Let me know if
you have any questions.
A: Some of the cases I get to see in the middle, and then it’s on to something else. I do know the little bloody
diarrhea dog was Xylitol poisoning. The border collie was a surgery site bandage change. I really didn’t get
much information on the dog’s surgery and what had happened to him. I will slow down and stick with
something until I get the whole story or at least more complete answers.
Week two June 22nd
– 24th
30 hours
Thursday, June 22, 2017 (1300 – 2300)
I have been looking forward to getting back to the hospital since I left. As soon as I walked in I spied
Amanda. I snapped her up for some one on one math. This is the example I used in my last report. I had the
numbers wrong, so here is the corrected math.
5 kg cat, 1 mg/1 kg of Butorphanol, concentration is 10 mg/mL
5 kg X 1 mg = 5 mg dose 5 mg X 10 mg ⇒ 5 mg X 10 mL = 5 mL = 0.5
1 1 mL 1 10 mL 1 10 mg 10
mL volume to be drawn up in a 1 mL syringe.
After about 30 – 40 minuets trying to understand what I was doing wrong, eureka the light bulb went on.
Amanda stressed that I try to break up calculations into small bite-sized chunks. I think she is right. Ame my
Internship coordinator said it has been very quiet all day and there were literally no animals at the hospital. I
suggested that I become more acquainted with making blood slides. Ame said, “go for it”.
I grabbed a tube of old blood from the refrigerator from a few days ago. Ame had said that they keep
old blood from patients for about a week just in case more tests are needed. I began by gently rocking the tube
and gathering my supplies. I will need many slides and a pipette and some paper towels. I began with
enthusiasm, which slowly became defeat. These are hard to get right. Amanda joined me after an hour. She
made a few slides and told me we are looking for a feathered edge, the longer the better. If this edge is longer,
we will have more area to look in for anything /everything.
Finally, we decided after I had eight so-so slides to get them stained. Yeah! Something I know how to
do by my self. I reviewed the house rules. She said this hospital is pretty easy going on stain technique use
what you prefer. The Some people here are strict timed staining others are dippers.

9. I went with Amanda’s 20 dips to a container. The Diff- Quik they use are two exact sets, one named dirty for
fecal’s, and the other named clean for blood and urine. The cups contain in order: The Methanol fixative
reagent, which is blue, the eosinophilic solution, which is red, and the basophilic solution, which is deep,
purple. After the slides were dry, I began the process. I start with the blue fixative, the red solution, and then
the purple solution. I rinse gently and leave them to dry. This whole time no emergencies have come in and it
has been two hours. Amanda tells me that if I am ok with out a dosimeter I can assist in x- ray positioning, if I
do not mind the radiation exposure. I tell her I will consider it after I speak to Ame.
It is now 1630 and in thirty minuets I will have to move up to the front of the hospital to the rehab front
desk. I ask if I can help out before I leave. I see that the trash around the ER needs to be dumped and proceed
to hunt for other areas that need the same in the back where dogs stay during the day waiting for appointments
in the Rehab unit. At 1700 I move up to the Rehab front desk and meet Kate.
She is the appointments manager for this area of the Hospital. We speak about what the Rehab side of the
hospital does. There are so many procedures and types of therapy they offer.
I am pretty blown away by the shear variety and what kinds of things are available. Before we get to
really talk too much about any of it, I decide now would be a good time to break for dinner. When I come back
Kate has a list of filing and faxing for me. She shows me how they do these things and I complete my tasks.
Then she has computer next day entries for me, both AM and PM appointments, with files to be pulled and new
procedure consults attached. This takes awhile to complete. Kate’s day comes to a close at 2000, and I am
moved to the Emergency front desk side of the hospital with Ashley. I will remain here for the remainder of the
night. Ashley and I really do not get much time together before a mad rush happens. Three dogs and one cat
come in; all are in very bad shape. I cannot really do much because I do not know the procedures. I ask
continually what can I do to help.
Ashley is swamped with getting these animals triaged, and the paper work started, I do what I can to
accommodate by grabbing paperwork for each and trying to listen to what is going on with their animal. It’s a
mad house. But everyone here is calm and ridiculously fast. I clean rooms and invite clients to sit and wait for
the Vet Tech or Dr. to come. I move back and forth from the front desk to the ER to chase Ashley down or the
Vet Tech to try to find out what is going on. I realize, that all I can really do is help when asked and to try to
stay out of everyone’s way would be the best thing. So that is what I did.
From what I could make out, there was a very old golden retriever that came in first. Her name was
Lucy; the whole family brought her in. Apparently she was on medication for the last few days. What kind I
did not get a chance to ask. But her prognosis was extremely bad, and expensive. The family decided to have
her euthanized. I did not get to help with any of the euthanasia IV’s or dosages, I was not assigned to the ER.
The family of the golden retriever wanted to say goodbye and visit with her after the procedure. This was very
sad to see. But, there is more to come. This evening all four animals brought in were euthanized for various
reasons. There was a poodle named Molly that seemed to have everyone’s attention in the back, a chair had

10. fallen on her head and she was having neurological problems. This is what I could make out from what the Dr.
said very quickly. She was euthanatized after the Dr. explained to the owner what was going on and the
expense. I did not get to hear what was really wrong. When I asked, the ER staff was reluctant to come
forward with information.
The next was a 17-½ year old Chihuahua named Chico. When I finally got a chance to see him, the
owner had already signed off to have him euthanized. He was shaking violently with his tongue out. I did not
get to see him alive again. The last was a blocked Tom named Hanz. He also was signed off for euthanasia.
I at least got to watch him be taped up for his injection and said goodbye.
By the time it was all over and I came back to the ER, there were four dead animals and no one really
wanted to go over what had just happened. I left it alone. Maybe I can address them individually tomorrow.
I wanted to stay but it was 2330. I will have to be back in twelve hours. I tell Ashley I am sorry for not really
being able to help more. She smiled and said, “You did great, you offered those people coffee and tea from the
Rehab side of the hospital, no one here has ever done that. It may not seem like much, but everyone you
offered it to went and got some, so they obviously appreciated it.” I’m glad Ashley thinks I helped, because
I did not.
I’m not weeping or crying about the animals that were euthanized only for the family’s loss. Some of
the family’s did what they could; others just signed off and left their animal alone to die. I understand not
everyone has the stomach for this. But it seemed harsh and I was not expecting the disregard in some cases.
I guess the staff was overwhelmed; they all said the same thing. They have not seen so many animals come in
at the same time with the same ending. As I left I went to each animal and said a small goodbye and reminded
myself that all dogs go to heaven and cats too. As I drove home I felt sad, but remembered that these animals
were no longer suffering, and that is a good thing.
Friday, June 23, 2017 (2300 – 0950)
During this shift it was very slow. We had a dachshund puppy named Misho that could not have been
more than seven weeks, ridiculously cute. The owners told Dr. Armbruster that they think he got into
marijuana, but they were not sure. The Dr. asked me what are the classic signs of this toxicity? I got to work
looking up this information. I came back with this: Whole nervous system depression and derangement. The
animal may display a glassy-eyed look, ataxic (loss of coordination), hyperactive, or comatose, dilated pupils,
bradycardia (slow heart rate), and may have loss of bladder (dribble urine). I gave general treatment information
from the book; it said to induce emesis (vomiting), and gastric lavage.
Dr. Armbruster said yes, exactly, we have done all these things already what next? I told her fluids to
flush the toxins and monitoring? She said yes, sounds like you are putting your observations and knowledge to
work. She went on to explain that when this dog came in initially he had a low temp of 97.30
, she asked me
what is normal? I remembered the hospitals’ TPR numbers. Normal is 99.60
-102.50
, she said ok, now tell me
if puppies can regulate their own body temperature? I said not right away. She said why? I made an attempt to

11. explain that puppies are still developing internally to manage their own body systems. She said yes. Over the
course of the night I was able to obtain three separate accurate TPR’s for Misho, my numbers were confirmed
by another vet tech. Confidence was high! At 0200 Misho had an axillary temperature 101.20
, Pulse 148, and
Respirations 48. At 0300 Misho had an axillary temperature 100.40
, Pulse 132, and Respirations 40. I started
to add in the mucus membranes here, pink to light pink, tacky and CRT 1 -2 seconds. At 0500 Temperature
100.700
, Pulse 160, Respirations 60, MM pink, CRT 1 -2 seconds. At 0700 Temperature 99.60
, Pulse 118,
Respirations 52, MM pink, CRT 1 -2 seconds. The breaks where I did not have numbers someone else had
done the TPR.
I had the chance much earlier in the night to see part of his IV catheter being put in. The two other vet
techs held off for a cephalic with a 22-gage needle. The fluids were called Lactated ringers and the Dr.
prescribed dextrose. They used a machine called a syringe pump. Emma sat me down and asked me to do the
math for the dextrose. The Dr. asked me why were we giving fluids in the first place? I said because the puppy
had been vomiting he was likely dehydrated and puppies require feeding almost every two hours, he really
needs sugar in his system to keep up his strength. She said yes. She said she wanted a total volume of 60 mL
of Lactated ringers with 2 1/2 % solution of dextrose, the dextrose concentration was at 50%. So here is the
math, C1 2.5 % dextrose times V1 60 mL Lactated ringers solution = C2 50% dextrose concentration times V2.
2.5 x 60 mL = 50 x X = 3 mL, she wanted a volume total of 60 mL so I need to subtract the 3 ml from the 60
mL to get a volume of 57 mL of Lactated ringers with 2.5 % dextrose that has a 50 % concentration. Dr. Bauer
would be proud! Dr. Armbruster said good job on the math; we got the same thing.
Some time in the 0300 time frame a Heeler mix dog came in named Dom. When I went in with Emma I
observed the owner and dog together. This male was unaltered and nervous. The owner said he has a healthy
appetite but has not been eating since Thursday night and had large volumes of vomit. She also said he is acting
out of character by snipping at her kids and brother in law. She said he had not gotten into the trash they
looked. Dom does have a history of eating plastic toys though. Dr. Armbruster asked my immediate thoughts.
I said well with all the evidence, I would like to rule out foreign body with x-ray and see what his Chemistry
panel says about any toxicity? She said yes, sounds reasonable. What about Dom’s demeanor and behavior? I
said he seemed nervous and anxious; the out of character snipping at family members makes me think he’s in
pain. He is not eating, also a possible sign of pain? She said maybe, but ultimately yes. She took Emma’s
advice and brought a muzzle in but did not have to use it.
The owner was financially unable to do all of the procedures or recommendations. Dr. Armbruster
wanted to give Zofran IV but gave oral Zofran for the nausea and vomiting and some SQ fluids for the
dehydration because it was all the owner could afford. Dom was trying to burp and was dehydrated from
vomiting earlier. Zofran is the proprietary name for the drug Ondansetron. Here is the Math she asked me to
do. Boy I am getting to do lots of math.
16 mg dose of Zofran and Dom weighs 75 lbs Dosage

12. 75 lbs X 1 kg = 34.09 kg weight of Dom in kg 16 mg = 0.469 mg/ kg = 0.5 mg/kg 1 2.2 kg
34.09 kg
Dr. Armbruster had 0.1 – 1 mg/kg, and said my numbers were with in range.
I was asked to look up a common drug by Emma called Dexmedetomidine. What I found in the
Plumb’s: It is an alpha 2 adrenergic agonist. This means it increases inhibition of the SNS. It induces smooth
muscle constriction and sedation. It acts as an analgesic and is useful for minor procedures like dentals and is
sometimes used as a pre anesthetic. Dexmedetomidine depresses the CNS, GI, endocrine function and
peripheral and cardiac systems. Other effects of Dexmedetomidine; vasoconstriction, bradycardia, respiratory
depression, diuresis (increased production of urine), hypothermia, muscle relaxation, blanched or cyanotic MM.
I used some of the quiet down time to make more blood slides and stain them for tomorrow to look at. For a
quiet night there was still plenty to do and I kept busy with math questions and drug profiles from Emma and
Dr. Armbruster. I like the time to investigate, but really hate the time being flip-flopped. I do not see myself
liking overnights as a full time thing.
Saturday, June 24, 2017 (2300 – 0900)
When I came to work this evening we had a full house. A 10-year-old spayed female dachshund named
Lilly was in for suspected pancreatitis. Lucy was a 1½-year-old spayed female golden retriever hit by a car.
Lu Lu an 11-month-old spayed female Boston mix was in for vomiting and anorexia (not eating). I was asked
by Dr. Armbruster to help with another dog that had come in, she had a mass removal and had ripped her
stitches out. I watched as the Dr. gently cleaned the area and began irrigation to flush and clean out the gaping
hole in this dog’s neck. She asked me to get a stapler to put the dogs torn skin back together. I got it for her
and she began to staple the skin back together, I was really amazed how well the dog took it. I figured the dog
would be fairly angry about it. She really did not seem to mind. I started the first of many TPR’s for all the
dogs that were staying overnight. Lucy the retriever that was hit by a car I was able to get a few for. She was
on a few different drugs and I got to do the math for them, it was after the fact but I got all the calculations
correct. Here goes,
Mannitol: given by Dr. 20% concentration Lucy weighs 60 lbs.
60 lbs X 1 kg = 27.27 kg 1 g X 27.27 kg = 27.27 g this is the dose
1 2.2 lbs 1 kg 1
27.27 g X 100 mL = 136.35 mL volume to be drawn up.
1 20 g
Fentanyl: CRI constant rate infusion dosage given by Dr. 2 mcg. Concentration of Fentanyl 50 mcg
1 kg/ hr 1 mL
Emma asked me what rate can we run Fentanyl at?
I used the metric number I got for Lucy’s weight.

13. 27.27 kg X 2 mcg = 54.54 mcg 54.54 mcg X 1 mL =1.0908 mL or just 1.1 mL
1 1 kg/1 hr 1 hr 1 hr 50 mcg 1 hr
Lidocaine: Given by Dr. 20 mcg. Concentration of lidocaine 2% = 2 g
1 kg/min 100 mL
27.27 kg X 20 mcg = 545.4 mcg X 1 mg X 1 g X 100 mL = 54,540 mL =
1 1 kg /1 min 1 min 1000 mcg 1000 mg 2 g 200,000 min 0.025 mL
1 min
0.025 mL X 60 min = 1.5 mL Emma asked me to change this to per hour instead of per minute.
1 min 1 hr 1 hr
Cefazolin: Given by Dr. 600 mg dose. This medication needed to be reconstituted
100 mg, mix with sterile Saline
1 kg
15 – 35 mg I used both for a range, and the dog’s kg weight
1 kg
27.27 kg X 15 mg = 409.05 mg
1 1 kg range appropriate and within limit
27.27 kg X 35 mg = 954.45 mg
1 100 kg
600 mg X 1 mL = 6 mL volume to be drawn up
1 100 mg
The saline is made a whole vile at a time.
Cerenia: Given by Dr. 30 mg dose, concentration 10 mg
1 mL
30 mg X 1 mL = 3 mL volume to be drawn up.
1 10 mg
Dr. Armbruster asked me to help her with Lucy. She has a large open road rash wound in her axillary
area. We got her to the table and lifted her up to get some light on the wound site for flushing and cleaning. I
held her gently, she really did not mind the attention and the cool fluids felt good I guess.
After the Dr. finished she wanted to do some Laser therapy on Lucy’s wound. I asked what it is and what will it
do for Lucy? The Dr. said Laser therapy is fast becoming the standard of care in most practices and emergency
rooms. Laser therapy is used for after wound care and management; the treatment stimulates mitochondrial
repair and increases mitochondrial growth. The therapy decreases inflammation, swelling and edema. It is a
huge factor for pain management.
Laser therapy can be used to treat osteoarthritis and intervertebral disease. She said out here in Colorado
it is very useful for snakebites. She did say not to use Laser therapy if you know a patient has cancer or tumors,

14. she added that growing animals were off limits too. The therapy increases cell division and that would be very
bad for cancer or tumor patients. Amidst the TPR’s and math calculations I got a chance to do some more
blood slides, practice, practice, and practice! I also observed one of my peers go down in flames. I wanted to
say something but felt it was not my place to say something. Dr. Armbruster had called me over to Lucy’s cage
and told me that she was bothered by something on the dog’s chart. She explained the pain scale they use is
1 – 5. When Lucy came in she had just bee hit by a car and was in a lot of pain, she was a 5 out of 5. After the
medications had time to work, the Dr. said she observed Lucy carefully and she was sleeping and looked very
comfortable. She said so why did this vet tech write down 3-4 out of 5 for the first 4 hours and not say anything
to me?
This is something we can do something about. The numbers the vet tech used were then 2-3 out of 5.
Either the vet tech that wrote this was not paying attention to what she was writing and just threw down some
number to fill the space and did not tell me about it, or the dog was really in that much pain and the numbers are
accurate and she still did not address it with me. Either way she is wrong because she did not come to me with
her assessment. The Dr. called over the vet tech, and asked her why she did not come to her with these high
pain numbers to get it addressed and change the medications to better meet the pain needs of the patient?
Unfortunately the tech said that she wrote down the numbers and that they were there for the Dr. to see, and that
it was still very busy here and everyone had their hands full so she figured that the Dr. would see it and address
it when she saw it. Dr. Armbruster said, this is a teaching moment and that the vet tech should not just put
down numbers and assume the numbers are there for the Dr. to see, I have done my job. Your job is to use the
pain scale appropriately and come to me if you see and animal is in that much pain. I observed Lucy all night
and she was not at the rate you put down, you should have come to me if you really thought she was and you
did not.
The tech was defiant, and repeated her self with more insistence that it was not her fault. Dr.
Armbruster repeated that this was a teaching moment not a time for arguing. That was all, and the vet tech fell
silent and I did not see her for about 3 hours. What I took away from this is, Dr.’s cannot be everywhere and
depend on the vet tech to be their eyes, ears and hands when they cannot be there. Dr.’s depend on our
expertise and knowledge; we are the front line and must be vigilant in our assessments.
Communication with team members and the Dr. is paramount. Every animal that comes through the
door is depending on the vet tech to use all their skill to help with pain and even save their life. If you have a
question, never be afraid to ask, when the time is right. Give your best, and refer to the Dr. and their years of
education and experience, do not play the blame game, own your mistakes and keep on trying to do the job to
the best of your abilities. I was very impressed with Dr. Armbruster’s candor and her compassion for the
animals as well as the staff.
She said she was impressed with my interest in the use of kitty burritos and why this hospital does not
use this technique. She and a few of the other vet tech’s said it is just not really and option in most cases, we

15. just need to get in and get out fast. She said she appreciated me asking, most people do not give cats much
respect and that it was a compassionate gesture on my part. I am very glad that I had the opportunity to learn
how to use this restraint in class; some of the other vet techs were quick to dismiss its merits.
Weekly Report
Week Three July 6th
– 8th
30 hours
Thursday, July 6th
, 2017 (1300 – 2300)
This is what was waiting for me at the hospital when I got there. I got permission from all my clients and
from the staff to take pictures of all the animals I observed. This was just about the coolest, cutest animal I have
had the chance to interact with. A mom and her son brought “Fiona” in earlier on Thursday.
She is about 3 weeks old and was hit by a car and left on the road. Dr. Armbruster said that she my have some
neurological problems and that they were hooking her up with a herd to care for her. I really did not get to
interact with Fiona until much later in my shift. I also realized she is a wild animal that is going back to the
wild and the less human interaction the better. We will visit Fiona later for an update and more pictures.
Ame introduced me to Michael Hernandez; he is one of the HBOT technicians here and has a unique
job. HBOT stands for Hyperbaric Oxygen Therapy. HBOT is considered regenerative therapy and increases
the amount of oxygen able to be carried. The oxygen is driven into the blood plasma not just the hemoglobin.
Oxygen is also driven into the cerebrospinal fluid and lymph fluid. The animal is exposed to 100% oxygen at a
maximum of two atmospheres of pressure; approximately 12.2 pounds per square inch (psi). This means that
the oxygen can penetrate 3-4 times deeper into oxygen deprived damaged tissue. Oxygen deprived areas can
now receive the healing they need. The list of conditions that could benefit from HBOT treatment is fairly long.
This is a sampling from the many conditions that may benefit from HBOT: nerve damage or
degeneration, spinal cord disease or injury, intervertebral disc disease, non-healing wounds due to mobility
issues or friction from brace hardware which can develop into antibiotic – resistant infections, and recovering

16. post-surgical cases like cruciate ligament repair. I only spoke with Michael for a short time before the Rehab
tour. At Fort Collins Emergency and Rehabilitation the other side of the same building they have 5 dedicated
rooms. Three of the rooms are specific for treatment and the others are the HBOT room and a small wound
repair room.
I will go through each of the physical therapy treatments as we move from patient to patient. I also want
to note that upstairs is where I met the Rehab staff I will be working with. I observed the morning client briefing
with Dr. Jordan Sedlacek, Janice and Melissa. They all talked about who was coming in and what the last
treatment was, the pertinent history, if there were any new problems, and what they want to do today. Janice
and I stuck together through most of the shift. Darma was our first patient. She is an eight-year-old black and
white, 120-pound female, Newfoundland. Darma is here because she has degenerative diseases. Elbow
dysplasia and stifle degenerative disease to be more precise.
This is the reason I am here at this hospital and not somewhere else. This is what I observed from the lobby the
day I came in to request an interview. I finally get to see this mysterious and fantastic treatment! Darma is
using the Underwater Treadmill Therapy (UTT) or Hydrotherapy. This type of rehabilitation can be used for
orthopedic surgery and neurologic injuries. UTT helps to maintain strength and mobility in elderly dogs with
arthritis or heart disease. UTT can be part of the overall weight loss in overweight patients, and a quicker more
complete recovery for post surgical neck and spinal injuries.
Hydrotherapy with its reduced gravity environment allows animals to learn to walk again and rebuild strength
after neck and spinal surgery. Even feline patients can benefit from hydrotherapy with or without water.
Some of the listed benefits:
-Reduces pain when walking or standing -Enhances cardiopulmonary endurance
-Reduces swelling in joints -Builds overall strength, Improves balance
-Facilitates use of weak limbs -Decreases muscle spasm
-Improves flexibility

17. For Dharma, it will help with her degenerative elbow and stifle disease by maintaining strength and mobility,
and reduce the swelling in her joints. Janice told me that we will only be covering the physical part of physical
rehabilitation. She said that the drugs involved are a completely separate part of the whole patient care that they
do here and that she would not be able to include this part in today’s caseload. Dharma also received as part of
her Rehab treatment today Platelet Rich Plasma (PRP). I think she received this before I came into the room.
PRP is a procedure where blood is drawn and spun down in a specialized centrifuge. The fraction of the blood
that is rich in platelets, growth factors and monocytes is removed and saved for injection at the site of injury or
pain. Placing high concentrations of platelets at theses sites of injury and damage can mediate inflammation
and expedite healing. Lists of conditions that can benefit from PRP are tendonitis, arthritis, ligament injury,
hip and elbow dysplasia, and muscle injury. For Dharma PRP will help with the pain and inflammation
associated with the degenerative elbow and stifle diseases that plague her.
We moved from the hydrotherapy room to another room for the rest of Dharma’s treatments. Dharma
also received Shockwave therapy. Extracorporeal Shockwave Therapy (ESWT) is primarily used for
degenerative disease (arthritis) and tissue healing. Shock waves are pressure waves delivered to injured tissue
and joints initiating healing. High energy sound waves stimulate cells in the area treated and release healing
growth factors in the whole body that reduce inflammation and swelling. ESWT increases blood flow, help
bones to form and enhances wound healing. ESWT has the potential to reverse joint disease and improve joint
health by improving the health of the underlying bone and helping with regeneration of cartilage. ESWT is
used for both acute and chronic joint disease, tendon and ligament injury, hip and elbow dysplasia, and surgery
recovery. For Dharma ESWT will help with the underlying problem of arthritis by improving the health of the
diseased bone. The painful inflammation triggered by arthritis will also be addressed too. Dr. Sedlacek and
Janice sat down on the floor with Dharma to apply the next treatment. Dharma received Medical Acupuncture
(MA), and Electric Stimulation (E-Stim).
MA and E-Stim are separate treatments but are often used together for a powerful one, two punch. Let

18. us look at MA first. MA uses small flexible needles that are inserted into areas rich with nerves and blood
vessels, muscles that are tight, spasmed, or have formed trigger points. The needle interacts with tissue fibers
that wind around the needle and create a pull and tug on the tissues. A release of numerous types of
neurotransmitters and chemical mediators bring pain relief both locally and at distant sites. There is also a
cumulative effect that decreases chronic pain and windup pain type syndromes.
Windup pain: Wind-up pain is one of the hallmarks of the neuroplastic (neuroplasticity allows the
neurons in the brain to compensate for injury and disease) changes that create persistent pain. Persistent pain is
not just a longer lasting acute pain. Wind-up can happen anywhere in the spinal cord or brain. The pain signal
that comes into the central nervous system becomes stronger and longer lasting. This is a physiologic process
that involves activation of receptors that are normally dormant on postsynaptic nerve endings. The result is that
the nerve fires more frequently and with greater strength. It also means that the nerves fired this way keep firing
even without an ongoing stimulus. Hence animals may heal, but the pain circuit remains activated and are seen
as hypersensitive.
Compounds released after insertion of an acupuncture needle also stimulate the nerves themselves
helping to restore function in diseases that cause weakness, paralysis, or incontinence. Early and frequent
acupuncture treatment can speed neurologic recovery and help with severe pain. MA can mediate visceral
organ function and immune function. The variety of needle size, coating and handle type and are specifically
chosen for each patient. Most patients tolerate MA well and can experience significant relaxation and pain
relief. MA can even be applied in an ER setting, to help with appetite, pain management, surgical recovery,
organ dysfunction and even resuscitation. MA is used to treat severe pain (chronic, acute and post-operative),
neurologic disease (disc disease, spinal cord trauma), orthopedic disease (arthritis, CCL-cranial cruciate
ligament tear, fractures), visceral organ disease (kidney failure, liver disease, pancreatitis), and immune-
mediated diseases (allergies, cancer). Dharma will benefit from the restorative effects for her tight trigger points
and her wind up pain and dysplasia will be diminished.
Dharma also received along with the MA, E-Stim. E-Stim is the application of a gentle electrical
current between two acupuncture needles or (pads on shaved skin). Typically the current will be placed to
travel along a specific nerve tract or muscle belly. I said before that this treatment, and MA can and are used in
conjunction and may prolong the effects and benefits of MA. Treatment of acute and chronic pain can both be
treated with fine adjustment settings on the E-Stim. There is an increase in the release of neurotransmitters like
endorphins, opioids, serotonin, and norepinephrine; these are the body’s healing and pain relief apparatus. This
extra stimulation will speed healing for both of Dharma’s type of pain from the degenerative diseases in her
elbow and stifle.
The next patient was a seven-year-old black, shepherd-mix dog named Tucker. Tucker was in today for
stifle pain from CCL (cranial cruciate ligament) surgery and back pain.

19. Tucker received UTT, MA only, and Laser treatment (LT). LT utilizes photons of light delivered
directly to the tissues to improve neurologic function, heal wounds, decrease swelling and reduce pain. LT
interacts with the mitochondria and affects the electron transport chain. This increases the cell production of
ATP, the cells main energy source. Treatments can improve blood flow, decrease inflammation, and provide
analgesia (pain relief) to treated areas. Conditions that are treated with LT include osteoarthritis, joint pain,
spinal cord injuries, rattlesnake bite, muscle tension/trigger points, and wound care.
These combination treatments will stimulate pain relief, postoperative recovery- rebuilding strength and
flexibility; promote nerve restoration and function for Tucker.
The next patient stole my heart, a two-year-old female pug named Ruthie. She is here for Rehab treatment of a
congenital defect, bilateral luxating hips.
Janice has my dream job! How cool is this?
Ruthie’s Rehab treatments are UTT, companion LT (uses a smaller focused beam, no need for cool sunglasses
because the pulse is slower), and therapeutic exercises. The UTT Ruthie is receiving will help her build
strength and keep her mobility up. The LT will help decrease pain and swelling and improve blood flow to her
hip joints. From here I will use the acronyms or treatment names to shorten my report.

20. I will briefly discuss each patient and their reason for treatment and which treatment was used and what it will
help the patient with.
Cool concept/word: Proprioception from Latin proprius, meaning "one's own", "individual", and capio,
capere, to take or grasp, is the sense of the relative position of one's own parts of the body and strength of effort
being employed in movement. Another cool concept/word: Kyphosis from Greek kyphos, a hump is an
abnormally excessive convex kyphotic curvature of the spine as it occurs in the cervical, thorasic and sacral
regions. (Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called
Lordosis.) Kyphosis can be called round back or Kelso's hunchback.
Janice asked me what these words meant, had to look it up. She asked me how you can tell if an animal
is in pain, and what are the physical characteristics. I remembered the CSU pain scale that I received in our
Humane Treatment and Handling course. An animal in pain may react to tender areas being touched or
palpated, may have a worried expression, and may not want to interact.
The animal in pain may lick the site, and flinch or pull away from handling. Janice said that some of the
patients who come in display certain deficiencies or exaggerations of one or both of these things.
The next patient was a five-year-old male Rottweiler named Otis Blue. Otis is in for a disc injury and
the pain associated with this. His Rehab treatments are UTT, MA, and LT.

21. I just have to say Otis was a champ through this treatment and even though he was in quite a bit of pain,
Dr. Sedlacek was able to help relieve his discomfort. Dr. Sedlacek allowed me, with the client’s permission to
touch the patient before treatment and after. There was a huge improvement, Otis was knotted up and tight in
areas where the Dr. had me touch and then she did the MA and after the same areas were much looser and less
tight. As you can see Janice applied the LT during the MA. There are three more patients I could cover but
for time and space I will put them on another day. I moved into the ER at 2000 and I wanted to share the wild
deer photos and a few gory details. There really was not much that Dr. Armbruster could tell me about Fiona.
Just that they had her on fluids and were trying to get her to drink some goats milk.

22. How cute is this? The Dr. is trying not to let the deer lick her on the mouth. She is also wearing gloves because
of the large parasite load that was found, many were removed, but many still remained.

23. Tell Stacy; I almost asked if I could take these for her.
The rest of the night was pretty uneventful, I got to assist with a standard poodle who had just had
surgery for GDV (Gastric Dilation Volvulus) and was having diarrhea. I did learn the difference between where
diarrhea comes from. Pierre was straining a considerable amount, with very little volume. Dr. Armbruster said
this is because the feces is coming from the large intestines. If it was no straining and there was a large volume
the feces would be coming from the small intestines where it is actively being made.
Friday, June 7th
, 2017 (2300 – 0950)
Ame asked me last minuet to change my arrival time to 0800 instead of 0700, I was secretly grateful.
She and I did some math for Jack, a three year old, male Great Pyrenees /lab mix. He came in for vomiting and
diarrhea, and was given 1000 ml of SQ fluids (lactated ringers) with an 18-gauge needle, and a macro-drip set.
He also received Cerenia tablets (Maropitant Citrate), Propectalin tablets, and Trazodone tablets.
Dr. Wright prescribed:
60 mg of Cerenia PO Q 24 hours for three days, Cerenia comes in 60 mg tablets.
One 60 mg tablet of Cerenia every 24 hrs for three days = 3 tablets for three days.
Three tablets of ProPectalin PO Q 8 hrs for three days = 27 tablets for three days.
Three tablets per 9 kg every 8 hours, Jack’s weight is 86.7 lbs, 86.7 lb X 1 kg = 39.40 kg
1 2.2 lb
39.4 kg = 4 tablets (Dr. Wright decided to give 3 instead) every 8 hours,

24. 9 kg
3 tab X 24 hr = 9 tab
8 hr 1 day 1 day
9 tab X 3 day = 27 tablets for three days.
1 day 1
100 mg of Trazodone PO Q 8 hrs for three days, Trazodone comes in 100 mg tablets.
1 tab X 24 hr = 3 tab 3 tab X 3 day = 9 tablets for three days.
8 hr 1 day 1 day 1 day 1
One 100 mg tablet every 8 hours, three tablets every day. 9 tablets of Trazodone for three days.
Ame and I took a break and I asked to help Dr. Jensen with his cat. Raya is a 10-month-old domestic
shorthair in for vomiting and diarrhea. She is fractious and needs to have her catheter removed. I asked to
assist in restraint, but Dr. Jensen brought out Raya and showed me a classic kitty burrito with the cathetered leg
sticking out. He asked me to cut the bandage and remove the catheter. I did pretty well up until I had to pull the
tape and catheter off together, this being my first time, I was hesitant and was trying to gauge how to do it. I
suppose my hesitation was viewed as fear, Dr. Jensen asked me to treat it like any other band aid and just pull it
off fast. I pulled too slowly and he grew impatient, asked to switch palaces and he pulled the catheter and tape
all together and it slipped out and off quite easily. I felt a little ashamed and disappointed in myself. I think I
could do this procedure now that I have seen it done and felt what the tension of the tape and catheter feel like.
The rest of the day and afternoon went on similarly. I was asked to do a fecal float for a dog, and forgot
exactly all the details of how to do it. I did not know the hospital’s protocol or where to find all the supplies.
When I did get the supplies, I still needed help to perform the procedure. Again, I felt ashamed and
disappointed in my ability to remember what Stacy taught me. I did some more math on Pierre the standard
poodle with the GDV surgery from last night. Pierre weights 30 kg and received Fentanyl in a CRI (Constant
Rate Infusion) at
2 mcg
1 kg/1 hr
The concentration for Fentanyl is 50 mcg per 1 ml
Cody is another Vet tech here and helped me with the math.
30 kg X 2 mcg = 60 mcg mcg dosage, he told me he wants it in ml
1 1 kg/hr 1 hr
60 mcg X 1 ml = 1.2 ml this is the ml dose volume
1 hr 50 mcg
Dosage

25. 15 mcg X 30 kg = 450 mcg mcg dosage 450 mcg X 1 ml = 9 ml ml
1 kg/hr 1 1 hr 1 hr 50 mcg 1 hr
I did a lot more math for example cases that Ame walked me through.
Lucy the dog weights 15 kg and needs 2.2 mg of Rimidyl PO Q 12 hr for 5 days, Rimidyl comes in 25 mg
tablets 1 kg
2.2 mg X 15 lb = 33 mg this is a calculated dose.
1 kg 1
Because Rimidyl comes in 25 mg tablets that have scoring we would use one and a half tablets to give a total of
37.5 mg, half of 25 is 12.5 + 33 = 37.5 mg.
37.5 mg X 1 tab = 1.5 tab X 24 hr = 3 tab 3 tab X 5 day = 15 tablets
1 25 mg 12 hr 1 day 1 day 1 day 1
But Ame says this dog has a preexisting liver condition.
Let’s just drop 37.5 mg and stick with one 25 mg tablet.
25 mg X 1 tab = 1 tab X 24 hr = 2 tab X 5 day = 10 tablets
1 tab 25 mg 12 hr 1 day 1 day 1
It was very slow with two patients Pierre and Raya; I think everyone was a bit stir crazy. When
Jellybean the pit-bull came in, I definitely felt like a fifth wheel. With five techs and one dog it seemed
everyone was jockeying for position. I offered to help with restraint with Jellybean, who was obviously pretty
strong and they needed a third person to help. I said, I can help out here guys, I squatted down and reached out
to hold Jellybean’s backend. I was told by the two techs that were wrangling the dog, no thanks we will just use
the wall of the counter to back him up into instead. I thought that seems strange. I tried to reassert, and moved
to assist and was physically cut off. Instead of pushing my way in or arguing, I just stood back and watched.
Dr. Wright told the techs to get an IV catheter in and get Jellybean up on the counter with some oxygen.
I tried to move to the drawer with the catheters to retrieve one and wanted to ask what size before I grabbed.
Before I could get to the drawer, two other techs were already in the drawer and setting up the tape and
supplies. I said hey guys, can I restrain while you put in the catheter? I heard someone say, nope we got this. I
asked what size catheter are you using and why? I guess no one heard me, and my question went unanswered.
I decided to do what I could to help. Jellybean was cathetered and up on the table with oxygen. Dr. Wright had
a ultrasound machine and was tracing Jellybeans shoulder joint. She said the owner thinks her dog is in
significant pain, and I am obliged to agree.
Dr. Wright wanted blood to be drawn, to be spun down and the serum plasma to be separated to inject

26. back into Jellybean’s very sore shoulder joint plus her rhomboids and supraspinatus. Because the owner cannot
afford he PRP (Platelet Rich Plasma) procedure, Dr. Wright said this is the next best thing she can do for the
dog. This was a fascinating procedure to watch. I walked over to the centrifuge and observed the Vet Tech and
she said when the timer goes off, wait until it finishes spinning and bring me the tube please. I diligently waited
and brought her the tube, I watched her draw off the serum and hand it to Dr. Wright. The Dr. began injecting
at specific points in the shoulder joint.
I admit I could not really understand what I was looking at on the ultrasound. I asked one of the Vet
Techs if she knew what this procedure would do for Jellybeans’ pain, and how long he effects would last? She
said she did not know. Dr. Wright chimed in and said the effects would last less than the PRP procedure, but
Jellybean would get some much needed relief and the effects would last about 2 -3 weeks. I thought how cool
is this? After Jellybean came out of the sedation, and was checked out back to her owner, there were no
patients admitted for the rest of my shift. I reflected on my inaction, and hesitation.
It had brought about a feeling of disappointment and was tearing down my confidence. How can I
change this? I am not sure how to approach the other Vet Tech’s when I am the source of my problem. I
cannot remember how to do things, and feel strange asking to do them and then asking for guidance and help
doing them. I used the remainder of my time to look over some of the Rehab patients from Thursday.
Moose is an eleven-year-old male, lab mix in for Rehab treatment post surgery. He recently had FHO
surgery, (Femoral Head Osteotomy). He has hip dysplasia and is in pain from both. His Rehab treatments are
MA with E-Stim, LT, and manual massage. The MA treatments should bring significant relief from the pain
associated with the surgery and help restore function in his hip with dysplasia. The E-Stim will help prolong the
benefits of the neurotransmitters that are released like norepinephrine and endorphins. The LT will improve
blood flow to the area, and reduce inflammation associate with both problems. One more interesting nugget, Dr.
Sedlacek said that after this type of surgery (FHO), dogs can regenerate a new synovial joint capsule with
synovial fluid. I’m pretty sure my jaw was in my lap. How amazing is this? I am completely inspired by this
information. I want to know how dog’s can do this! I will have to save it for the next time I see Dr. Sedlacek.
Saturday, July 8th
, 2017 (2100 – 0700)
The dreaded graveyard shift, this is my last one. This shift was also very slow with too many Vet Techs.
I decided to immerse my self in one of the cases that was here when I came in. Dixie is a fourteen-year-old
female Lhasa Apso poodle mix; she is in because she is having difficulty breathing. I got to listen to her heart
murmur. Dixie’s murmur was very distinct and defined thump, thump, and whoosh. Dixie’s x-rays reveled her
heart is enlarged, she has fluid around her liver and her lungs were significantly filled with fluid. This dog has
alopecia and a swollen abdomen and is in bad shape. Dr. Mc Grath had put on Dixie’s chart “Suspected
pneumonia and Suspected Cushing’s”. I wanted to know more about Cushing’s so I spent a significant amount
of time looking up what it is and used the numbers from Dixie’s chart to serve as evidence.
Cushing’s is hyperadrenocorticism secondary to excessive pituitary excretion of adrenocorticotropic

27. hormone secretion of adrenocorticotropic hormone (ATCH) from the pituitary gland. I speculated it may
actually be a faulty release of corticotropic-releaseing factor (CRF) from the hypothalamus or a functional
tumor, it is usually corticotropic adenomas. It could be a tumor of the adrenal cortex itself, causing hyper
secretion of the glucocorticoids. Iatrogenic Cushing’s syndrome resulting from excessive or prolonged
administration of exogenous glucocorticoids. Iatrogenic- Caused by the treatment given by the physician, gave
glucocorticoids for anti-inflammatory pain relief. Exogenous- Originating from outside the body.
Cushing’s disease manifests symptoms like alopecia, pendulous abdomen, polyuria, polydipsia,
polyphagia, muscle weakness and atrophy (clue 1). Dr. Bauer said these dogs look like Homer Simpson, bald
and have what looks to be fat bellies. The Cushing’s response is increased intracranial pressure. This causes
decreased cerebral blood flow, which leads to systemic hypertension (to maintain cerebral blood flow), are a
reflex bradycardia and respiratory depression, (clue 2) Dixie came in with respiratory problems. I used Dixie’s
chemical and blood panel as a sort of map of clues to guide me to the same conclusion that Dr. Mc Grath
diagnosed.

28. Here goes from the book.
Most dogs with increased glucocorticoids develop a stress leukogram (clue 3). It is characterized by:
1. Neutrophilia - A high number of neutrophils (clue 4)
(Without a left shift) in Dixie’s case there was a significant left shift (clue 5)
2. Lymphopenia - Low lymphocytes (clue 6)
3. Eosinopenia - Low eosinophils, Dixie was barley WNL
4. Monocytosis – Increase in the number of monocytes (clue 7)
Left shift – A high number of young to very young WBC present in the blood. It means there is an infection or
inflammation present and the bone marrow is producing more WBC’s and releasing them into the blood before

29. they are fully mature.
The dog will show increases in serum alkaline phosphorous (ALP) (clue 8). This is due to induction of a
glucocorticoid isoenzyme (a hyper glycosylated form of the intestinal isoenzyme unique to dogs).
Isoenzyme – Enzymes that differ in amino acid sequence but catalyze the same chemical reaction.
Mild increase in Alanine Amino Transferase (ALT) attributed to hepatocellular leakage and cell swelling or
minor necrosis (clue 9).
Mild to moderate increases in cholesterol, increased lipolysis (clue 10).
Lipolysis – The breakdown of lipids and involves hydrolysis of triglycerides into glycerol and free fatty acids.
Alterations in glucose metabolism.
Blood Urea Nitrogen and Creatine concentrations are low as a result of diuresis (clue 11).
Diuresis – Increased production of urine.
Hypophosphatemia- An electrolyte disturbance in which there is an abnormally low level of phosphate in the
blood (clue 12).
Mild decreases in potassium concentrations can occur.
Serum Bile Acids mildly elevated.
When primary liver disease is considered a major differential diagnosis, this finding together with an elevation
in liver enzymes points to Hyperadrenocorticism. Dixie had other alarming numbers in her panel as well. She
had an extremely high (PLT) platelet count; this leads me to believe she is fighting infection or inflammation.
All numbers from Dixie’s blood and chemistry match up with the explanations listed in the book I studied. I
have tagged each with a clue. With twelve pieces of evidence I think I would concur with Dr. Mc Grath’s
overall diagnosis.
Around 0400 a pit bull mix dog named Bodie came in with a 2-½ inch gash on his back. I suspect it is
on T13 or L1. I assisted in Bodies wound wash, drain and suture. Dr. Mc Grath had two other Vet Techs get
him sedated, I tried to help in anyway I could. He was very nervous and fearful. Once he was sedated I was
able to help get him to the table and assist with the oxygen and got to put drops in his eyes to keep them moist
during the procedure. Dr. Mc Grath was very thorough with her debridement and wash of the inside of the
gash. Bodie received Butorphanol and Dexmedetomidine and he also received Antisedan. Here is the math:
Bodie weighs 23.9 kg; Dr. Mc Grath prescribed 0.2 mg/kg of Butorphanol and 5 mcg/kg of Dexmedetomidine.
Butorphanol concentration 10 mg/ml
23.9 kg X 0.2 mg = 4.78 mg dose 4.78 mg X 1 ml = 0.478 ml volume
1 1 kg 1 10 mg
Dexmedetomidine 0.5 mg/1 ml

30. 23.9 kg X 5 mcg =119.5 mcg dose 119.5 mcg X 1 mg = 0.1195 mg volume
1 1 kg 1 1000 mcg
0.1195 mg X 1 ml = 0.239 ml volume
1 0.5 mg
To bring Bodie back from sedation the drug Antisedan was used with same volume as the Butorphanol volume.
I reflected on my shortcomings quite a lot during this shift. I understand that the Vet Tech’s here are not
students or teachers and are not here to teach me what I should already know. I need to step up my game and
not be afraid to make a mistake. I should be looking at the charts more and just do what I know. I think I
should go in with the Vet Tech’s to the exam rooms, this where I seem to be loosing the ball. They emerge
already with a firm grip on the situation and the animal. I feel a bit defeated but I am determined to Rally!

31. Conclusion
I have been so fortunate to have the opportunity to intern at FCVERH. The staff and everyone there
made me feel welcome and challenged me to rise to the occasion. There is no chance I cannot mention my
favorite parts of this internship were in the rehab side of the practice. Being able to watch Dr. Sedlacek,
Melissa and Janice work with the animals in the rehab center was definitely the high light of the internship for
me. They are my heroes, as well as the amazing animals they work with.
I also must mention a few key people who were great mentors and whom I could not have accomplished
my internship without, Amanda “math” Duty, Dosia, Dr. Armbruster and Stacy. Each of these people
committed themselves to being a good teacher and pushed me to look closer, dig deeper and try harder. I think
of myself as a good teacher. I can recognize and appreciate their professional attitude and sense of duty to help
a struggling peer. It goes without saying that if I am ever in the position to do what they have done for me, I
will try to emulate their example and extend a helping hand.
Because of the incredible experience at FCVERH I will continue to strive for a deeper answer to my
questions and seek those answers out. I will also try to carry the optimism and kindness they showed to me into
my dealings with people I work with. I also have a new healthy understanding of what it will take to make it in
this demanding career choice. Politics are for politicians; as I suspected there is no place for politics in the
classroom or on a team. I feel ready for the next step in my education to be a Veterinary Technician.
I know Kim had reservations about my internship at this particular place. I did too after a few hard days.
But, anything you want badly enough, is worth fighting for. I did have to fight, but it was worth it. What an
experience! I’m glad I trusted my self and committed to something that was not easy. It makes it all the
sweeter, knowing I made it.
Thank you Kim and all my teachers at Front Range for kicking this old Marine’s booty and believing in me,
even when I did not.