Reading up on reptiles...

01 July 2016, at 1:00am

Nikki Cumberbeach steps up to a challenging case involving a 17ft python with a tumour, and finds herself rising to the occasion.

ONE OF THE REASONS I LOVE MY JOB is that you never quite know what one day is going to bring. However, we all have certain things that we dread having to be involved in, and I am no exception.

I seem to have perfected an unflappable exterior over the years in response to whatever is thrown at me, but that does not mean I’m not quaking in my boots and trying hard not to allow my stomach to reveal the true extent of my fear.

This emotion is often transient and once our training kicks in in the emergency scenario I am fine; however, recently I found myself in a situation in which it was not transient and my training and previous experience were not going to kick in as I had none. What was the situation? A 17kg python admitted for a tumour to be removed from its jaw. This was most definitely out of my comfort zone. In fact, if I am going to admit a phobia, this is as close as I get.

Ever since I can remember I have not really liked the way snakes just are... I think seeing The Jungle Book as achild and being rather haunted by Kaa the snake has made me feel that out of any creature, snakes are the most untrustworthy and should be feared.

So not only do I not like snakes, but any information I had learnt about them at college while training had been stored in the “won’t ever need to know ‘cause I won’t be going there” brain vaults.

Time to ‘man up’

Well on this day I had to. As head nurse, with my only other allies at this particular time being eager students, I couldn’t crumble – I had to “man up”.

I should have been more prepared – I’d known that the practice principal had an interest in snakes and I’d meant to at least read something, but in the excitement of starting a new job there had always been something else I should be doing. So, stomach churning and after a hasty toilet break I ran upstairs to consult my trusty library.

Wherever I have worked I have always brought my books with me. As a clinical coach it has always proved helpful when trying to appear like the guru of all knowledge to your students. A quick flick through Veterinary Nursing of Exotic Pets by Simon Girling started to make me feel a little less like a rabbit in the headlights. 

This confidence ebbed away when the box appeared and the combination code belt securing the lid was released. My boss had already got some injectables ready – we were going to be using a medetomidine/ketamine combination, and he was injecting, but help was required for the restraint.

Luckily at this point one of the other vets appeared and helped at the head end, while I and one of the student VNs held the more caudal end.

The feel of the snake was so different to what I expected that I started to feel my stomach churning ebb away and my curiosity started to get the better of me. To feel the strength of the muscles was quite something.

Total recall

Memories of lectures at college about snakes broke out of my brain vault and I found myself remembering how their organs are placed and how you shouldn’t grip them too tight as bruising releases myoglobin and causes damage to kidney filtration membranes, at which point I loosened my grip.

The snake was returned to her box for the drugs to take effect and we prepared for the surgery. I was feeling rather proud of myself for helping restrain the snake and slightly embarrassed by my reluctance and now subsequent excitement at the prospect of something new.

It took a good 20 minutes for the injection to take enough effect for us to be able to remove the snake and place it on the theatre table to intubate. At this point it seemed I was at the head end and feeling con dent that as a non-venomous snake this wasn’t such a bad place to be.

I held the head behind the occiput and used my thumb and middle finger to support the head laterally with my index finger placed on top of the head. My boss proceeded to intubate. Intubation proved easy – the glottis was immediately visible – and once this was achieved, we were able to start maintaining anaesthesia using IPPV (two to four breathes per minute) and sevo urane gas.

The snake’s temperature was maintained throughout using a combination of heat pads carefully insulated and a bair hugger. In such a large snake the heart rate could be auscultated using a stethoscope – re exes proved harder to monitor, but as it happened the snake helped us out by exhibiting what I later learnt was the Bauchstreich response – where ventral stroking of the scales cranial to caudal produces movement in the body wall, which helped us tailor the anaesthetic depth, between 3-4% sevo urane throughout the procedure. 

The procedure was performed to remove the tumour on the jaw and once surgery was complete we concentrated on recovery. Atipamezole was given as a reversal agent, and the sevo urane turned off. Oxygen was given for a further minute at only two breathes per minute and then removed. The anaesthetic plane had been light throughout the surgery and the snake recovered uneventfully.

This experience has since meant I have made a concentrated effort to read up on my reptiles and although I feel con dent about the bigger snakes, I’ve heard it’s those smaller ones you need to watch...