The Ralpher – May 2019 Edition
Spring is officially here! We are enjoying the warmer weather and lighter evenings, plus our patchy lawn is starting to recover from our building works! In this edition of The Ralpher, we see what happens at The Ralph after dark, meet more of our wonderful patients and hear the latest Ralph news including meeting some of our new team members.
As always, we would love to hear from you. So if you have a question, feedback, or a suggestion please drop us a line.
In this month’s edition…
Meet Eva, our Veterinary Anaesthetist and Head of our Anaesthesia + Analgesia Department
Tales from the clinical floor:
It has been another busy month. Here we meet another two of our patients – Moon and Pebbles
The Ralph by night:
Meet Michelle, one of our fabulous Out of Hours Nurses!
Outpatient ultrasound service, Primary Care Out of Hours Service, our latest CPD event and lots of puppies!
Team Ralph is growing!
We have been joined by a number of new starters and are excited to have them here. Here’s a little introduction to our newest team members…
Hennie Lien-Garshoel and Toni Hicks join our Out of Hours Nurse team providing care for patients during the night and at weekends.
The multitalented Liam Hodsdon joins the team as both Lab Technician and Pharmacy Assistant.
Jasmine Huddy has joined our Patient Care Assistant Team and will be providing hands-on care for our patients.
Ali Lees joins our Customer Care Team havingpreviously worked in air traffic control.
Natalia Mohr joins our Emergency and Critical Care Team as a clinician having recently relocated from Glasgow.
We also have more exciting news to share in our next edition of The Ralpher with a new Orthopaedic Diplomate Surgeon joining our Surgery Service in July, so stay tuned for more details!
Spotlight on Anaesthesia + Analgesia
Our Anaesthesia and Analgesia Service is at the very heart of what we do at The Ralph; it supports many of our other clinical services to provide excellent and compassionate care. Eva, our Veterinary Anaesthetist, ensures the safe and effective use of anaesthesia to allow our team to perform investigations (e.g. a CT or MRI scan), surgeries and other procedures.
When a patient requires anaesthesia, Eva reviews the patient’s medical history and performs a pre-anaesthetic examination. She then creates a tailored anaesthetic protocol. Once we have anaesthetised the patient, Eva and the team keep a very close eye on them. Sophisticated monitoring equipment supplements close attention by our experienced team. We keep a detailed record for every patient. This includes the drug protocol used and their vital parameters (e.g. heart rate, respiratory rate, temperature) throughout their anaesthetic. This close attention continues during recovery until the patient is fully awake.
We have a range of state of the art anaesthetic machines at The Ralph. In our surgical theatres, the anaesthetic machines have a built-in ventilator. This allows us to breathe for patients who cannot breathe well enough on their own which can occur for various reasons.
If you would like to get in touch with Eva, please email [email protected]
Tales from the clinical floor
The Tale of Moon
Moon is just 9 months old and came to The Ralph after she sustained a fracture whilst playing with her sister Bloo (also 9 months old!).
Moon was admitted to our Orthopaedic Surgery Service with acute onset of right forelimb non-weight bearing lameness while playing with her sister, Bloo. The radiograph shared by the referring veterinary practice showed a right distal radioulnar fracture that appeared transverse and was found to be located near the physis in the sizing radiographs we subsequently performed.
Distal radial fractures in small dogs like Moon are often very challenging due to the small amount of space available for the plate between the carpal joint and fracture line. These fractures require excellent reduction and realignment.
A craniomedial surgical approach to the right radius was performed by Stefano, our Orthopaedic Surgeon, to access the fracture. A 2mm T-shaped Synthes locking compression plate was used to perform the radial osteosynthesis. Post-operative radiographs confirmed excellent implant position, fracture reduction and radial alignment.
To support Moon’s recovery our Head of Physiotherapy + Rehabilitation, Kim, fitted Moon with Kinesio tape to help improve circulation and reduce the swelling.
Moon has made an excellent recovery and is home with her sister Bloo and rest of the family. Moon’s carer recently updated us that the swelling is reducing and she is starting to use the operated limb well.
The Tale of Pebbles
Pebbles, a 4-year-old Domestic short hair cat, was referred to our Emergency and Critical Care Service at the end of March 2019. Pebbles had climbed under a car (which isn’t uncommon during the colder months), and then went into the engine where she stayed whilst the car was driven. As a result, she had sustained nasty, full thickness third-degree burns. The burns extended from the back of the skull to the lower back comprising 20% of her total body surface area as well as third-degree burns to the tips of her ears.
Pebbles underwent surgery the next day to remove the eschar (blackened, dead tissue from the burn injury) from her back. The extensive skin defect was managed with dressings for four days. Pebbles had a feeding tube placed for nutrition and a urinary catheter was placed for bladder management. Wound microbiology was performed to allow an appropriate antibiotic to be chosen.
Due to blood loss from the wound itself and destruction of damaged blood cells by the body, Pebbles progressively became more anaemic. She was transfused with blood type-specific and crossmatch compatible packed red blood cells. Pebbles was on continuous multimodal analgesia which was tapered as she became more comfortable. She made a gradual but marked improvement, started eating and became brighter in herself.
Pebbles underwent a second surgery on the 1st April 2019 at which time primary wound closure was performed and the skin and cartilage on the tips of her ears were trimmed. She continued to improve and started eating very well!
At her recent follow up appointments, it was wonderful to see her skin wounds have healed well. She is a very sweet cat with a very caring family!
The Ralph by night with Michelle
In this edition of The Ralpher, we meet Michelle, one of our Out of Hours Nurses, who looks after the patients during the late and early hours of the day.
What inspired you to be an Out of Hours Nurse?
I qualified as a veterinary nurse in 1992 and have worked in a variety of first opinion veterinary practices since then. A few years ago I started working in the Out of Hours side of veterinary medicine as an Emergency and Critical Care nurse.
Commonly likened to A&E, it can be a fast-paced and challenging environment with a variety of important duties to complete. The cases presented are interesting and more complex than many seen during normal opening hours. RVN’s provide skilled and expert supportive care and I enjoyed learning new skills and practising hands on nursing. My love of ECC was born!
And so what happens in the hospital after dark?
At the Ralph, our Out of Hours shifts start with rounds where patients are discussed and care is handed over to us from the daytime team. Then the treatments, monitoring, along with any procedures or diagnostics are completed and nursing plans and clinical records updated.
We are a relatively small team that provide care and hold the fort overnight so work very closely with my colleagues.
What do you enjoy most about being part of the Out of Hours Team at The Ralph?
I enjoy working at the Ralph as we have many varied and interesting cases and I’m always learning new skills and expanding my knowledge.
We have a great working environment and our core values help to maintain a rewarding and fulfilling career. Pet carers are often worried about leaving their pets overnight so I like providing some peace of mind by showing that our highest standard of care remains consistent. We really do care for your cat or dog as if they were one of our own pets.
Lastly, what advice would you give to a young nurse just starting out on their career?
My advice for any nurse just starting out in this important and varied career is to be prepared to keep learning. The role of a veterinary nurse is constantly evolving and developing so take opportunities to further train or specialise or complete further qualifications.
The other piece of advice is to try and keep a sense of humour. The job role is often stressful and demanding and being able to remain positive and cheerful helps you and your team.
We are busy planning our next (free) CPD event which will take place at the end of June. This event will be led by our Soft Tissue Surgery Diplomate, Dani McCready, and will cover the topic of seasonal respiratory disease in dogs (BOAS and laryngeal paralysis). The event is open to all members of the veterinary community and will be hosted at our referral centre.
Check out our Events page for further details on the event and to register your attendance.
Launching The Ralph Outpatient Ultrasound Service
With our Head of Diagnostic Imaging…
DVM MRCVS FHEA PGCertAP CertVDI DipECVDI RCVS (British) and EBVS® (European) recognised Specialist in Veterinary Diagnostic Imaging
To make an appointment please contact us via phone or email at: www.theralph.vet | [email protected] | 01628 308330
Introducing The Ralph Primary Care Out of Hours Service
The Primary Care Out of Hours Service at The Ralph is among the best equipped and expert emergency services in the country. Our highly experienced team work alongside our Emergency and Critical Care Diplomates and have access to advanced equipment and great facilities, including our separate dog and cat ICUs. This allows us to provide excellent and compassionate care to our patients 24/7/365.
To out more about our Primary Care Out of Hours Service and how we can best support you please email [email protected]
For the love of puppies
Before we bid farewell in this issue of The Ralpher, we couldn’t help but share this wonderful photo of Jess, one of our Customer Care Team Members with the Schnauzer puppies who visited us from the Diana Brimblecombe Rescue Centre (DBARC) for a check-up with our Ophthalmology Service. We are overjoyed to say that all puppies passed their eye exams with flying colours.
Thank you for taking the time to read our news and stories from inside the hospital. Stay tuned for our next edition, and more news on our upcoming events.