Fate brought me to Karma...

I was into my fourth day lazing on Maderas beach just north of San Juan Del Sur on the Pacific coast of Nicaragua - I had tried and mostly failed at surfing and had decided that sunbathing, reading books and drinking beer was easier!

Maderas beach

Karma - Sylvia's Labrador

In my beachside backpackers most of the others were doing the same but there were some long term residents there as well including Sylvia - a French Fashion Designer

Sylvia's Creations

I bought a couple of things from Sylvia and we got talking about her dog Karma - a huge black Labrador I mentioned I was a vet and soon I was having a look at the sore leg she sprained on the beach - no problem there but the dentist in me spotted other bigger issues - 2 slab fractured carnassial teeth with apical abscesses
This was a problem that needed attention - veterinary dentistry is in it's infancy here - specialised equipment is needed to do this complicated extraction - I wasn't hopeful but I knew I could improvise!

Karma and Sylvia on the beach shuttle to San Juan

Karma arrived on the Saturday morning on the beach shuttle from Maderas and Sylvia transferred her to a Trike to take her to the vets

On the trike going to the vets

 Karma's vet Fernando Lopez-Ponce in San Juan - he was happy to do the anaesthesia while I extracted the teeth - however he had very few dental instruments - no drill or elevators/luxators!

My equipment

Karma premeded

Once there I gathered together my instruments and materials. The carnassial tooth has to be surgically extracted - a flap needs to be raised and the tooth cut into 3 parts (it has 3 roots)
As before there was no inhalational anaethesia - she was premeded with ACP, a catheter placed and GA was maintained with Valium and Ketamine to effect
We tubed her and packed her throat - we were ready to go!
The drilling was done by a conventional DIY drill and bit - cooled by sprayed on water - compared to an air driven drill it took ages but got the job done

Left Carnassial - note swelling above muco-gingival line indicating apical involvement

Tooth sectioned

The 3 portions of each tooth were extracted - in each tooth the abscess was in the caudal root - the extraction sites was closed with vicryl

Post extraction - site closed with vicryl

Right carnassial - probe indicated pulp exposure - note fistula above M-G line

The caudal roots of both teeth - note the apical granulomas

Karma recovering in her trike

Antibiotic and NSAID cover had been started pre-op the day before and would continue for 5 days Then began a very long recovery period - because of the length of the surgery and all the Val-Ket top-ups (she had 18ml of the mix over the 1.5 hours) she wasn't able to walk on to the returning beach shuttle at 4 o'clock San Juan was really busy that night but luckily Sylvia found somewhere she and Karma could sleep.

Next day she had recovered and was able to go back to Maderas beach where she likes to play in the surf!

Back on the beach where she belongs!

Nicaraguan Veterinary Project

Just a reminder that this blog is written for Vets and Veterinary Nurses primarily but hopefully might interest others. As a result some of the language is technical and some of the pictures are of disease and surgery

The taxi dropped me on a dusty road on the edge of Leon - I had an address but addresses are not quite what they seem in Nicaragua - there is a serious lack of house numbers and street names - makes life tricky! Luckily I had a phone number so I was rescued from the side of the road!

Yelena and her husband Mario came later that day - they started the Nicaraguan-Veterinary-Project 7 years ago - helping the dogs and cats of Leon and surrounding villages with a free neutering service as well as parasite treatment.

Yelena - founder of the project

We were joined next day by Luis a vet from Peru who works in a zoo in Iquitos and 2 vets from Leon - Erick and Jorge Their small animal surgical experience was low so part of our job was to teach them new techniques

Checking our supplies

Steam Sterilising in Terrero

We held clinics in Yelena's house in Leon and in 3 other areas including down by the beach in Poneloya and in a dusty rural village Terrero

All Creatures Great and Small....

There were two main objectives - parasite treatment and neutering. Each day we would treat about 30 animals for internal and external parasites - the older animals receiving ivermectin injections and  pyrantel-praziquantel tablets - the younger ones fipronil spray (they call it Shooter round here!) and pyrantel liquid - the expensive spot-ons that cover all the bases that we have in the UK are not economically feasible for the project In this sort of work compromises have to be made and difficult decisions taken

Road Block Nica Style

Worming puppies

Nicaraguans like their vitamins - and traditionally they like their pets to have them too - not something I was totally convinced about plus it meant a painful intramuscular injection which wasn't much fun to give or receive!

Neutering were carried out as in Cuba with no gaseous anaesthesia - premed with xylazine and atropine.  A catheter is placed and a 50:50 mix of valium and ketamine is given to effect
 IV fluids were  provided in all cases - if you have a catheter in why not! Smaller bitches were spayed flank - larger ones midline

Luis neutering a cat

Luis and Jorge operating

Operating well into the evening by headlight

This year Yelena bought a steriliser and we had sterile drapes and excellent kits - this enabled us to do nearly 90 surgeries in the 2 weeks

Local dog refuge

The majority were bitch spays - Nica guys are reluctant to let their male dogs lose their cojones!!

All the ops got IVF

Waiting for an op

Once the animals showed signs of rousing home they went - in a variety of transport - cars bikes wheelbarrows horse drawn carts and bici-taxis!!

Recovery ward!

Leaving by bicitaxi

Arrival by  horse and cart in Terrero

Heading home!

Erick one of the Nica vets and Yelena

Jorge castrating a pig

Our makeshift operating table

Hazards and problems not encountered on the UK were common - how about sun in your eyes or the wind blowing the drapes (we operated outside a lot)- operating at night or on a variety of different height tables - we even had to construct a table out of barrels and a sheet of corrugated iron!

Luis doing the caesar on the sheep

Then there were health issues - canine obesity is not an issue here believe me - parasites and poor nutrition lead to some very skinny pets - combine that with the fact that many bitches were in poor condition due to repeated litters and the risk factor went up

Hooking up the IV

Spaying Kia - the dog with Ehrlichia

Tick borne diseases such as Erlichiosis and Babesiosis we're common - leaving our patients anaemic and with clotting problems!!

Dripping the dog with clotting problems post spay

Waiting for attention in Leon

Jorge operating - always lots of haemorrhage because of Ehrlichia

But we knew that those pets would have a better life once they were neutered so the risks were taken - we had no losses which was great

The visit to Terrero brought more challenges and different species! I castrated my first pig in 25 years and my colleagues operated in cattle and did a Caesarian on a Pelibuey- a type of non-wool sheep kept for meat

The team

At the end of the trip Jorge and Erick took me up to their vet school in Leon The school produces about 200 vets a year - a lot if the focus is towards food animals but small animal teaching is becoming more important The facilities to be honest are quite poor by UK standards - one of the biggest surprises here was the absence of laboratory diagnostic equipment - e.g. biochemistry, hormones and all the other assays we take for granted in the UK This makes diagnosis very difficult for Nica vets - its often a guessing game...

Leon Vet School

Lab at Leon

Things are not helped by the lax pharmaceutical regulations - owners can readily obtain drugs (which would be POM in the UK) over the counter here without prescription The vets hold no stock of drugs - they scribble down lists of drugs (often 5 or 6 items) on pieces of paper and send people off to the pharmacies

Another big difference here is the perception of animal pain - in the span of my career in the UK there are been huge advances in this area but down here very few animals receive pain relief post op or for painful medical conditions The lack of readily available cheap animal NSAIDS doesn't help - but I managed to get some human meloxicam although splitting it into eighths was more challenging than the surgery!

Post op NSAIDS

Other things I saw were a lot of untreated neoplasia - Transmissable Venereal Tumour - lots of mammary tumours and soft tissue sarcomas left to grow and ulcerate...

Transmissable Venereal Tumour

Dental problems were also rife - vets are totally unaware of the issues here - there is a huge amount of periodontal disease, lots of fractures and retained deciduous teeth Due to lack of suitable instrumentation I  couldn't do a lot of the work I wanted but I managed to do a little with my single elevator and forecep!

Dental problems in one of the refuge dogs

Sorted!

In Nicaragua people keep dogs mainly for protection - hence the reluctance to get males neutered It makes me appreciate our clients back in the UK - the huge majority of whom care deeply about their pets and present problems quickly
Not to say that Nicaraguans are uncaring about their dogs  - the difference is cultural - and the gratitude we received for the work we did was fantastic

Cake to celebrate the end of the project - all natural colourings!

The Street Dogs of Leon

So ended my first intensive veterinary volunteer experience ( the work in Cuba was much more low key) I would really recommend it - for lots of different reasons - but the bottom line is the same as it is in the UK or any other part of the world - its about making animals lives better...