Today I got to biopsy a big subcutaneous tumor. It's probably the most hands-on I've been allowed to be in vet school!
"A" is a 12 year old labrador with a golf ball sized mass over her shoulder that seems to be causing her to limp.
We were highly suspicious that it would be a primary bone tumor called osteosarcoma. But, we took radiographs and were delighted to find out that the tumor was not affecting the bone. (Osteosarcoma generally carries a very poor prognosis.)
This leaves us with several other potential causes.
We did a fine needle aspirate of the mass and came away with a lot of blood and some maybe soft tissue tumor cells. Essentially, the fine needle aspirate wasn't diagnostic.
So, today we did a biopsy of the tumor.
We put A under general anesthesia. We then clipped the hair over the mass and did a sterile preparation. Then, Dr. Daly let me do the wedge biopsy. I took a big slice out of the tumor and Dr. Daly commented that I was not a wimpy biopsy-er. After that, the tumor bled and bled and bled. We stopped the bleeding primarily through cautery. Then, I even got to place the sutures!
The biopsy results are still pending.
But, overall a very exciting time!
Friday, July 15, 2011
Wednesday, July 13, 2011
Oncology- Today was hard
Today was hard. As much as I love Oncology- and I really do- sometimes it's just hard. Cancer isn't an easy thing. Most patients are not cured. A lot of them can be made to feel better for a while. But, there are some patients who we just really can't do anything for them.
Today was one of those days where it seems like all of the cases we see are those can't-do-anything cases.
My patient, "S", was a 5 year old orange tabby cat. He was so sweet. And his owner loves, loves, loves him. S was dumped by the owner's house as a kitten. One day, while dying of respiratory infection, S jumped up into the owner's lap and declared himself adopted. The receptionist put him in an exam room this morning and told us that she could hear him crying when she left. He cried a couple times while we gathered the history and physical exam. He also cried a little while we talked to him about our diagnostic plan.
The thing is, watching an older man cry just pulls my heart strings. As Kristen (one of my classmates) puts it, I am a co-cryer. His eyes well up and it is just totally reflexive for mine to well up too.
Even starting off in tears, it only got worse from there.
On ultrasound, S had a large mass originating from his pancreas with several other organs involved. On cytology, there was evidence of carcinoma. So, he has a pancreatic carcinoma that has already metastasized.
Even in humans, this is a bad, bad, bad tumor to have. There's no good treatment options.
We broke this news to his owner, who just sobbed. He hung his head, tugged his hair, sobbed and apologized. We told him there was nothing to apologize for.
It was heartbreaking to hear that he hates the month of July because his wife was diagnosed with cancer in July, he was diagnosed with cancer in July, and now his cat was diagnosed with cancer in July. I think we all cried a little.
Today was one of those days where it seems like all of the cases we see are those can't-do-anything cases.
My patient, "S", was a 5 year old orange tabby cat. He was so sweet. And his owner loves, loves, loves him. S was dumped by the owner's house as a kitten. One day, while dying of respiratory infection, S jumped up into the owner's lap and declared himself adopted. The receptionist put him in an exam room this morning and told us that she could hear him crying when she left. He cried a couple times while we gathered the history and physical exam. He also cried a little while we talked to him about our diagnostic plan.
The thing is, watching an older man cry just pulls my heart strings. As Kristen (one of my classmates) puts it, I am a co-cryer. His eyes well up and it is just totally reflexive for mine to well up too.
Even starting off in tears, it only got worse from there.
On ultrasound, S had a large mass originating from his pancreas with several other organs involved. On cytology, there was evidence of carcinoma. So, he has a pancreatic carcinoma that has already metastasized.
Even in humans, this is a bad, bad, bad tumor to have. There's no good treatment options.
We broke this news to his owner, who just sobbed. He hung his head, tugged his hair, sobbed and apologized. We told him there was nothing to apologize for.
It was heartbreaking to hear that he hates the month of July because his wife was diagnosed with cancer in July, he was diagnosed with cancer in July, and now his cat was diagnosed with cancer in July. I think we all cried a little.
Monday, July 4, 2011
Soft Tissue Surgery- compliments
True compliments in vet school are few and far between; but I got a very nice one today.
Dr Bonin, Caroline and I were leaving ICU after doing a final check in on our patients and he said "you two are the hardest workers on this rotation. You do such a good job and have such a good attitude. And you're pretty knowlegable too."
He also told us that we were going to do well this year if we keep up this attitude and work ethic.
(He also mentioned that 2 of our rotation-mates are not doing a very good job. On top of being lazy, one of them makes really stupid mistakes because he doesn't ask questions and doesn't take initiative.)
Overall, a very uplifting moment!
Dr Bonin, Caroline and I were leaving ICU after doing a final check in on our patients and he said "you two are the hardest workers on this rotation. You do such a good job and have such a good attitude. And you're pretty knowlegable too."
He also told us that we were going to do well this year if we keep up this attitude and work ethic.
(He also mentioned that 2 of our rotation-mates are not doing a very good job. On top of being lazy, one of them makes really stupid mistakes because he doesn't ask questions and doesn't take initiative.)
Overall, a very uplifting moment!
Friday, July 1, 2011
Soft Tissue Surgery- Electrocautery is awesome
We amputated G's leg today. We did what is called a proximal third amputation, where we left a piece of the femur. Dr. Bonin feels like this is more cosmetically appealing. Right now, that's hard to judge. I'd have to see it when it's healed better.
The amputation process was so interesting! While I'm pretty sure I won't have electrocautery in general practice, it was really awesome to use in surgery today! I even got to control it for most of the procedure. We used it to control bleeding vessels and to cut muscle bellies- simultaneously cutting and cauterizing.
The coolest part of cutting the muscles with the cautery was the way the muscle fasciculated after being cut. It looked like the muscle was boiling.
The primary surgeon found my fascination with that hilarious.
What have you found fascinating lately?
The amputation process was so interesting! While I'm pretty sure I won't have electrocautery in general practice, it was really awesome to use in surgery today! I even got to control it for most of the procedure. We used it to control bleeding vessels and to cut muscle bellies- simultaneously cutting and cauterizing.
The coolest part of cutting the muscles with the cautery was the way the muscle fasciculated after being cut. It looked like the muscle was boiling.
The primary surgeon found my fascination with that hilarious.
What have you found fascinating lately?
Wednesday, June 29, 2011
Soft Tissue Surgery- "G"
"G" came in early this morning on Emergency because she was hit by a car last night. As far as we can tell, she doesn't have any broken bones, but she has really significant soft tissue injuries.
She has a puncture wound over her right eye that made a pocket under her skin that goes back to the level of her ears on the top and all the way over to the left eye. We're managing that wound conservatively with bandages for a while before we really close it up in a few days.
She also had a pretty big abrasion on the front of her right front leg. We're doing the same bandage song and dance on that one.
The big story is her left hind leg which has what we call a "degloving injury." Think about when you're wearing a glove and you peel it off at the end. It's like that, except skin instead of a glove. The skin from her ankle to her toes is missing. There are exposed pieces of muscle and bone. We could manage this with bandages for 3-4 weeks and probably save the leg, but that would cost the owner $6,000-$8,000. Instead, tomorrow we're going to amputate her left hind limb.
I'm really looking forward to the surgery! And I think that she'll feel a lot better once the dead/dying foot is gone.
She has a puncture wound over her right eye that made a pocket under her skin that goes back to the level of her ears on the top and all the way over to the left eye. We're managing that wound conservatively with bandages for a while before we really close it up in a few days.
She also had a pretty big abrasion on the front of her right front leg. We're doing the same bandage song and dance on that one.
The big story is her left hind leg which has what we call a "degloving injury." Think about when you're wearing a glove and you peel it off at the end. It's like that, except skin instead of a glove. The skin from her ankle to her toes is missing. There are exposed pieces of muscle and bone. We could manage this with bandages for 3-4 weeks and probably save the leg, but that would cost the owner $6,000-$8,000. Instead, tomorrow we're going to amputate her left hind limb.
I'm really looking forward to the surgery! And I think that she'll feel a lot better once the dead/dying foot is gone.
Monday, June 27, 2011
Soft Tissue Surgery- "J"
"J" is a 3 year old Bulldog who has had skin infections since his owner rescued him a year and a half ago. He has a severe infection underneath his tail.
The infection under J's tail, which is what he came in for, is so painful that he screams and bites when anyone tries to examine it. He also has a severe ear infection, a deep chin furunculosis (deeply infected hair follicles) and several other patches of pyoderma (skin infection.)
Overall, he is a little ball of greasy skin infection. And he REEKS. A lot. It's honestly nauseating to stand near him for too long.
Tomorrow, we're doing surgery to remove his tail, which will eliminate the fold the infection under his tail has been growing in. It will also remove the skin that is most affected. After he recovers from the pain of surgery, that should help him a lot. We already consulted Dermatology to help set up a lifelong management plan for his skin problems.
This case just re-inforces for me that Bulldogs are a breed I will never, ever own. What dog (or cat!) breeds do you never want to have?
The infection under J's tail, which is what he came in for, is so painful that he screams and bites when anyone tries to examine it. He also has a severe ear infection, a deep chin furunculosis (deeply infected hair follicles) and several other patches of pyoderma (skin infection.)
Overall, he is a little ball of greasy skin infection. And he REEKS. A lot. It's honestly nauseating to stand near him for too long.
Tomorrow, we're doing surgery to remove his tail, which will eliminate the fold the infection under his tail has been growing in. It will also remove the skin that is most affected. After he recovers from the pain of surgery, that should help him a lot. We already consulted Dermatology to help set up a lifelong management plan for his skin problems.
This case just re-inforces for me that Bulldogs are a breed I will never, ever own. What dog (or cat!) breeds do you never want to have?
Thursday, June 23, 2011
Soft Tissue Surgery- And the surprises keep on coming!
A's CT scan brought even more surprises to her already complicated case.
The CT scan revealed several very small nodules (in the 1-2 mm range.) Beyond that, the radiologists had a hard time agreeing on what the CT scan showed. Part of the process is using the software that comes with the CT machine to evaluate the density of the masses.
One of the radiologists got values indicating the masses were mineral density, which would likely mean that they are benign mineralizations that happen in old lungs. The other radiologist got values indicating that the masses were soft tissue density, which would likely mean that they are actually malignant. And the fact that different "windows" (ways to look at CT images) and different computers give different values indicate that the CT machine is broken in a way the radiologists can't explain.
Either way, benign or malignant, surgery is not the best option. If the masses are benign, then obviously the risks of removing a lung lobe significantly outweigh the benefits. If the masses are tumors, the fact that there are multiple ones in multiple lung lobes makes surgical resection a poor option.
The owner has a follow up appointment in a month with oncology for a repeat CT scan and further advice.
Interestingly, I'm on oncology in a month so I'll get to see how this case ends!
The CT scan revealed several very small nodules (in the 1-2 mm range.) Beyond that, the radiologists had a hard time agreeing on what the CT scan showed. Part of the process is using the software that comes with the CT machine to evaluate the density of the masses.
One of the radiologists got values indicating the masses were mineral density, which would likely mean that they are benign mineralizations that happen in old lungs. The other radiologist got values indicating that the masses were soft tissue density, which would likely mean that they are actually malignant. And the fact that different "windows" (ways to look at CT images) and different computers give different values indicate that the CT machine is broken in a way the radiologists can't explain.
Either way, benign or malignant, surgery is not the best option. If the masses are benign, then obviously the risks of removing a lung lobe significantly outweigh the benefits. If the masses are tumors, the fact that there are multiple ones in multiple lung lobes makes surgical resection a poor option.
The owner has a follow up appointment in a month with oncology for a repeat CT scan and further advice.
Interestingly, I'm on oncology in a month so I'll get to see how this case ends!
Wednesday, June 22, 2011
Soft Tissue Surgery- Sometimes you're in for a surprise
My first day of Soft Tissue Surgery was a day of surprises- for me, the doctors, my patient and her owner.
I signed up for "A", who was in for a mass removal. We had a long fax from her primary veterinarian with pretty much everything that's ever happened to "A" in her care, including a long string of text messages about hookworms.
As far as I could tell from A's record, she had a mass over her right hip that her owner wanted removed. Talking to her owner, she's had masses for quite some time and they've just been there. She had one that came in more recently and seemed to grow more quickly than the other masses. She also had a murmur that had been noted in her record, but her owner hadn't been informed about (which is an entirely seperate issue! Always tell owners about their pets' medical problems!)
Because of her age and the different kinds of masses she had, we opted to do a 3 view thoracic radiographs (aka, "a met check") to see if any of those skin masses had metastasized because if she had lungs full of tumor, it doesn't make sense to put her under anesthesia for skin tumors. On those radiographs, we found a single very small nodule. We did fluoroscopy and rubbed barium on the masses on her skin at that level to make sure it was really a lung nodule and not just her skin masses projected over her lungs. Sadly, it was a lung mass.
Based on that, we really changed our workup. We ended up doing an abdominal ultrasound, aspirating and looking at all her masses under a microscope, doing bloodwork and a urinalysis and doing an echocardiogram (to evaluate her murmur). All the masses are benign, and she's the picture of health for an 11 year old dog.
Tomorrow, we're going to do a CT scan. We can see smaller masses on a CT than on radiographs. If we see lots of masses she becomes an oncology case (because surgical treatment is no longer a possibility and chemo would be the only viable option.) If not, we're going to do a thoracotomy (cut open the chest) and a partial lung-lobectomy (remove a piece of her lung).
So, surprise! You come in for a mass removal and end up losing a piece of lung instead!
I signed up for "A", who was in for a mass removal. We had a long fax from her primary veterinarian with pretty much everything that's ever happened to "A" in her care, including a long string of text messages about hookworms.
As far as I could tell from A's record, she had a mass over her right hip that her owner wanted removed. Talking to her owner, she's had masses for quite some time and they've just been there. She had one that came in more recently and seemed to grow more quickly than the other masses. She also had a murmur that had been noted in her record, but her owner hadn't been informed about (which is an entirely seperate issue! Always tell owners about their pets' medical problems!)
Because of her age and the different kinds of masses she had, we opted to do a 3 view thoracic radiographs (aka, "a met check") to see if any of those skin masses had metastasized because if she had lungs full of tumor, it doesn't make sense to put her under anesthesia for skin tumors. On those radiographs, we found a single very small nodule. We did fluoroscopy and rubbed barium on the masses on her skin at that level to make sure it was really a lung nodule and not just her skin masses projected over her lungs. Sadly, it was a lung mass.
Based on that, we really changed our workup. We ended up doing an abdominal ultrasound, aspirating and looking at all her masses under a microscope, doing bloodwork and a urinalysis and doing an echocardiogram (to evaluate her murmur). All the masses are benign, and she's the picture of health for an 11 year old dog.
Tomorrow, we're going to do a CT scan. We can see smaller masses on a CT than on radiographs. If we see lots of masses she becomes an oncology case (because surgical treatment is no longer a possibility and chemo would be the only viable option.) If not, we're going to do a thoracotomy (cut open the chest) and a partial lung-lobectomy (remove a piece of her lung).
So, surprise! You come in for a mass removal and end up losing a piece of lung instead!
Monday, June 20, 2011
Equine Internal Medicine- Foals
I got a really great text message last night from Dr. Norton, one of the residents I worked with on Equine Internal Medicine, even though I've been off the rotation for a week and a half. She was letting me know that the owners of one of my first equine patients had finally named the foal.
For some background, it is very common for owners/breeders to not name foals until they're older. I don't really know why that is. But, when foals are born, they're called Mare'sName Year'F (F for foal.) My guess is that you don't get as attached to animals that don't have names and that foals (like puppies or kittens) sometimes take very ill and die. It's easier to let an animal go, or to make hard decisions weighing life and finances, if the life doesn't have a name.
But, anyway, my patient was a little foal with significant diarrhea. She was in the hospital for a little over a week, and cost her owners close to $3,000.
They named her Aggie's Special Country Star. They "had to name her aggie because she wouldn't be alive without all or our hard work." That's so sweat! And it feels really good to have all the hard work I did noticed. (I had to do treatments every 2 hours for the first couple days she was in my care.)
For some background, it is very common for owners/breeders to not name foals until they're older. I don't really know why that is. But, when foals are born, they're called Mare'sName Year'F (F for foal.) My guess is that you don't get as attached to animals that don't have names and that foals (like puppies or kittens) sometimes take very ill and die. It's easier to let an animal go, or to make hard decisions weighing life and finances, if the life doesn't have a name.
But, anyway, my patient was a little foal with significant diarrhea. She was in the hospital for a little over a week, and cost her owners close to $3,000.
They named her Aggie's Special Country Star. They "had to name her aggie because she wouldn't be alive without all or our hard work." That's so sweat! And it feels really good to have all the hard work I did noticed. (I had to do treatments every 2 hours for the first couple days she was in my care.)
Friday, June 17, 2011
Cardiology- Heartworm Disease
One of my patients on Cardiology was a 3 year old rescued dog who had been previously diagnosed with Heartworm Disease. While the rescue organization and his new owners have done fabulously by this dog, it makes me sad that so many dogs still get heartworm disease.
Heartworm disease in dogs (and cats!) is preventable by the administration of one little pill a month. Or in the case of cats, a vial of liquid applied to their skin. Most of the time, the dogs even actually like the pill.
Here are some basic facts about heartworm disese that every pet owner should know:
-Heartworm disease is a preventable infection
-Dogs get heartworm disease from being bitten by a mosquito carrying heartworm larvae
-Cats are an atypical host for heartworm, but they can get it. And if you tell me your cat is an indoor cat, I have to ask if you've ever seen an outdor only mosquito. I haven't! I get bitten by mosquitoes inside buildings all the time!
-Heartworm preventative medications are much less expensive than treatment
-Heartworm infection can cause permanent changes to your dog's heart and lungs
-One of the most common signs of heartworm infection in cats is that they just drop dead
In conclusion, make sure your pets get heartworm prevention regularly!
Heartworm disease in dogs (and cats!) is preventable by the administration of one little pill a month. Or in the case of cats, a vial of liquid applied to their skin. Most of the time, the dogs even actually like the pill.
Here are some basic facts about heartworm disese that every pet owner should know:
-Heartworm disease is a preventable infection
-Dogs get heartworm disease from being bitten by a mosquito carrying heartworm larvae
-Cats are an atypical host for heartworm, but they can get it. And if you tell me your cat is an indoor cat, I have to ask if you've ever seen an outdor only mosquito. I haven't! I get bitten by mosquitoes inside buildings all the time!
-Heartworm preventative medications are much less expensive than treatment
-Heartworm infection can cause permanent changes to your dog's heart and lungs
-One of the most common signs of heartworm infection in cats is that they just drop dead
In conclusion, make sure your pets get heartworm prevention regularly!
Wednesday, June 15, 2011
Equine Internal Medicine- "Spitfire"
I feel so blessed to have been involved in Spitfire's life, as short as it was.
He came in as a 10 day old pony foal who had intermittently had fevers, fast heart rates and fast breathing since he was born. When we asked his owners more, they said that he sometimes dribbles milk out his nose when he's been laying down.
When we were looking at chest radiographs to look for aspiration pneumonia, the radiologist said "Well, if this was a dog, I would say this looks like a persistent right aortic arch (PRAA)." We didn't really do much about it then, but when I brought up the radiologist's comment again in rounds, we decided to pursue it a little further. I got sent over to the small animal hospital to talk to people who might know more about PRAAs, because it isn't something that's really reported in horses (9 times in large animals in general, it turns out.)
It got everyone all twitterpated and very excited. He had a lot of very good prognositic factors. After that, it was a very emotional rollercoaster between doing the surgery or euthanizing him.
In the meantime, Spitfire and I really bonded. I named him Spitfire because he had such a delightful personality. He was full of spunk and silliness. He'd walk right up to people and chew on their pants or lab coat. The emergency/overnight students who did his midnight-2AM treatments called him Chompers. He liked to run and buck around the paddock outside when we turned them out in the morning. He liked to steal stethescopes and carry them around his stall. His mother put up with him with goodnatured grace. Overall, he was just a little spitfire. (His owners ended up naming him something else, but I still like Spitfire better.)
Sadly, the surgical attempt to correct his congenital defect didn't go as planned. It ended up going really poorly and he was euthanized on the table. We all knew it was a real long shot that he'd make it, but that doesn't make it any less sad.
He came in as a 10 day old pony foal who had intermittently had fevers, fast heart rates and fast breathing since he was born. When we asked his owners more, they said that he sometimes dribbles milk out his nose when he's been laying down.
When we were looking at chest radiographs to look for aspiration pneumonia, the radiologist said "Well, if this was a dog, I would say this looks like a persistent right aortic arch (PRAA)." We didn't really do much about it then, but when I brought up the radiologist's comment again in rounds, we decided to pursue it a little further. I got sent over to the small animal hospital to talk to people who might know more about PRAAs, because it isn't something that's really reported in horses (9 times in large animals in general, it turns out.)
It got everyone all twitterpated and very excited. He had a lot of very good prognositic factors. After that, it was a very emotional rollercoaster between doing the surgery or euthanizing him.
In the meantime, Spitfire and I really bonded. I named him Spitfire because he had such a delightful personality. He was full of spunk and silliness. He'd walk right up to people and chew on their pants or lab coat. The emergency/overnight students who did his midnight-2AM treatments called him Chompers. He liked to run and buck around the paddock outside when we turned them out in the morning. He liked to steal stethescopes and carry them around his stall. His mother put up with him with goodnatured grace. Overall, he was just a little spitfire. (His owners ended up naming him something else, but I still like Spitfire better.)
Sadly, the surgical attempt to correct his congenital defect didn't go as planned. It ended up going really poorly and he was euthanized on the table. We all knew it was a real long shot that he'd make it, but that doesn't make it any less sad.
Monday, June 13, 2011
Equine Internal Medicine- Toxicity Horses
My first day of Equine Internal Medicine was a little overwhelming! We started the day with 4 students and 13 patients! But, 6 of them were from the same ranch and had all come in together with an unusual neurological presentation.
11 of the family's 20 horses were taken on a trail ride and left in a dry lot pen with a bale of crappy hay afterwards while the family dealt with another problem. The horses ended up eating all the way down to the bottom of the bale of hay, including some plants they wouldn't normally eat. They were also given a normal dose of their normal dewormer.
A day or so later, those 11 horses were in some state of neurological distress. They were somewhere between ataxic ("walking drunk") and recumbent (unable to get up.) The owners ended up bringing in the 6 worst off horses. They got supportive care- fluids, nursing care, etc- and they got better!
It felt like such a miracle! We were so glad to see them all turn around and get better.
11 of the family's 20 horses were taken on a trail ride and left in a dry lot pen with a bale of crappy hay afterwards while the family dealt with another problem. The horses ended up eating all the way down to the bottom of the bale of hay, including some plants they wouldn't normally eat. They were also given a normal dose of their normal dewormer.
A day or so later, those 11 horses were in some state of neurological distress. They were somewhere between ataxic ("walking drunk") and recumbent (unable to get up.) The owners ended up bringing in the 6 worst off horses. They got supportive care- fluids, nursing care, etc- and they got better!
It felt like such a miracle! We were so glad to see them all turn around and get better.
Friday, June 10, 2011
Orthopedic Surgery- "M"
Friday, June 10, 2011
Orthopedic Surgery- "M"
M is an 8 year old Golden Retriever who came in morbidly obese (secondary to recently diagnosed hypothyroidism) and completely non-ambulatory in the back because he had ruptured both his cranial cruciate ligaments.
Cranial Cruciate Ligament ruptures are like ACL tears in humans. If you've ever met someone with an ACL tear, they are incredibly painful! Especially if the medial meniscus gets involved.
We performed Tibial Plateau Leveling Osteotomies on both of his legs at the same time. I got to put in 1 bone screw in each leg! While the first 24 hours after surgery were pretty painful, he was way better than when he came in the day after surgery. It was really awesome to see.
The only problem with him was that his owner was away on a business trip and he ended up spending nearly a week longer in the hospital than he needed to. For a while, M went on a hunger strike. I went through almost every food in our dog food kitchen. I tried puppy food of several brands, I tried the high calorie recovery foods, I tried baby food, I tried hot dogs and hamburgers and chicken breast. He'd eat maybe one bite of anything new then refuse to eat more. Finally, while some of my classmates were eating lunch, he looker interested in their food and willingly ate their leftovers. We were ecstatic! I think he ended up with nearly a pound of turkey and brisket that day. Then we fed.him Turkey lunch meat (with progressively more dog food and less turkey until he was on just dog food.)
Orthopedic Surgery- "M"
M is an 8 year old Golden Retriever who came in morbidly obese (secondary to recently diagnosed hypothyroidism) and completely non-ambulatory in the back because he had ruptured both his cranial cruciate ligaments.
Cranial Cruciate Ligament ruptures are like ACL tears in humans. If you've ever met someone with an ACL tear, they are incredibly painful! Especially if the medial meniscus gets involved.
We performed Tibial Plateau Leveling Osteotomies on both of his legs at the same time. I got to put in 1 bone screw in each leg! While the first 24 hours after surgery were pretty painful, he was way better than when he came in the day after surgery. It was really awesome to see.
The only problem with him was that his owner was away on a business trip and he ended up spending nearly a week longer in the hospital than he needed to. For a while, M went on a hunger strike. I went through almost every food in our dog food kitchen. I tried puppy food of several brands, I tried the high calorie recovery foods, I tried baby food, I tried hot dogs and hamburgers and chicken breast. He'd eat maybe one bite of anything new then refuse to eat more. Finally, while some of my classmates were eating lunch, he looker interested in their food and willingly ate their leftovers. We were ecstatic! I think he ended up with nearly a pound of turkey and brisket that day. Then we fed.him Turkey lunch meat (with progressively more dog food and less turkey until he was on just dog food.)
Wednesday, June 8, 2011
Orthopedic Surgery- "Z"
My first patient ever was a 140 pound Saint Bernard puppy. He came in because his referring veterinarian found an Osteochondrosis Dissecans lesion on both his shoulders after he started coming up lame while exercising.
We confirmed the diagnosis and evaluated the rest of his shoulder joints and both his elbow joints using CT. It still blows me away that we use CT on animals! Z's CT scan made quite a first day for me, because even though he was highly sedated, he jumped off the gurney and tried to take off across the parking lot! Luckily, Wendy (the orthopedics technician) caught his leash as he came off the gurney and he didn't get away. He also slept soundly through his CT scan.
He stayed with us for nearly a week before we did arthroscopic surgery on his shoulders. He was such a handful! Young, exuberant, and strong! I had bruises on my wrists from him pulling on the end of the leash.
We confirmed the diagnosis and evaluated the rest of his shoulder joints and both his elbow joints using CT. It still blows me away that we use CT on animals! Z's CT scan made quite a first day for me, because even though he was highly sedated, he jumped off the gurney and tried to take off across the parking lot! Luckily, Wendy (the orthopedics technician) caught his leash as he came off the gurney and he didn't get away. He also slept soundly through his CT scan.
He stayed with us for nearly a week before we did arthroscopic surgery on his shoulders. He was such a handful! Young, exuberant, and strong! I had bruises on my wrists from him pulling on the end of the leash.
Monday, February 14, 2011
Technology
I've been thinking about technology- specifically technology for networking and communication- a lot lately.
I've come to the conclusion that, by and large, veterinary medicine is either uninterested or stuck in the past. For example, love it or hate it, Twitter is continuing to increase in prevalence as a way that businesses and organizations choose to connect with customers, consumers and otherwise interested parties. There are a handful of veterinary related organizations on Twitter (AVMA, AVMA's governmental relations arm, some individual animal hospitals and vets, a few professional organizations- Texas Veterinary Medical Association, American Animal Hospital Association and American Society for Veterinary Journalists are especially active- and a few vet schools with varying degrees of activity.) But overall, vets refuse to take the time to do it.
I, however, really love all of the technology that exists right now. I blog, I tweet, I post. I want more of my peers and colleagues to come do it with me!
I've come to the conclusion that, by and large, veterinary medicine is either uninterested or stuck in the past. For example, love it or hate it, Twitter is continuing to increase in prevalence as a way that businesses and organizations choose to connect with customers, consumers and otherwise interested parties. There are a handful of veterinary related organizations on Twitter (AVMA, AVMA's governmental relations arm, some individual animal hospitals and vets, a few professional organizations- Texas Veterinary Medical Association, American Animal Hospital Association and American Society for Veterinary Journalists are especially active- and a few vet schools with varying degrees of activity.) But overall, vets refuse to take the time to do it.
I, however, really love all of the technology that exists right now. I blog, I tweet, I post. I want more of my peers and colleagues to come do it with me!
Thursday, February 10, 2011
Things I’m Tired of Hearing
There are some things that they tell us a lot during vet school that I’ve gotten really tired of hearing.
1) “Grades don’t matter!”
That is just, quite frankly, not true to me! It may be that nobody’s really going to look at your GPA when you get a job (though, I don’t really believe that), but that doesn’t mean grades don’t matter. What if you want an internship or a residency? Or what if you just don’t not want an internship or a residency? (You just don’t want to close that door yet?) Or, what if you’re just accustomed to getting good grades? What if just the getting of good grades is what matters to you?
2) “You’ll get this later.”
We hear this a lot in lecture. They’ll be talking about something and mention a caveat or a detail (or even sometimes another major concept) then backpedal with “but you’ll get that later.” Uh, guys, we’re nearing the end of third year; there’s not a lot of later left!
3) x% of you will be divorced
That’s not very nice… but they’ve been telling us that throughout vet school. In orientation it was that some percent of you will get divorced by the end of vet school (and some more by the end of vet school.) Later they start telling us that x% of us that have gotten married in school or made it past the relationship killer that was vet school will get divorced once we start in practice because we apparently can’t balance our lives. It feels kind of like the people who tell you that you shouldn’t bother getting married because half of marriages end in divorce (although, I read recently that statistic is changing and fewer marriages are ending in divorce.)
1) “Grades don’t matter!”
That is just, quite frankly, not true to me! It may be that nobody’s really going to look at your GPA when you get a job (though, I don’t really believe that), but that doesn’t mean grades don’t matter. What if you want an internship or a residency? Or what if you just don’t not want an internship or a residency? (You just don’t want to close that door yet?) Or, what if you’re just accustomed to getting good grades? What if just the getting of good grades is what matters to you?
2) “You’ll get this later.”
We hear this a lot in lecture. They’ll be talking about something and mention a caveat or a detail (or even sometimes another major concept) then backpedal with “but you’ll get that later.” Uh, guys, we’re nearing the end of third year; there’s not a lot of later left!
3) x% of you will be divorced
That’s not very nice… but they’ve been telling us that throughout vet school. In orientation it was that some percent of you will get divorced by the end of vet school (and some more by the end of vet school.) Later they start telling us that x% of us that have gotten married in school or made it past the relationship killer that was vet school will get divorced once we start in practice because we apparently can’t balance our lives. It feels kind of like the people who tell you that you shouldn’t bother getting married because half of marriages end in divorce (although, I read recently that statistic is changing and fewer marriages are ending in divorce.)
Tuesday, February 8, 2011
Practice Management
It's been a long time since I updated; I haven't been very good at keeping this up. But I'll try to do better.
This past weekend was a rough one for the third years.
While it seemed like everyone else in Texas- from Dallas to Houston- was celebrating having Friday (or more) off due to snow, the third years took their lives in their hands and came to school anyway for a seminar about Practice Management. (We did get to start an hour late...)
It was good information- very good information- but with 2 8 hour days, I'm not sure how effectively we absorbed all of it. That's just a really long time to be listening to the same topic.
I enjoyed the information on how to operate a succesful practice. The things clients say they want (a coat hook in the exam room!), the amount of time a client will wait in your lobby before they give up and leave (15 minutes) and how to use financial statements to evaluate the success of your business.
I found the stuff about contract negotiation to be important, but hard to absorb. Most of what I got from that is that you should hire a lawyer to look over your employment contract before you sign it.
This past weekend was a rough one for the third years.
While it seemed like everyone else in Texas- from Dallas to Houston- was celebrating having Friday (or more) off due to snow, the third years took their lives in their hands and came to school anyway for a seminar about Practice Management. (We did get to start an hour late...)
It was good information- very good information- but with 2 8 hour days, I'm not sure how effectively we absorbed all of it. That's just a really long time to be listening to the same topic.
I enjoyed the information on how to operate a succesful practice. The things clients say they want (a coat hook in the exam room!), the amount of time a client will wait in your lobby before they give up and leave (15 minutes) and how to use financial statements to evaluate the success of your business.
I found the stuff about contract negotiation to be important, but hard to absorb. Most of what I got from that is that you should hire a lawyer to look over your employment contract before you sign it.
Tuesday, January 25, 2011
Animal Behavior
While I don't always agree with what Dr. Beaver has to say, I've learned a lot in this class.
For example, there are 10-15 kinds of aggression. All of them need to be dealt with in different ways and some of them are easier to treat than others. For example, dominance aggression is usually easier to deal with than prey aggression. Prey aggression has its own internal reward (getting to chase/catch the animal playing prey item!)
Today, we talked about ADHD, which is over-diagnosed in humans and under-diagnosed in animals.
For example, there are 10-15 kinds of aggression. All of them need to be dealt with in different ways and some of them are easier to treat than others. For example, dominance aggression is usually easier to deal with than prey aggression. Prey aggression has its own internal reward (getting to chase/catch the animal playing prey item!)
Today, we talked about ADHD, which is over-diagnosed in humans and under-diagnosed in animals.
Monday, January 17, 2011
Week One, in review
My first week back to school went really well!
I only have one elective this block- Resolving Small Animal Behavior Problems- which should be interesting. It's important information but I find myself presenting arguments in my head when this particular professor lectures. Especially when she starts talking about cat behavior. But, hopefully, I'll get something valuable out of the class!
Small Animal Medicine has been entertaining so far (my favorite vet school professor has been lecturing.) It's a little rough that it meets 8 hours a week, though!
Correlates is, well, correlates. We got our first case last week. I spent something like 6-8 hours on it... but it really reaches this point of diminishing returns where doing more isn't getting you anywhere. You've followed the process as well as you can but you're going to make the wrong judgement call anyway, so why bother?
Practice management is... something. The projects should be fun and worthwhile and assuming we have guest speakers pretty often it should be ok. While I like Dr. Posey very much as a person, I find his lecture style a little disjointed which can be frustrating.
Radiology is rough. It just doesn't seem fair to have it in the 3-5 timeslot on Friday!
However, I have all this free time... I have no idea what to do with all of it! It's crazy!
I only have one elective this block- Resolving Small Animal Behavior Problems- which should be interesting. It's important information but I find myself presenting arguments in my head when this particular professor lectures. Especially when she starts talking about cat behavior. But, hopefully, I'll get something valuable out of the class!
Small Animal Medicine has been entertaining so far (my favorite vet school professor has been lecturing.) It's a little rough that it meets 8 hours a week, though!
Correlates is, well, correlates. We got our first case last week. I spent something like 6-8 hours on it... but it really reaches this point of diminishing returns where doing more isn't getting you anywhere. You've followed the process as well as you can but you're going to make the wrong judgement call anyway, so why bother?
Practice management is... something. The projects should be fun and worthwhile and assuming we have guest speakers pretty often it should be ok. While I like Dr. Posey very much as a person, I find his lecture style a little disjointed which can be frustrating.
Radiology is rough. It just doesn't seem fair to have it in the 3-5 timeslot on Friday!
However, I have all this free time... I have no idea what to do with all of it! It's crazy!
Monday, January 10, 2011
New Semester
Classes start today (I'm actually writing this from break in my Resolving Small Animal Behavior Problems class).
I'm both excited and a little nervous. For some reason, I feel the least prepared I've ever been for the start of a semester. I don't feel like I have all my stuff organized very well. I feel just all at odds! (And I would much rather be at home with my fiance and my parents!)
At least there's just one more semester of classroom stuff before clinics!
I'm both excited and a little nervous. For some reason, I feel the least prepared I've ever been for the start of a semester. I don't feel like I have all my stuff organized very well. I feel just all at odds! (And I would much rather be at home with my fiance and my parents!)
At least there's just one more semester of classroom stuff before clinics!
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