Back at it

Shelter medicine finished with a lot of anesthesia preparation, induction, and monitoring -- which was good for me, since I've had minimal experience giving IV injections without a catheter and performing endotracheal intubation. However, we were supposed to get to do some tom cat or male kitten castrations sometime during the week, and we only ended up with female kitties, so surgery experience was limited.

Last week was spring break, which flew by and was more exhausting than relaxing by the time it was over. We moved out of our condo and into an apartment on Friday and Saturday, spent Sunday unpacking as much as possible ("minimally functional" was the goal we achieved), and headed back to school on Monday.

My rotation this week is Orthopedics. It's been interesting, but pretty slow. One of the downsides of an economic recession for vet med is that clients have less disposable income to spend fixing their pets -- which can mean that procedures like knee, hip, and elbow repairs get postponed and the pet is just put on pain meds for the time being, rather than seeking a surgical cure. Instead of putting a plate or external fixator on a fractured leg, the owner might seek amputation instead. Owners of dogs that are only mildly lame opt for a 'wait and see' approach rather than going for radiographs and a CT scan.

What I'm trying to get at is, there hasn't been a huge caseload.

On Monday I saw one case with a senior -- a 6 year old, black miniature poodle -- who was completely sweet and adorable. He had been diagnosed with bilateral medial luxating patellas (a hugely common problem in toy breeds) by the referring vet after his owners noticed intermittent lameness. Though he was only a Grade I-II out of IV on each side, his owners seemed interested in pursuing a proactive surgical solution, knowing that MPL can progress in severity and cause pain and dysfunction.

Tuesday's case was a 4.5 month old Great Dane puppy (such a sweet thing, although almost 75 lb!). He was stepped on by his dam when he was only about 3 weeks old, and fractured his tibia and fibula. The breeder (clearly a responsible individual) neglected to seek any veterinary care for the next few weeks, and had just decided to have the puppy put down when the breeder's mother intervened and 'rescued' the dog. Unfortunately, the breeder's mom didn't get the pup to a vet quickly either, and he was eventually passed along to his current owner at about 12 weeks of age.

Thankfully, the current owner recognized immediately that the puppy needed some serious medical care, and brought him to the VTH. The plan decided by the orthopods was to monitor the puppy's growth and see him for a recheck physical and orthopedic exam, as well as serial radiographs, every 3 weeks. Long story short, what started as a pretty badly malformed tibia 6 weeks ago, was getting worse at the recheck 3 weeks ago, and had worsened so much by yesterday's visit that the dog's tibia (the shinbone) was basically bent at a 90-degree angle.

At this point, it was pretty obvious that the leg wasn't going to fix itself as the puppy grew. Though the owner had previously indicated a reluctance to pursue surgery, she was gung-ho yesterday that it was time to do whatever needed to be done -- which, in order to have a chance of saving the leg and having it be functional, meant 3-4 surgeries over the next 6-8 months, probably with placement of a circular external skeletal fixator, all with a prognosis that couldn't guarantee that the leg would be functional in the end.

My vote was for amputation, but the owner was vehemently against that as anything other than an absolutely last resort. Bummer, because the orthopedic surgeries to attempt to salvage the leg were estimated to cost $7-10K altogether, and the dog still might have to have the leg amputated if they can't fix it.

Anyway, getting off my soapbox.

Today, Day 3 of orthopedics, was totally dead. There was one appointment all day -- a bandage change in the afternoon. So we had rounds talking about elbow dysplasia for 2.5 hours, then the dozen of us headed over to surgery to watch a craniodorsal traumatic hip luxation undergo surgical repair. Unfortunately, the joint was so badly damaged that just replacing the femur into the acetabulum wasn't really an option. But since the owners apparently had plenty of money, the surgeons got to go ahead with a total hip replacement (which was admittedly pretty cool to see).

Outside of school, I've got a whole long list of errands to run, in addition to finishing unpacking and putting away plenty of stuff in the new apartment, getting back to the Windsor condo for some final cleaning, spending 8+ hours on Saturday at the shelter medicine conference, 4 hours of class on Sunday afternoon because of Open House the following weekend.... so I guess it's time for bed!