Guess I should blog someday, eh?

I'm glad to be done with neuro. Although the second week with a different clinician was much, MUCH better than the first, it was still a draining, depressing rotation. It's not much fun to spend 10-12 hours a day seeing dogs that can't walk, dogs with brain tumors, dogs with fatal nerve diseases, dogs with spinal cord cancer, dogs with severe congenital birth defects and owners in denial.

But it's over now! And on to dermatology, which is.... unexciting.

Don't get me wrong, it's nice to have a change of pace for a couple weeks. Knowing that I really won't ever have to be here early in the morning, late at night, or on weekends to care for "dermatology inpatients" (haha, oxymoron) is pretty awesome. Spending last weekend at the Renaissance Festival 2 hours away, a friend's house for dinner, and watching the Harry Potter movie made for some pretty nice relaxation. And you won't hear me complaining about the fact that I've left at or before 5 pm on 4 out of the last 6 weekdays. No, I can see why some people are really drawn to dermatology. (Would I commit another 3-6 years of my life to an internship and residency to become a dermatologist? Um, no.)

However, any enthusiasm I had for seeing dermatology patients in the very first days of my rotation has long since worn off.

The dermatology schedule works like this:

Monday, Tuesday, and Thursday -- 8:30 am topic rounds, then a "never been here" appointment (new patient) at 9:30 am; rechecks every 30-60 minutes from 10:30 am until 2:30 pm.

Wednesday -- reserved for general anesthetic procedures (e.g. biopsies, ear cleanings) and any "emergency" patients that need to be seen sooner than they can be worked into the regular schedule (note: there are not really any true derm "emergencies," but there are dogs and cats that are very itchy, painful, or uncomfortable because their rDVMs have exhausted their resources on how to treat or manage said dogs and cats, so they need to see a specialist). During the rest of the day when we are not helping with appointments or procedures, we work on "unknown" cases that are supposed to make us think about differentials, diagnostics, and treatments when presented with a fictitious patient, history, physical exam, and pictures of lesions

Friday -- grand rounds at 8:30, then rechecks every 45-60 minutes from 9:30 am to 2:30 pm

As you can see, with only 3 new patients in most weeks, that adds up to a LOT of rechecks. And frankly, after going through "How's Maddie been doing since her last appointment? Fine? You feel like her allergies are pretty well under control? She's been doing fine on antihistamines, shampoos, and weekly allergy shots? No new lesions? No new concerns today? OK, let me get the doctor" about 10 times, you're just sort of over it. I feel like, among our recheck appointments last week, a good 75% of them had to be dogs that were undergoing therapy for allergies and pretty much doing just fine.

The dermatology department is having somewhat of a freak-out this week because last week was their last week with multiple dermatologists. Over the last several months, they have made a transition from a four-doctor team to a single dermatologist on staff (albeit with brand new residents due to start sometime later this summer, but likely to need lots of hand-holding and mentorship at first, understandably so). This means they are packing in as many appointments as possible, so that instead of seeing perhaps 4 appointments in one day (the previous "usual" schedule for a single doctor), we're now seeing 7 or 8 appointments. Add to that the fact that there are normally 4-5 senior students on dermatology, and last week and this week it is just me and one other student, and you've got some hectic, paperwork-filled days.

Part of what is also discouraging about dermatology is that so many of the cases require so much time to reach a resolution. Many of the rechecks we see have been coming to see the dermatologists for months or years. Even among the new patients we see, the ones that should have a skin test for allergies, or biopsies of lesions, or anesthetized ear cleanings, can't be fit into the schedule until several weeks down the road, or need to have their medications withdrawn so the tests will be accurate -- which allows for very little continuity with the patients we get to know.

My lone rotation-mate is a poor large animal tracker who is not required to take dermatology. Large animal trackers take 1 small animal "core" rotation of their choosing, selecting from dermatology, ophthalmology, cardiology, or oncology. My rotation-mate got placed in dermatology by accident (it was her last choice of the four), and tried desperately to switch out of derm into another rotation, but since there were only the 2 of us scheduled for derm (and the minimum number of students for derm is usually 4), she couldn't get out of it. The poor thing; she has zero interest in small animals, and we haven't seen a single patient or discussed a single case that wasn't a dog or a cat. Even worse, she greatly dislikes cats and has ended up stuck with both of the cats that we've seen in the last week. I personally think she's doing a remarkable job, given that half of the dermatology lectures I've had took place in a small animal course that she didn't even take. I can't imagine being thrown out into the barn as a small animal tracker thoroughly uninterested in large animals, and being expected to stay cheerful and engaged and do a decent job.

Anyhoo, my first patient tomorrow morning is an itchy (and hopefully cooperative) 6 year old kitty. Here's hoping I don't bring anything contagious home with me!