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?
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