Chad #14 2019
The X-ray machine I brought is working great. The pictures are good quality. I do worry about the cords that are attached and constantly being moved, as I expect them to break at some point and not work anymore. A charging DR plate with wifi would be awesome but that is likely 40,000 to $60,000 and would require new software too. So we will see how long this one lasts and get new cords when needed. One is like a long USB printer cord, and the other is the Naomi power cord. Today we did X-rays of a woman with 3 months treatment of TB looking for residual disease and she had some residual TB in an upper lobe. Another was a woman who had been in a moto accident and was having some abdominal pain. I told them an ultrasound was the answer we had, but they wanted an x-ray and as expected was normal. Then there was a man who had been in an accident with finger pain, who had evidence of an old fracture. Apparently one of the hospitals about an hour away in Lai doesn’t have X-ray either. So now they will be sending all their patients to us to take them.
We put off some surgeries today as Olen, Denae, and I were all having diarrhea. Sarah, Gabriel and Stacey had it the week before, so I’m not sure if we got it from them or from eating at the elders house after church the last week, as they didn’t eat there.
I find amusement out of peoples reactions on Ketamine. Often there are different facial contortions people make and sometimes sounds too. Often these sounds are yelling someone’s name repeatedly, or talking randomly. We had a woman recently coming out of anesthesia from ketamine who started singing hymns. It was in Nangere so I didn’t know the words but some of the tunes I recognized. I asked the nursing students if she was making sense. They said she was singing perfectly. Often we call in a family member into the preop/postop room, to watch the patient so they don’t sit up and fall off the stretcher. So this woman’s husband was called in. We explained that she didn’t know what was happening and that he needed to watch her. A short time later as she sang with a loud voice he joined in and they sang hymns together. They did this for many songs, until she was wheeled back to the surgical ward. It was so joyful and pleasant, it made my day! I’ve not seen anyone else that came out of ketamine singing.
Stacey asked if I had any vet friends. I said Audrey does, what’s up? She wanted to spay her cat and Sarah wants hers neutered. So I offered my services. I’ve done our cat in Cameroon with a vet, and I’ve spayed two dogs as well. And neutering, I figured, I can definitely do that! I’ve done that for men, and well, I guess I’ve done the surgery for women as well- but a bit different in a cat. So Stacey and Sarah purchased the supplies needed and we headed to their house to make their animals sterile. I warned them that my concern was the sedation needed. How much Ketamine is needed? I remembered that it was the same as humans and Stacey was able to figure it out. We held the male cat and shot him in the muscle with ketamine- he made a horrible sound and then looked drunk shortly there after. Not enough. So we gave another half dose and waited another 15 min. Still he just sat there with his head wagging back and forth as if he was a live bobblehead! We gave another half dose and with each one he made a terrible meow! After about 5 min, we put him on his back and put a clamp on the scrotum, the bad meow again. So we gave him the “full” dose again.
I want to give a brief background why I’m hesitant to sedate cats up till now. When we were in Cameroon, Audrey was back in the US with her mom who was dying of cancer. I was back in Cameroon and Audrey’s favorite cat became sick and was having diarrhea, and eventually got so dehydrated that he couldn’t walk. I had one of the nurses come to our house and try to start an IV in the cat. It worked for a second then with the cat thrashing about it came out. I decided the only way I could hydrate the cat was to sedate it first. I called the local vet, who only treated local cow diseases, I thought. He said that he knew how to sedate a cat with Ketamine. So he drew up what was much larger a dose than for a human. I told him my surprise that it would take more than a human, and he said that’s the normal dose. I didn’t know any better and I know that different sized creatures have different metabolisms, so a smaller animal has a faster heart rate… maybe they require more ketamine. So he injected the cat into the muscle. In about 2 minutes he was calm, then stopped breathing. I was frantic, this was Audrey’s favorite cat, I didn’t want him to die. I exclaimed that he gave to much, and he calmly says, oh it’s OK, they always do that then start breathing again. Well, he didn’t, and I found myself giving mouth to nose respirations on Tiger for about 30 minutes before I finally gave up. So my hesitation about sedating the cat and giving small doses repeatedly.
So this stripped yellow cat is finally asleep, tongue out a little, eyes wide open and fully dilated, and breathing. I clamp his scrotum and no reaction. I prep him with betadine, though I believe vets have told me that sterility is nearly impossible and really doesn’t matter (I hope to confirm that again when I get back). I pull the testicle down and choose a place to cut. We briefly considered shaving, and then realized that seemed impossible. I cut down onto the testicle. I expressed it through the incision and then, clamped, cut and tied off the vessels. I got the other testicle to the same incision and did the same. Then I sewed up the skin. He was wrapped in a towel to stay put and we got the female cat.
I recall that the female cat uterus seemed long as well as the fallopian tubes, compared to a human, so I planned a higher incision. We went through the same halting, repeat injection of ketamine for this cat as well, and eventually were successful with a sleeping, breathing cat. I shaved her belly in the lower area and made my incision. WOW cat intestines are tiny compared to humans. I searched and searched for the fallopian tubes. Hmmmm, I must have forgotten the technique on grabbing them, I say. Eventually I am able to sweep them up and take off the tubes and the ovaries. The two cats didn’t eat or drink that evening. The next day the male cat was back to normal, and the female was subdued and ate a little, so was on the mend. A successful day in the home OR.