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?

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