Today I had another cardiology patient whose main problem wasn't really cardiac-related. (See: The case of Mr. Beagle.)
My patient was Rosie, a cute little fluffy 14-year-old mutt dog, a "never been here" appointment whose presenting complaint was "murmur/cough." Nothing too surprising there -- most patients who present to cardiology come in because of murmurs, and dogs with heart enlargement and/or heart failure often cough.
When discussing Rosie's history with her mom, she mentioned that Rosie's housemate was diagnosed with fleas a couple weeks ago, and both dogs were treated with Frontline. Rosie's housemate, who is much larger than Rosie, was prescribed the "large dog" size of Frontline, and Rosie's mom figured she could just use half of a tube on Rosie.
However, almost immediately after we started discussing the flea issue, a plump little flea jumped onto Rosie's chart with impeccable timing, and I promptly squished him.
Sigh.
I hate fleas.
To make a long story short, after ausculting Rosie and listening to her history (which included a cough of several years' duration), we felt she most likely had some degree of mitral valve degeneration and regurgitation (extraordinarily common in older, small breed dogs) along with probable chronic bronchitis (also very common in ancient little dogs).
In order to get a look at Rosie's heart and lungs, to make sure her heart disease was what we expected and to evaluate her lungs for a pattern supportive of bronchitis, we decided to take some chest x-rays.
And, kindly and responsible veterinary student that I am, I made a note in the "comments" section of the radiology request that Rosie may have (a contagious infection/infestation potentially dangerous to other animals and people known as) fleas. Figuring that they'd like to know that information so they could properly disinfect their radiology table, etc. And figuring that they'd be happier if I told them up front that Rosie might have fleas, rather than them figuring it out halfway through taking her radiographs.
Oh my Lord. I was so wrong.
Radiology immediately flipped out and said there was no way they could radiograph Rosie while she still had fleas.
Which greatly irritated the senior cardiologist, who said he wasn't taking his irritation out on me (but it sure didn't feel that way).
I was sent to investigate ways to rid Rosie of her fleas, so I headed to Community Practice and Dermatology, both of which recommended administering Capstar, an oral medication that kills fleas almost instantly (not quite, but close). Which was something I already knew.
So I visited Pharmacy to pick up some Capstar for Rosie, only to find that Pharmacy was out of Capstar. But, "helpfully," they offered me an expired pill and generously told me I could have it for free.
The alternative was to readminister a topical flea product like Frontline. The problem was that Rosie had already been giving Frontline a week earlier, and likely got an overdose (which is fortunately not a big issue for that product) since her owner gave half of the large dog size. And although it probably would be pretty safe to just re-apply Frontline again today, neither Merial (the company that produces Frontline), Pharmacy, or Community Practice could comment on the safety of doing so.
All of which, after much running around the hospital like a headless chicken, I conveyed to the senior cardiologist. Who marched down to Radiology with Rosie and me and instructed Radiology that they would now be taking Rosie's radiographs. Which they did. And I almost ran out of the building, screaming with frustration.
The moral(s) of this story:
1. I don't feel comfortable administering an oral medication (Capstar) to a patient when said patient's owner is out of the hospital and cannot be reached by phone. Even if it's probably an innocuous medication.
2. I especially don't feel comfortable administering an expired oral medication to a patient without the owner's informed consent, especially since I have no idea if (a) said expired medication will no longer be efficacious, or worse, if (b) said expired medication may no longer be safe.
3. I don't feel comfortable administering a topical medication (Frontline) to a patient when doing so would be against the label instructions and I've been advised against doing so by the product manufacturers and two departments within the hospital.
4. I don't think it's right or fair for clinicians and students to request for the radiology and ultrasound departments to handle our patients when we know that a patient may have an easily transmissible disease or parasite, without first letting radiology/ultrasound know about the potential hazard. Even if the risk of contagion or transmission is extremely low. How would you feel if you paid $200 for your dog to have radiographs taken at a veterinary teaching hospital and he came home with fleas?
5. However, I don't think it's fair for Radiology to totally flip out if we do the right thing and inform them about a contagious disease. It sure is good motivation for other departments not to let them know the next time. I've encountered this in other departments, particularly with my leptospirosis suspect patient -- when we let Ultrasound know that the dog might have leptospirosis, they threw a fit, so the clinician then didn't want me to tell Radiology about the disease concern. (Granted, leptospirosis is a much bigger health threat than fleas, but the principle is the same.)
6. I think the pharmacy should stock Capstar that is in date. And I am really uncomfortable with the pharmacists handing out expired drugs for us to use on patients in the hospital with the advice, "It'll probably be safe." Not cool, Pharmacy.
7. If a student advises another department about a potential health concern with a patient that that department is expected to handle (e.g. to take radiographs), it is wholly unfair for the clinician to take it out on the student when the other department throws a hissy fit about the fact that they were properly notified about a contagious disease. If there are miscommunications or disagreements between department heads, it is not my job to play monkey in the middle.
8. I am really, really ready to be done with Cardiology. It has not been a fantastic two weeks.
Incidentally, Rosie's radiographs were eventually taken. To my knowledge, nobody got fleas. Her rads showed a large tumor in one of her lung lobes. Which was not at all what we were expecting, but sure does explain her cough. Rosie got a consult with Oncology and is scheduled to come in through them next week for additional diagnostics and possibly surgery. Cancer sucks. Earlier this week we diagnosed another super-sweet dog with a giant tumor on his heart. I want some cardiology patients we can fix.
Thursday, October 27, 2011
Sunday, October 23, 2011
I killed a little old lady's only companion
By "killed," I mean "humanely euthanized." By "little old lady," I mean the cutest 90-year-old woman you've ever met, who loves to tell hilarious stories. And by "only companion," I hope I'm wrong.
Ever-talented and CCU-loving student that I am, I managed a feat that few cardiology students ever achieve: I had a CCU inpatient while on cardiology rotation. (Yeah, I'm that good.)
My patient, a 13-year-old Beagle, arrived as a referral from a local clinic for what the rDVM felt was a cardiac arrhythmia (3rd degree AV block), with the intent of having the dog evaluated by the vet school's cardiology department for the feasibility of placing a pacemaker.
However, upon arrival Mr. Beagle was laterally recumbent, breathing quickly and shallowly, and had bluish purple gums and tongue. So, good student that I am, I immediately brought Mr. Beagle back to the cardiology department for some wonderful oxygen, then headed up to take a history from his owner.
Mr. Beagle's mom was the aforementioned elderly woman, accompanied (and driven, thankfully) by her son (who doesn't live with her). Mr. Beagle had started coughing several months ago, was diagnosed with an enlarged heart a month prior by his rDVM, and was placed on a diuretic that hadn't improved the cough at all. The night before presenting to the vet school, Mr. Beagle had experienced an acute onset of respiratory distress, which improved slightly overnight but not much, so Mr. Beagle headed to his rDVM that next morning.
Long story short, Mr. Beagle ended up in CCU in an oxygen cage overnight, along with several other treatments, none of which did anything to help his breathing. It turns out that his cardiac disease, while present, was rather minor. His arrhythmia was actually atrial standstill, not AV block, and was most likely incidental. His real problem was very severe respiratory disease, and we couldn't figure out the cause. Mr. Beagle's chest x-rays looked horrendous; a variety of diagnostics failed to show why. The next step would have been general anesthesia with airway endoscopy and possibly a bronchoalveolar lavage, but Mr. Beagle was just too unstable and probably would have died under anesthesia.
So Mr. Beagle's owner elected to do the unselfish thing and euthanize him. Tears were shed by all involved, but Mr. Beagle went peacefully with his owner telling us stories about the time he brought a live rabbit into the house and chased it around, how he once scared off a raccoon in the backyard, how he sleeps by his owner's feet in the living room every night before bed. When Mr. Beagle had passed, the cardiology resident and client counselor escorted Mr. Beagle's owner and her son out of CCU while I stayed behind to escort Mr. Beagle's remains down to necropsy. It broke my heart.
Ever-talented and CCU-loving student that I am, I managed a feat that few cardiology students ever achieve: I had a CCU inpatient while on cardiology rotation. (Yeah, I'm that good.)
My patient, a 13-year-old Beagle, arrived as a referral from a local clinic for what the rDVM felt was a cardiac arrhythmia (3rd degree AV block), with the intent of having the dog evaluated by the vet school's cardiology department for the feasibility of placing a pacemaker.
However, upon arrival Mr. Beagle was laterally recumbent, breathing quickly and shallowly, and had bluish purple gums and tongue. So, good student that I am, I immediately brought Mr. Beagle back to the cardiology department for some wonderful oxygen, then headed up to take a history from his owner.
Mr. Beagle's mom was the aforementioned elderly woman, accompanied (and driven, thankfully) by her son (who doesn't live with her). Mr. Beagle had started coughing several months ago, was diagnosed with an enlarged heart a month prior by his rDVM, and was placed on a diuretic that hadn't improved the cough at all. The night before presenting to the vet school, Mr. Beagle had experienced an acute onset of respiratory distress, which improved slightly overnight but not much, so Mr. Beagle headed to his rDVM that next morning.
Long story short, Mr. Beagle ended up in CCU in an oxygen cage overnight, along with several other treatments, none of which did anything to help his breathing. It turns out that his cardiac disease, while present, was rather minor. His arrhythmia was actually atrial standstill, not AV block, and was most likely incidental. His real problem was very severe respiratory disease, and we couldn't figure out the cause. Mr. Beagle's chest x-rays looked horrendous; a variety of diagnostics failed to show why. The next step would have been general anesthesia with airway endoscopy and possibly a bronchoalveolar lavage, but Mr. Beagle was just too unstable and probably would have died under anesthesia.
So Mr. Beagle's owner elected to do the unselfish thing and euthanize him. Tears were shed by all involved, but Mr. Beagle went peacefully with his owner telling us stories about the time he brought a live rabbit into the house and chased it around, how he once scared off a raccoon in the backyard, how he sleeps by his owner's feet in the living room every night before bed. When Mr. Beagle had passed, the cardiology resident and client counselor escorted Mr. Beagle's owner and her son out of CCU while I stayed behind to escort Mr. Beagle's remains down to necropsy. It broke my heart.
Ai, Chihuahua!
I got to have my very own high-maintenance CCU inpatient during the second half of my week of CCU day shifts. (A little clarification: most of the patients in CCU are under the "primary care" of another service -- like surgery, medicine, or oncology -- meaning that the doctor in charge of that patient's care comes from one of those services, and the patient's "primary student" also comes from that specialty service. The primary student is responsible for all of the communication with the clients [or making sure the DVM is giving the client updates], doing a physical exam on the patient every morning, writing new CCU orders, obtaining all drugs needed for that patient while in CCU, and, most fun of all, writing a daily "SOAP" which is an assessment of the patient's current status and a discussion of all of the patient's medical problems. Occasionally, however, a patient in CCU is under the primary care of one of the CCU clinicians, so one of the CCU day students "gets" to be the primary student on the case, meaning you "get" to take over all of the above responsibilities in addition to your already "action-packed" and "fun-filled" day of menial CCU tasks. So no, I was not overly excited to have my own CCU patient.)
Aside from the bureaucratic nonsense and busywork, though, I really liked my sad little patient, a middle-aged Chihuahua who presented in acute oliguric renal failure.
"Renal failure" means your kidneys have stopped working, or are close to it. "Acute" means it happened all of a sudden, versus being a drawn out process over months or years. "Oliguric" means "small urine," in that the kidneys have lost their ability to produce a normal amount of urine, so it's extraordinarily difficult for the body to remove excess fluid and waste/byproducts that are normally peed out. (However, "oliguric" is better than "anuric," which means no urine production.)
After many diagnostics, we determined the most likely cause for Mr. Chihuahua's acute renal failure to be leptospirosis, a nasty bacterial infection usually spread through contact with urine or contaminated standing water.
In addition to his renal failure, Mr. Chihuahua also had ongoing liver disease (also possibly caused by leptospirosis), unhappy muscles, complete loss of appetite, nausea and occasional vomiting, intermittent seizures, and diarrhea.
Since leptospirosis can be spread to people Mr. Chihuahua got his very own "isolation" area requiring people handling him and his urine/stools to wear a plastic gown, latex gloves, a cloth face mask, and plastic goggles. He also got 2 IV catheters (since he was on so many IV medications that many of them could not be combined into the same IV line because they didn't mix well), a urinary catheter, and a nasoesophageal feeding tube (which we fed down his throat through one of his nostrils, then stapled to his face. With a staple gun. While he was awake.).
Anyhow, Mr. Chihuahua was a pathetic mess for the longest time (okay, only about 4 days, but it felt like forever). Finally, he started producing massive amounts of urine (thus transitioning from oliguric ["small urine"] to polyuric ["many urine"] renal failure). Seriously, normal urine production is about 1-2 milliliters of urine per kilogram of body weight per hour, and Mr. Chihuahua got up to 25 ml/kg/hr. Yeesh.
Finally, after 9 days in the hospital, Mr. Chihuahua went home with a tiny appetite, no recent seizures, only a handful of medications, daily subcutaneous fluids to be given at home, and normal kidney values on his bloodwork! It's a testament to what we all need to be reminded of periodically: though the odds may be small, some animals can pull through even the most severe disease conditions if given a chance (and 9 days in CCU, and about $7000).
Aside from the bureaucratic nonsense and busywork, though, I really liked my sad little patient, a middle-aged Chihuahua who presented in acute oliguric renal failure.
"Renal failure" means your kidneys have stopped working, or are close to it. "Acute" means it happened all of a sudden, versus being a drawn out process over months or years. "Oliguric" means "small urine," in that the kidneys have lost their ability to produce a normal amount of urine, so it's extraordinarily difficult for the body to remove excess fluid and waste/byproducts that are normally peed out. (However, "oliguric" is better than "anuric," which means no urine production.)
After many diagnostics, we determined the most likely cause for Mr. Chihuahua's acute renal failure to be leptospirosis, a nasty bacterial infection usually spread through contact with urine or contaminated standing water.
In addition to his renal failure, Mr. Chihuahua also had ongoing liver disease (also possibly caused by leptospirosis), unhappy muscles, complete loss of appetite, nausea and occasional vomiting, intermittent seizures, and diarrhea.
Since leptospirosis can be spread to people Mr. Chihuahua got his very own "isolation" area requiring people handling him and his urine/stools to wear a plastic gown, latex gloves, a cloth face mask, and plastic goggles. He also got 2 IV catheters (since he was on so many IV medications that many of them could not be combined into the same IV line because they didn't mix well), a urinary catheter, and a nasoesophageal feeding tube (which we fed down his throat through one of his nostrils, then stapled to his face. With a staple gun. While he was awake.).
Anyhow, Mr. Chihuahua was a pathetic mess for the longest time (okay, only about 4 days, but it felt like forever). Finally, he started producing massive amounts of urine (thus transitioning from oliguric ["small urine"] to polyuric ["many urine"] renal failure). Seriously, normal urine production is about 1-2 milliliters of urine per kilogram of body weight per hour, and Mr. Chihuahua got up to 25 ml/kg/hr. Yeesh.
Finally, after 9 days in the hospital, Mr. Chihuahua went home with a tiny appetite, no recent seizures, only a handful of medications, daily subcutaneous fluids to be given at home, and normal kidney values on his bloodwork! It's a testament to what we all need to be reminded of periodically: though the odds may be small, some animals can pull through even the most severe disease conditions if given a chance (and 9 days in CCU, and about $7000).
I survived the marathon!
I'm greatly enjoying my first weekend after successfully completing my fantastical 19-days-in-a-row school/work marathon.
My second week of this most recent CCU rotation was the CCU "days" shift, requiring me to arrive at 6 am every day (Monday through Sunday) and stay till, on average, 6 pm. Yes, I kept track of my hours, and yes, it was a total of 85 hours in 7 days.
That week was definitely my most physically and emotionally challenging week of senior year (at least so far). For one thing, though I usually do quite well with being awake in the morning, I don't actually enjoy the act of getting up in the morning (at least not at an early time), and hearing the alarm go off at 5:15 am was, not unsurprisingly, even worse than getting up at 6 or 6:30.
There was the fact that I had multiple days in a row where it was pitch black when I left the house (my, how many stars you can see at 5:45 am!) and dusk when I got home. There was the way my days started with an hour of frantically running around CCU trying to catch up on all the 7 am treatments that the overnight students hadn't gotten done. There was the unpleasant habit of other students of walking hospitalized dogs on the nearest patch of grass outside the building and not taking the extra 1.5 seconds to grab a poop bag on their way out the door, or taking the extra 30 seconds to run back into the building and grab a poop sack. Which led to me stepping in a giant pile of dog crap and getting it all over my sneakers and scrub pants a mere 15 minutes into my 7th day shift. (Fortunately, it was a slow morning, so the night nurse sent me home to change into other pants, but it was oh-so-tempting just not to come back after that. Ask me how the rest of that day went. About the same as the first 15 minutes.)
The "fun" part about CCU is that they let you do a lot of procedures. As long as the patient isn't actively trying to die, you get to put in IV catheters, urinary catheters, arterial lines, jugular catheters, etc. However, that's not the case if you're working with an intern who also wants to practice those procedures.
The other "fun" part about the CCU day shift is teaching rounds in the afternoon. You work your butt off all day until 3 pm, then you have case rounds till about 3:30, then take a half hour or so to check on your patients and make sure all the 3 pm treatments were done, then you reconvene with the after-hours students and one of the residents for discussion on whatever topic you want to talk about from 4-5 pm.
Well, at least that's the idea. On Monday, our first day of the day shift, we finished case rounds at 3:30 pm then headed out to check on patients. By "we," I mean the students. The doctors and nurses all made a beeline for the brand new ultrasound machine so they could play with it and figure out how it worked. Which they did for an hour and a half. Until it was 5 o'clock and it was too late for teaching rounds and we students had wasted 90 minutes waiting for someone to teach us something. I confess, I had a little bit of a breakdown. Remember, I worked from 3-11 pm on Sunday night and had to be back at 6 am the next morning to start the day shift. For myriad other reasons, it was such a crummy Monday that the thought of having teaching rounds (which I honestly enjoy) was really all that had gotten me through the day. All I wanted to do was learn something then go home and sleep, and instead I worked my butt off then waited around doing nothing for 90 minutes then went home. There may have been some under-my-breath ranting about not getting my money's worth from the ~$1000/week in tuition I'm paying for senior year. It was not only the wasted time and the lack of teaching rounds, but the fact that 90% of a senior student's time in CCU is spent walking dogs, cleaning cages, feeding animals, giving pills, reconnecting tangled EKG leads, and trying to get the %&#*!@ IV catheters to draw so you don't have to stick the animal for the blood sample. I don't learn anything any time I do one of those things.
Anyhow, though it's only been a week since my last day in CCU, it feels like it was months ago -- which is great. And on the positive side, I've now completed all 3 of my weeks in CCU, so I never have a rotation there again!
I've moved on to cardiology, and thankfully I'm halfway through that. Well, kind of thankfully. On the one hand, the schedule is wonderful. We have morning rounds at 8:30, followed by one appointment every hour for 2-6 hours depending on the day (Tuesdays are "procedure days" so no appointments). There are no afternoon rounds; if it's slow, we talk about a cardiology topic like radiograph or EKG interpretation. We have time to eat lunch (at actual lunch time -- novel idea!) and as long as nothing's happening, we get to head home between 4 and 5.
However, cardiology is one of my least favorite subjects. I do feel like I've learned it better by working with some actual cardiology patients than by listening to lectures, but it's still a huge challenge for me. And one of the cardiology residents is not the nicest person in the world. Additionally, my single rotation-mate is probably my least favorite person in the entire senior class.
Oh well. You can do anything for 2 weeks, right? Only one more week to go for me, and then it's on to a fun-filled month of anesthesia. Yahoo!
My second week of this most recent CCU rotation was the CCU "days" shift, requiring me to arrive at 6 am every day (Monday through Sunday) and stay till, on average, 6 pm. Yes, I kept track of my hours, and yes, it was a total of 85 hours in 7 days.
That week was definitely my most physically and emotionally challenging week of senior year (at least so far). For one thing, though I usually do quite well with being awake in the morning, I don't actually enjoy the act of getting up in the morning (at least not at an early time), and hearing the alarm go off at 5:15 am was, not unsurprisingly, even worse than getting up at 6 or 6:30.
There was the fact that I had multiple days in a row where it was pitch black when I left the house (my, how many stars you can see at 5:45 am!) and dusk when I got home. There was the way my days started with an hour of frantically running around CCU trying to catch up on all the 7 am treatments that the overnight students hadn't gotten done. There was the unpleasant habit of other students of walking hospitalized dogs on the nearest patch of grass outside the building and not taking the extra 1.5 seconds to grab a poop bag on their way out the door, or taking the extra 30 seconds to run back into the building and grab a poop sack. Which led to me stepping in a giant pile of dog crap and getting it all over my sneakers and scrub pants a mere 15 minutes into my 7th day shift. (Fortunately, it was a slow morning, so the night nurse sent me home to change into other pants, but it was oh-so-tempting just not to come back after that. Ask me how the rest of that day went. About the same as the first 15 minutes.)
The "fun" part about CCU is that they let you do a lot of procedures. As long as the patient isn't actively trying to die, you get to put in IV catheters, urinary catheters, arterial lines, jugular catheters, etc. However, that's not the case if you're working with an intern who also wants to practice those procedures.
The other "fun" part about the CCU day shift is teaching rounds in the afternoon. You work your butt off all day until 3 pm, then you have case rounds till about 3:30, then take a half hour or so to check on your patients and make sure all the 3 pm treatments were done, then you reconvene with the after-hours students and one of the residents for discussion on whatever topic you want to talk about from 4-5 pm.
Well, at least that's the idea. On Monday, our first day of the day shift, we finished case rounds at 3:30 pm then headed out to check on patients. By "we," I mean the students. The doctors and nurses all made a beeline for the brand new ultrasound machine so they could play with it and figure out how it worked. Which they did for an hour and a half. Until it was 5 o'clock and it was too late for teaching rounds and we students had wasted 90 minutes waiting for someone to teach us something. I confess, I had a little bit of a breakdown. Remember, I worked from 3-11 pm on Sunday night and had to be back at 6 am the next morning to start the day shift. For myriad other reasons, it was such a crummy Monday that the thought of having teaching rounds (which I honestly enjoy) was really all that had gotten me through the day. All I wanted to do was learn something then go home and sleep, and instead I worked my butt off then waited around doing nothing for 90 minutes then went home. There may have been some under-my-breath ranting about not getting my money's worth from the ~$1000/week in tuition I'm paying for senior year. It was not only the wasted time and the lack of teaching rounds, but the fact that 90% of a senior student's time in CCU is spent walking dogs, cleaning cages, feeding animals, giving pills, reconnecting tangled EKG leads, and trying to get the %&#*!@ IV catheters to draw so you don't have to stick the animal for the blood sample. I don't learn anything any time I do one of those things.
Anyhow, though it's only been a week since my last day in CCU, it feels like it was months ago -- which is great. And on the positive side, I've now completed all 3 of my weeks in CCU, so I never have a rotation there again!
I've moved on to cardiology, and thankfully I'm halfway through that. Well, kind of thankfully. On the one hand, the schedule is wonderful. We have morning rounds at 8:30, followed by one appointment every hour for 2-6 hours depending on the day (Tuesdays are "procedure days" so no appointments). There are no afternoon rounds; if it's slow, we talk about a cardiology topic like radiograph or EKG interpretation. We have time to eat lunch (at actual lunch time -- novel idea!) and as long as nothing's happening, we get to head home between 4 and 5.
However, cardiology is one of my least favorite subjects. I do feel like I've learned it better by working with some actual cardiology patients than by listening to lectures, but it's still a huge challenge for me. And one of the cardiology residents is not the nicest person in the world. Additionally, my single rotation-mate is probably my least favorite person in the entire senior class.
Oh well. You can do anything for 2 weeks, right? Only one more week to go for me, and then it's on to a fun-filled month of anesthesia. Yahoo!
Thursday, October 13, 2011
The marathon continues
I'm halfway through my epic 19-full-work/school-days-in-a-row-with-no-breaks marathon.
It started with 7 days of the CCU swing shift (roughly 2:45-10:45 pm).
I'm now 3 days into my 7 days of the CCU day shift, and I've worked 38 hours in the last 3 days, with 4 more days to go at this pace. Ask me how that's going. (There have been tears.) PS: this shift starts at 6 am every day.
The last 5 days of the marathon will be my first week of cardiology, which I'm hoping (praying, begging, pleading) will be as laidback as I've heard. I could really use some days of showing up at 8:30 and leaving by 5 or 6. Plus, the odds of an inpatient are fairly low, so if all goes as planned, I'll actually have the weekend off once my 19-day marathon is done.
Would love to blog about what I've been doing on CCU (good and bad) but too tired. Stay tuned...
It started with 7 days of the CCU swing shift (roughly 2:45-10:45 pm).
I'm now 3 days into my 7 days of the CCU day shift, and I've worked 38 hours in the last 3 days, with 4 more days to go at this pace. Ask me how that's going. (There have been tears.) PS: this shift starts at 6 am every day.
The last 5 days of the marathon will be my first week of cardiology, which I'm hoping (praying, begging, pleading) will be as laidback as I've heard. I could really use some days of showing up at 8:30 and leaving by 5 or 6. Plus, the odds of an inpatient are fairly low, so if all goes as planned, I'll actually have the weekend off once my 19-day marathon is done.
Would love to blog about what I've been doing on CCU (good and bad) but too tired. Stay tuned...
Saturday, October 1, 2011
Necropsy: meh
That pretty much sums up my second week on necropsy. I've become somewhat accustomed to the gore, though I don't think I'd ever get to the point of enjoying hacking up people's pets and companions. However, it was easier to head to the necropsy floor during this second week knowing that I was nearing the end.
This week we necropsied lots of dogs, some cats, a few adult horses, several sheep, a couple chickens, a chameleon, a hedgehog, and a hamster. I stayed as far away as possible from anything but dogs and cats, though I did end up with one of the chickens. (Turns out chickens look all weird on the inside.)
My coolest case of the rotation was a 6 month old kitten who presented for an acute onset of respiratory difficulty. His owners didn't have any money so their rDVM took thoracic radiographs for free and diagnosed a diaphragmatic hernia. That's a hole in the diaphragm, which normally provides a complete separation between the chest cavity and abdominal cavity. With a hernia present, abdominal organs can sometimes migrate up into the thoracic cavity where, obviously, they can cause some difficulty breathing.
And it was no surprise that this kitten had been in so much respiratory distress. His entire intestinal tract, including all of his duodenum, jejunum, ileum, and most of his colon, were up in his chest, along with 2 of the 6 lobes of his liver, and his right kidney.
Most of the "ooooh!" moments came when we first opened up his abdomen and noticed how empty it was, then opened up his chest and observed that it looked like a second abdomen, then kept pulling organs back through the hernia and discovering more and more things that had displaced up there.
After taking "courtesy" (i.e. free) radiographs, the rDVM referred the kitten to the vet school for possible surgery. Why, I don't know, because if they couldn't even afford the $$ for radiographs, there's no way they could afford surgery. Had the kitten been a little more stable, and had finances allowed, surgery would probably have been curative. However, he was so distressed by the time he arrived that even putting him in an oxygen cage didn't really help. He might have died during surgery, even being on 100% oxygen and a ventilator. On necropsy his lungs were totally collapsed, so I can see why he couldn't breathe.
Other than that, my personal cases (we all help on most of the cases but one person has primary responsibility for each case and writing the necropsy report) were an old golden retriever with some kind of weird disseminated abdominal cancer, an old golden retriever with probable GI lymphoma, and an adult chicken with respiratory disease and conjunctivitis. (Here's a tip: turns out that deciding on your own to medicate the sick birds in your backyard flock with random antibiotics you have "left over" from your own illnesses generally does not do the birds any good, as evidenced by their presentation to necropsy.)
Anyhoo, I only had to go in for a couple hours this morning, which was nice, and I'm going to be optimistic and just head to church tomorrow morning in hopes that I won't get called in for a fun and exciting horse or cow necropsy. Fingers crossed I'm done with this unpleasant rotation!
Next week I start my second CCU rotation. The first week is the "after hours" shift, requiring me to arrive every day (Monday through Sunday) at 3 pm and hopefully finish between 10-11 pm, though it's possible I'll have to stay later sometimes. The second week is the "days" shift, where I'm scheduled for 7 days in a row (Monday through Sunday) from 6 am to 5:30 pm. Yes, that's right, 11.5 hours x 7 days = an 80.5 hour workweek (and note that those are the hours I'm scheduled for -- it doesn't include any time I have to stay late to do paperwork or finish up patient care, or any time I spend at home reviewing topics or studying for rounds -- hooray?). Suffice it to say, blogging may be intermittent or nonexistent for the next few weeks. Oh well, weekends, sleep, and sanity are overrated, right?
This week we necropsied lots of dogs, some cats, a few adult horses, several sheep, a couple chickens, a chameleon, a hedgehog, and a hamster. I stayed as far away as possible from anything but dogs and cats, though I did end up with one of the chickens. (Turns out chickens look all weird on the inside.)
My coolest case of the rotation was a 6 month old kitten who presented for an acute onset of respiratory difficulty. His owners didn't have any money so their rDVM took thoracic radiographs for free and diagnosed a diaphragmatic hernia. That's a hole in the diaphragm, which normally provides a complete separation between the chest cavity and abdominal cavity. With a hernia present, abdominal organs can sometimes migrate up into the thoracic cavity where, obviously, they can cause some difficulty breathing.
And it was no surprise that this kitten had been in so much respiratory distress. His entire intestinal tract, including all of his duodenum, jejunum, ileum, and most of his colon, were up in his chest, along with 2 of the 6 lobes of his liver, and his right kidney.
Most of the "ooooh!" moments came when we first opened up his abdomen and noticed how empty it was, then opened up his chest and observed that it looked like a second abdomen, then kept pulling organs back through the hernia and discovering more and more things that had displaced up there.
After taking "courtesy" (i.e. free) radiographs, the rDVM referred the kitten to the vet school for possible surgery. Why, I don't know, because if they couldn't even afford the $$ for radiographs, there's no way they could afford surgery. Had the kitten been a little more stable, and had finances allowed, surgery would probably have been curative. However, he was so distressed by the time he arrived that even putting him in an oxygen cage didn't really help. He might have died during surgery, even being on 100% oxygen and a ventilator. On necropsy his lungs were totally collapsed, so I can see why he couldn't breathe.
Other than that, my personal cases (we all help on most of the cases but one person has primary responsibility for each case and writing the necropsy report) were an old golden retriever with some kind of weird disseminated abdominal cancer, an old golden retriever with probable GI lymphoma, and an adult chicken with respiratory disease and conjunctivitis. (Here's a tip: turns out that deciding on your own to medicate the sick birds in your backyard flock with random antibiotics you have "left over" from your own illnesses generally does not do the birds any good, as evidenced by their presentation to necropsy.)
Anyhoo, I only had to go in for a couple hours this morning, which was nice, and I'm going to be optimistic and just head to church tomorrow morning in hopes that I won't get called in for a fun and exciting horse or cow necropsy. Fingers crossed I'm done with this unpleasant rotation!
Next week I start my second CCU rotation. The first week is the "after hours" shift, requiring me to arrive every day (Monday through Sunday) at 3 pm and hopefully finish between 10-11 pm, though it's possible I'll have to stay later sometimes. The second week is the "days" shift, where I'm scheduled for 7 days in a row (Monday through Sunday) from 6 am to 5:30 pm. Yes, that's right, 11.5 hours x 7 days = an 80.5 hour workweek (and note that those are the hours I'm scheduled for -- it doesn't include any time I have to stay late to do paperwork or finish up patient care, or any time I spend at home reviewing topics or studying for rounds -- hooray?). Suffice it to say, blogging may be intermittent or nonexistent for the next few weeks. Oh well, weekends, sleep, and sanity are overrated, right?
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