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!
Showing posts with label soft tissue surgery. Show all posts
Showing posts with label soft tissue surgery. Show all posts
Monday, July 4, 2011
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!
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