Soft Tissue Diagnostics (aka RTDFABC)

The official title of this week's rotation is "Soft Tissue Diagnostics."

However, that vague course name could easily be clarified to "Restrain This Dog For A Bandage Change."

When we were ranking our electives for this year, the Soft Tissue Diagnostics (SD) rotation description clearly said "This is NOT a surgery laboratory."

That's fine.

However, I really expected my 4 mornings of SD rotation thus far to encompass a little something more than restraining the same 4 or 5 dogs every morning for the first of their twice-daily bandage changes.

Don't get me wrong, it is definitely cool to see wounds and infected surgical sites healing on a day-to-day basis.

But come on. Us juniors don't even get to do anything with the bandages! We just keep the dogs from biting the senior students, interns, residents, and faculty, who are the ones who actually change the bandages. (Well, I guess our job is important if they want to keep their fingers. Also, hooray for chemical restraint, i.e. heavy-duty sedatives!)

Among this week's recurrent SD patients are:

- An old golden retriever who came in for a small mass on his forearm, which was removed and diagnosed as a low-grade soft tissue sarcoma; the tumor was sitting right on his cephalic vein (the main vein draining the foot), so they had to resect part of that vein; his surgical closure had too much tension in the sutures, causing a tourniquet effect and horrible swelling in his paw, so they cut open several of the sutures in the middle to relieve some tension; after a few days there was still too much swelling so they just cut open all the rest of the sutures and have been managing the surgery site as an open wound with bandaging; yesterday the wound culture came back and surprise, poor dog has MRSA! (an antibiotic-resistant superbug)

- A middle-aged *psychotic* Australian cattle dog who will try to rip your face off unless he can hold his leash in his mouth; had some sort of degloving injury to his paw, which had lost so much skin that they had to take a piece of skin from his abdomen and graft it onto the wound on his paw; so now he has a huge bandaged leg to keep him from getting at his paw, a draining disgusting hole on his abdomen, and a wonderful e-collar

- A sweet black lab who presented several weeks ago for a migrating foreign body in the tissues on her face (turned out to be a grass awn); they removed the grass awn but after surgery she developed a baseball-sized seroma on her cheek; hot compresses at home have been ineffective, so today they placed a drain to get some of the fluid out

- A *beautiful* long-haired mini Dachshund who had a hemilaminectomy to relieve pressure on her spinal cord from an extruded intervertebral disc; she has been slowly regaining function to her bladder, bowels, and hind legs, but still has a long way to go and can't urinate on her own, so she's been living at the hospital and having her bladder manually expressed every 6-8 hours

- An enormous, rambunctious, bone-headed 90 lb hound mix who tried jumping over a fence and ended up with a huge laceration across his stifle; it was a couple days before his owners got him to their regular vet to have the laceration repaired; the rDVM sewed it up but Mr. Hound got his stitches out the next day and came into the vet school with a fantastically huge gaping horizontal wound across his knee, all the muscles showing, etc.; he has been a true Houdini in getting his e-collar off and removing his bandage on an almost daily basis, and everybody is straining to keep coming up with creative options to make him be good (the current solution is basically round-the-clock sedatives)

- A 5-month-old golden puppy who got an intussusception resulting in removal of a large piece of her small intestine, and placement of a feeding tube

- A tiny, ancient Italian Greyhound with a laceration on his shoulder that was sutured, but he keeps biting or scratching at it, resulting in Mom & Dad making him wear an e-collar so he can't lick/chew AND booties on his feet so he can't scratch -- pretty darn pathetic

- A Jack Russell Terrier (JRT, or "jert" as everyone calls them here) who got hit by a car and unfortunately his owners have no money, so he's been getting the leftover bandaging supplies (half rolls of cast padding, gauze, etc.) from everybody else's bandages, and free drugs from somebody in the pharmacy with a soft spot for jerts; we all liked this little guy a lot better until today, when he bit one of the interns; now he has to wear a muzzle for all of his treatments, and unfortunately for him, the only muzzle in his size is neon pink; guess that's what you get for starting to be nasty, little guy!

There have been a few surgeries this week -- I guess the caseload really varies from week to week -- but almost all of them start later in the morning or not until the afternoon, at which point we juniors need to head upstairs for class. There have been some cool ones, though:

- A 7 year old cat who came in for persistent swelling on a hind limb several months after having her leg shut in a door; after biopsy, the swelling turned out to be totally unrelated to the previous injury and was actually a fibrosarcoma (horrible aggressive tumor sometimes induced by vaccines in cats), resulting in poor kitty having her entire leg amputated yesterday

- A 2 year old lab who was hit by a car in June, and was apparently fine since, until last night when he developed acute respiratory distress, had some chest x-rays, and had some very obvious loops of intestine in his thoracic cavity compressing his lungs; hellooooo, diaphragmatic hernia! He stabilized overnight and went into surgery today; usually these hernias can be fixed through the abdominal cavity, but his was so chronic that he had built up adhesions between his intestinal loops and the lining of his thoracic cavity, so they had to open up both his thorax and his abdomen

- A middle-aged border collie with a brachial plexus avulsion (dislocation of all the nerves in the armpit that supply the front leg), resulting finally in an amputation this week

- A cystotomy to remove yet another bladder stone from a poor 14 year old kitty with apparently very recurrent bladder stones; he has had a cystotomy every year for the last 5 years, plus had 1 cancerous kidney removed two years ago

I might actually get to do something cool tomorrow -- this is the first week they are offering the Junior Surgery Lab elective (aka "pig lab") where juniors practice terminal surgeries on culled pigs. One of my classmates got pretty sick today and had to leave before noon, and isn't sure if she'll be there tomorrow. Most of the surgeries take 2 people scrubbed in, so someone is potentially without a partner for tomorrow, and the lab coordinator invited either me or my fellow SD junior to take the place in the lab as long as there isn't too much SD stuff going on. I have a Dr appt early tomorrow morning that might interfere, but I've got my fingers crossed that I'll get to go into the lab. I'm sick of bandages changes!!!