A Special Student

-"Are you a vet student from NC State?"

-"No - I am just a high school student taking a gap year before university."

- "Really! I would never have guessed...."

And thus my externship began at TVRH, and not once have I regretted my decision to spend a year under the guidance of Dr. Grafinger and his admirable team.  Spurred by my interest in biology and medicine, I began shadowing Dr. Grafinger in May 2012 during my senior year at Durham Academy.  Keen on learning how medicine and science are truly applied in the world around me, I viewed shadowing at the hospital as a way to explore the realms of emergency surgery while gaining work experience with animals and exposing myself to the atmosphere of an emergency hospital.  Barely eighteen and inexperienced in the field, I knew that to be granted such a special opportunity was rare and invaluable.  Dr. Grafinger took a risk by allowing someone as young and untrained as myself behind-the-scenes in such a hectic and unpredictable field, and, everyday, I hope that he and his team have not been disillusioned by their choice. 

From the moment I began working with the vets and techs at TVRH, I have felt welcomed in every single way.  Rather than viewing me as an intrusion or burden, everyone at the vet has embraced my presence and demonstrated kindness, sincerity, and patience - qualities that I have found absolutely priceless.  Knowing their willingness to help me understand, I feel free to ask questions without the worry of being judged or criticized for my ignorance.  Even when procedures are so new to me that I am at a loss of questions, I have found that simply watching in silence can be the most valuable way to learn.  Thus, whether shadowing in surgery or helping to restrain an animal, I experience everything as though I were a student with a personal mentor; from the preparatory work of anesthetics and sterilization to the actual incisions and operations, I am continually exposed not only to various techniques and procedures, but also to the importance of teamwork and trust between colleagues, and the dedication and strength required to work under demanding conditions.

By the time June arrives and it is time for me to leave, I will have learned so much more than anyone will ever realize.  Every day, I think to myself how thank you seem such empty and lifeless words compared to the gratitude I feel towards everyone at the vet, and I wonder how I will ever repay everything that I have received over this wonderful year.  Yet, for now, I will let myself relish every priceless moment I spend with TVRH because, thankfully, I know I still have many months ahead of me. 

-Simone Robinson

Vet Tech Week

We all come from different backgrounds, different places….but chances are we were the little kid who loved animals and were always trying to bring home another one, even the sick ones, because we wanted to make them better.  We are veterinary technicians, veterinary assistants, animal health care workers….whatever the title, we are caregivers.  We are the ones who care for your pets when they are in the veterinary hospital or clinic. 

Most people don’t really know what a veterinary technician does.  What you see is not necessarily what you are getting.  You may think we just hold animals, or take temperatures and weigh them…..but what goes on behind the scenes is what makes us who we are.  We are nurses, phlebotomists, anesthesiologists, surgery assistant’s lab technicians, x-ray technicians, pharmacists, client educators, nutritionists, cage cleaners, groomers, a warm touch when they are scared.  We often work long hours, staying late when we’re needed, we often think about our patients even after we’ve left work.  We are the ones who keep them healthy and nurse them back to health when they are sick or injured.  We get attached to them, we get excited when they get better and we are sad when they don’t. 

It doesn’t matter what part of veterinary care we are involved in, zoos, academia, research, small animal, large animal….. we all want what is best for them.  We all want to make a difference and help provide the best quality of life we can for our fuzzy friends and regardless of how many backaches, headaches, or heartaches we endure in our challenging job, this is still such a rewarding career.  We love what we do.  We take pride in our work and truly enjoy being caregivers for your pets.  We are veterinary technicians.

-Michelle Schoepper, RVT

Dr Grafinger's Sea Turtle Adventure

damaged right front flipper

damaged carapace

I was recently invited to NCSU school of Veterinary Medicine to perform surgery on a Loggerhead sea turtle rescued off the coast of North Carolina.   The sea turtle had a crushing injury to her carapace and a severely lacerated right front flipper.   Her carapace or shell injury was the likely result of a boat collision.  Her flipper laceration was secondary to becoming entangled in a crab pot line.  The turtle’s name is Nichols and she was rescued by the Karen Beasley SeaTurtle Rescue and Rehabilitation Center.

The Karen Beasley Sea Turtle Rescueand Rehabilitation Center (KBSTRRC) is a nonprofit organization staffed by volunteers lead by Jean Beasley, in Topsail Beach, NC. Their mission is to successfully rehabilitate and release injured or sick sea turtles from the wild.  Since 1996, 152 sea turtles have undergone successful rehabilitation at the center and have been released. Currently, the Karen Beasley Sea Turtle Rescue and Rehabilitation Center has the capability to treat and care for ~15-20 injured or sick sea turtles at one time.   They are currently transitioning into a new facility where they can house and treat many more injured turtles.  The facility is now under construction.

The most common sea turtle species found off the coast of NC include: Loggerhead (Carettacaretta), Green (Chelonia mydas), and Kemp’s Ridley (Lepidochelys kempi).

Kemp's Ridley

The Kemp’s Ridley is considered the world’s most endangered sea turtle, and has been listed as an endangered species since 1970.  An adult Kemp’s Ridley measures 24 to 28 inches (62-70 cm) in carapace length and weighs between 77 and 100 pounds (35-45 kg).  The Kemp’s Ridley is the smallest of the local N.C sea turtles.

Green

Green sea turtles are another endangered species found around the world.  They nest in significant numbers on the east coast of Florida, as well as NC. The green turtle is the largest member of the Cheloniidae family. An average adult female green turtle can have a three foot carapace length, and weigh close to300 pounds. The largest green sea turtle ever found was an adult male with a carapace length over 5 feet.

Loggerhead

Loggerhead sea turtles are the most prevalent species in NC waters and they are the most common species treated at the Karen Beasley Sea Turtle Rescue and Rehabilitation Center. While all other species of sea turtles found near the U.S. coastline are listed as endangered, the loggerhead is classified as threatened.  Adult loggerheads weigh up to 350 pounds when fully grown, with a carapace length of ~32 to 41 inches long (82-105cm).

Sea turtles spend the majority of their life in the ocean, and only come ashore when they are nesting or sick/injured.   They are often injured by boaters, because sea turtles must surface to breathe.   In NC, boating injuries seem to be most prevalent in the late spring to early fall.  Female turtles migrate closer to shore to nest during this time.  Boating accidents frequently result in severe carapace or plastron fractures, flipper lacerations, head trauma, etc.   Turtles also frequently become entangled in fishing line, crab traps, rope and fishing nets, which can result in severe lacerations or even amputations of flippers.    

Complete or partial flipper amputations were the most common forms of treatment for severe flipper lacerations in the past.   If the amputee is a male sea turtle, the prognosis for losing a rear flipper is better than losing a front flipper since they hold onto females during breeding. On the contrary, females are better off losing a front flipper since the rear flippers are essential for digging nests in the sand.   Female turtles can not dig a hole of appropriate depth with only one hind flipper.  It has been shown that navigation and swimming is not affected by the loss of one flipper.   

I have been involved in multiple surgical sea turtle procedures for KBSTRRC.  Shell or carapace fractures are treated by stabilizing the shell with stainless steel plates and screws.  Many times the broken shell becomes nonviable or necrotic and is debrided along with dead soft tissue.  Overtime the healing new shell and soft tissue fill-in the space.   Head injuries are also addressed by repairing associated soft tissue or applying bone plates to the skull.  I have also repaired or salvaged severe lacerations in these turtles instead of complete or partial amputations.   Primary repair of a severe flipper laceration gives the turtle the best chance of success once released in the wild to nest or breed.  It is probable the same turtle could have another injury to a flipper over time. 

I have reconstructed two flippers in Sea turtles in the past.  I repaired a near full thickness back flipper laceration on a Loggerhead turtle (Bunswick II) who was completely rehabilitated.  He was released approximately 1 year post-injury with nearly normal flipper function.    A partial amputation was performed on a Kemps Ridley sea turtle (Briggy) because the end of the flipper could be preserved.  However I used some of the viable skin to create a skin flap to reconstruct the remaining flipper.  He was rehabilitated and released nearly a year later as well.   Both cases were reported in the Journal of Zoo and Wildlife Medicine in 2009.  The journal discusses each case in more detail, and is listed below.

I recently repaired Nichols flipper laceration in the same manner as Brunswick II. His bones were pulled together with suture (Toggled) and then the soft tissue was repaired. My counterpart in surgery Dr. Roe debrided and cleaned his Carapace injury. The carapace wound will be allowed to heal by second intention (allow his body to repair the wound over time). Last report is he has been doing well. However, some of the sutures have loosened which toggled his bones back together. I suspect it will continue to stabilize with scar tissue over time, and hopefully he will be released as well. 

Simon and Grafinger viewing CT results

CT of flipper

Nichols after surgery

You can check on status of Nichols if you visit the www.seaturtlehospital.org website; just click on Nichols.   You can also review past histories of the other turtles rehabilitated (Briggy, Brunswick II, etc.).  Consider adopting a turtle and contributing to the sea turtle hospital by volunteering or making a financial donation.    They do wonderful work and continue to give each and every sea turtle a fighting chance. 

-Mike Grafinger, DVM, DACVS

BAKE SALE!!

TRIANGLE VETERINARY REFERRAL HOSPITAL BAKE SALE TO BENEFIT PAWS4EVER!!

Please come and support our fundraising efforts for Paws4Ever and satisfy your sweet tooth at the same time!!!  We are raising money to donate to this wonderful organization!   We will sell a variety of yummy sweets at TVRH (608 Morreene Rd. Durham, NC) this Sunday September 30 from 9am until 3pm.  Please consider contributing to Paws4Ever and their goal of helping all animals in need!  The following items will be available for purchase:

COOKIES

BROWNIES

CUPCAKES

CHEESECAKE

PEANUT BUTTER BALLS

Please help support us in this great cause!!!!  Thank you in advance!

Paws4Ever will hold their 7th annual Walk for Animal Protection on Saturday October 6, 2012 from 10am-2pm at Southern Village in Chapel Hill.  Please come visit us at our booth!

Not your everyday patient

Sadie, anesthetized and closely monitored by technicians Beth, Bobby, and Dina

Triangle Veterinary Referral Hospital had a wonderful opportunity to support an important organization last Friday.  One of our surgeons, Dr Mike Grafinger, and several of our support staff made a "house call" to the Conservators' Center in Mebane, NC.

The Conservators' Center is home to the largest collection of lions in the Southeast. Their 21 lions and 11 tigers attract visitors who are fascinated by these predaceous felines. Although most visitors are drawn to the Center for the thrill of seeing big cats up close, many leave talking about other species in their eclectic collection, which includes wolves, New Guinea singing dogs, lemurs, binturongs, servals, bobcats, jungle cats, and a lynx.

The lifeblood of the Center is a community of people committed to caring for almost 100 animals. With a very small staff, they depend on volunteers and interns to supply much of the labor; and on visitors, donors, and Lifetime Adopters to help fund their continuing growth. 
  
Sadie was originally part of a large number of big cats living at a breeding facility in Ohio. The facility had been repeatedly cited for a poor safety record, unsanitary conditions, neglecting to provide veterinary care, and other violations. After issuing close to 900 citations, the county's health department soon ordered the 14 lions and tigers to be removed - or euthanized, and the Center stepped in to help by providing a permanent home.   

Sadie had an infected mass on her chin that needed to be removed.  Dr Grafinger and his staff volunteered their time to help out;  what a unique opportunity for TVRH staff to be involved in this field surgery!

Sleeping well

After the tumor has been removed

Waking up after surgery

 If you'd like more information about the Conservators' Center, information about their animals, how to visit or volunteer, and how to support their important work, learn more at www.conservatorscenter.org  where you can read about the animals, sign up for a free e-newsletter, link to their Facebook pages (be sure to check out Arthur White Tiger's FB page, which is great fun to read), and find a way to get involved.