I'm on surgery C for anesthesia this week, meaning I'm assigned to my very own humane society anesthetic case tomorrow and Thursday, and my very own client-owned spay/neuter patient on Wednesday.
Tomorrow's patient, "Bullwinkle," is a scruffy little mutt dog, about 12 pounds, mostly black with a little white on his chest, with long wiry hair and two very large testicles. He's about a year old -- estimated only, because he was left overnight at one of the local humane societies. :(
I have to say: Bullwinkle's only chance at upcoming adoption is for someone to fall in love with his "quirky" appearance. I say "quirky," because it doesn't seem very politically correct to say what my anesthesia rotation-mate said when she saw him: "Oh my god! Your dog looks like a retard!"
True, Bullwinkle must have come from a motley line of cross-bred dogs, with nary a purebred ancestor in sight. True, his eyes do bug out of his head, one more than the other. And yes, he has one ear that stands straight up and one ear that flops over. And I'll admit that when he looks directly at you, you can't avoid a shiver of crazy running down your spine.
But he's sweet! Okay, he's really scared and doesn't want to look at you, or come near you. And if you put a leash or collar on him, he melts to the floor and magically weighs 80 pounds. But he let me pick him up and put him on my lap, and didn't try to get away. He's one of those "I'm so freaked out I can't move but I don't think I'm going to bite you" dogs. So I'm not sure anyone will fall in love with him based on his personality, unless he really warms up once he gets de-testicled.
I have a sterling anesthetic management plan worked out for him, including some acepromazine, atropine, and morphine as pre-meds; ketamine/diazepam for induction; isoflurane maintenance; an intratesticular lidocaine block; and carprofen/morphine injections post-op with his senior Community Practice student choosing what oral NSAIDs he'll take home with him. Doses and rates are calculated out for oxygen flow, IV fluids, and atropine/dobutamine/ephedrine if needed to help with his heart rate or blood pressure. He'll get a pulse oximeter, capnograph, EKG, Doppler blood pressure, and temperature probe to make sure he's doing well while asleep.
Here's hoping Bullwinkle's surgery goes well tomorrow, and that he doesn't try to give me a heart attack while I'm managing his anesthesia! Despite his "unique" looks, I'm starting to like him...
Monday, April 11, 2011
Why yes, I WOULD like a scholarship!
After last year's traumatic non-scholarship-experience detailed here, and an even-more-pathetic-than-usual essay submitted with my scholarship application last November, I finally got a scholarship!
OK, now that you're done cheering, the relevant details are: $2200 (yes! would have been happy with $50!), 9 other people got the same scholarship as me (holy rich people), it's only for junior students, and the criteria were "superior scholarship, initiative, perseverance, potential for leadership, and financial need." I'm going to pretend that I qualified for more of that than just "financial need."
So I joined many of my fellow junior, sophomore, and freshman classmates, as well as some biomedical sciences undergrads, to nosh on a pretty display of fruit, cheese, crackers, and cookies, accompanied by "golden punch" (which I'm 97% sure was straight orange juice) and listen to a 25-second congratulatory speech by the dean of the vet school.
Interesting statistic: apparently there are 440-some scholarships given out every year to vet students and biomed undergrads, totally some $1.6 million dollars annually. Wow. (And also, why haven't I seen some of this money before?? That comes out to about $2700/year per student!)
Anyway, I'm thoroughly satisfied by my scholarshippiness and look forward to the receipt of $2200 to help offset my upcoming tuition bill of $51,000 for senior year.
OK, now that you're done cheering, the relevant details are: $2200 (yes! would have been happy with $50!), 9 other people got the same scholarship as me (holy rich people), it's only for junior students, and the criteria were "superior scholarship, initiative, perseverance, potential for leadership, and financial need." I'm going to pretend that I qualified for more of that than just "financial need."
So I joined many of my fellow junior, sophomore, and freshman classmates, as well as some biomedical sciences undergrads, to nosh on a pretty display of fruit, cheese, crackers, and cookies, accompanied by "golden punch" (which I'm 97% sure was straight orange juice) and listen to a 25-second congratulatory speech by the dean of the vet school.
Interesting statistic: apparently there are 440-some scholarships given out every year to vet students and biomed undergrads, totally some $1.6 million dollars annually. Wow. (And also, why haven't I seen some of this money before?? That comes out to about $2700/year per student!)
Anyway, I'm thoroughly satisfied by my scholarshippiness and look forward to the receipt of $2200 to help offset my upcoming tuition bill of $51,000 for senior year.
Sunday, April 10, 2011
Welcome to anesthesia
I'm in between my 2 consecutive weeks of junior anesthesia rotation -- our only junior practicum rotation other than client communications that comprises more than a single week during the year.
Anesthesia is reputed to be one of the more challenging, time-consuming, and stressful, yet thought-provoking, interesting, and rewarding rotations we get to have during junior year. My 2-week block is the second-to-last of the academic year, meaning I've heard feedback from almost all of my classmates up to this point.
The dozen of us who started anesthesia last week showed up outside of room D107D shortly before 8 am, as instructed by the first page of our orientation packet that was delivered to our mailboxes the previous week, with "8 am on Monday, room D107D" highlighted for us in bright yellow.
Unfortunately, by 8 am, no instructor had arrived to unlock the door to the room we were supposed to be in, much less give us an actual orientation. Being good little vet students and understanding that clinicians and support staff can be very busy and the hospital has a priority to patient care as well as student learning, we sat patiently in the hallway for another 15 minutes.
At 8:15, I walked across the hospital to the anesthesia induction/recovery area to see if anyone might know what we were supposed to be doing. I found the anesthesia prep room as well as the rounds room completely unoccupied, so went to rejoin my classmates in our continuing exercise in patience.
At 8:30, nothing had changed, so I made the rounds again, and again found the prep room and rounds room with nary an anesthesia clinician or nurse in sight. Back I went to room D107D.
At 8:50 am, the surgical instructor who works with the spay/neuter cases seen on Community Practice came walking down our hallway, and we pretty much pounced on her to help us. Being a helpful person, she first let us into the room we were waiting in front of, and then paged the nurse who was supposed to be leading our orientation. The news she found out was that said orientation nurse had called in sick and advised whomever she talked to that she would be unable to lead junior orientation and they would have to find someone else to do it. Seems that message never got conveyed to anyone who might actually be interested in leading our orientation.
The kindly surgical instructor marched upstairs to where she knew all of the anesthesia faculty and nurses were listening to a guest lecturer give a presentation, hoping to snag one of them to come give us a hand. However, she returned at 9 am with the news that, despite having interrupted their meeting and advised them that a dozen juniors had been waiting for over an hour for the anesthesia orientation they had been commanded to appear for by an annoyingly highlighted orientation packet, the meeting was apparently so important and/or interesting that not a single person would be able to break away from it to come orient us. Word was that the meeting would be over at 9:30 am and orientation would commence at that point.
Fast forward after killing time for half an hour. We dozen students again await an instructor at 9:30 am. Finally, at 9:50 am (bearing in mind that we all showed up roughly 2 hours before this point), a couple of anesthesia nurses walked in nonchalantly with no apologies and proceeded to give us their version of "orientation" ("Keep in mind that we've never done an orientation before and we don't really know what they tell you... but we can show you where the equipment is"). An hour and 15 minutes later (including a 30 minute antiquated video of how to place an IV catheter and induce anesthesia, using protocols that probably haven't been used at the teaching hospital in the last 15 years), we had apparently received all of the orientation we needed.
The nurses asked if there were any questions, and we proceeded to spend another 30 minutes asking them about tons of relevant information they had neglected to mention during "orientation." We then went on our merry way, thoroughly confused about anesthesia rotation.
In discussing with some of my other classmates over lunch, almost all of them said their orientation was very thorough and had taken the full 4 hours allotted, sometimes even spilling over into the lunch hour, and leaving the juniors confident in how the following two weeks would go. Haha. I'm sure we didn't miss anything in our 75 minute "we don't know how to do orientation" orientation. Good thing it's not like anesthesia is a department in which patients' lives are at risk and juniors are expected to devise their own anesthetic protocols and run anesthesia on their own. Oh wait.
Long story short, we clinical juniors (6 of us, including me, spent the past week shadowing seniors on more complicated cases, while the other 6 were on 'surgery C' -- the humane society spay/neuter cases) figured out what we were doing after sort of muddling our way through it on the first day.
On Tuesday I had a 50kg female great Dane undergoing a laparoscopy-assisted gastropexy (preventative surgery for bloat/GDV). She was totally anxious and freaked out when her owner dropped her off (sexually intact because "I want to show her and breed her" -- good luck getting her into a show ring without biting anyone). She fortunately sedated well with her pre-meds, and went down easily at induction. The surgery and anesthesia were uneventful, but she totally flipped out in recovery, 110 lb of panicked, disoriented dog flailing around and trying to bite. Hooray for alpha2 agonists that knocked her right out again.
On Wednesday my case was another great Dane -- this time 80kg (176 lb) -- in through Community Practice for the removal of a couple of probably benign but totally gnarly-looking skin masses growing on stalks off of his elbows. He was somewhat friendlier than the previous day's Dane, but still nervous, and didn't sedate as well before induction. However, he went under smoothly and recovered smoothly, which was a huge relief after seeing the previous day's recovery.
On Thursday I followed along with a 9 year old Australian cattle dog cross undergoing surgical repair for an acutely ruptured ACL. She had a TPLO (a procedure in which the bone of the tibia is cut and a steel plate is put on it) as well as a lateral suture to add stability to her knee. Those are potentially very painful procedures, so it was lovely that she received a femoral and sciatic nerve block on the affected leg, which kept her from feeling anything at all during surgery and kept her anesthesia very smooth. Like Wednesday's Dane, this dog didn't sedate especially well with pre-meds, but did induce smoothly. Her surgery went on for a long time so I didn't get to see her recovery.
This week I'm heading into my surgery C cases. Monday and Friday will be case discussions and rounds all morning, and I'll manage my own cases (with no assistance from a senior student) on Tues-Wed-Thurs. Tuesday and Thursday are humane society animals that go back to be adopted; Wednesday is client owned animals. They should all be spays or neuters on relatively young, healthy patients, which can theoretically make the anesthesia more straightforward, but we're still learning and there are always plenty of things that can go wrong in any anesthetic case, so it will be a challenging but hopefully rewarding experience (and I'm trying to put out of my mind my classmate whose very first surgery C case last fall died under anesthesia and couldn't be recovered... la la la, I can't hear you!). The downside is that on surgery days, I'll have to have my anesthetic plan approved BY 7 am (which means I have to get to school in time to put away my stuff, change into scrubs, get my clinic smock/thermometer/stethoscope/watch/etc., and get downstairs to have the nurse look over my anesthetic plan by 7 am). Sleep is overrated. Or so I keep telling myself.
Anesthesia is reputed to be one of the more challenging, time-consuming, and stressful, yet thought-provoking, interesting, and rewarding rotations we get to have during junior year. My 2-week block is the second-to-last of the academic year, meaning I've heard feedback from almost all of my classmates up to this point.
The dozen of us who started anesthesia last week showed up outside of room D107D shortly before 8 am, as instructed by the first page of our orientation packet that was delivered to our mailboxes the previous week, with "8 am on Monday, room D107D" highlighted for us in bright yellow.
Unfortunately, by 8 am, no instructor had arrived to unlock the door to the room we were supposed to be in, much less give us an actual orientation. Being good little vet students and understanding that clinicians and support staff can be very busy and the hospital has a priority to patient care as well as student learning, we sat patiently in the hallway for another 15 minutes.
At 8:15, I walked across the hospital to the anesthesia induction/recovery area to see if anyone might know what we were supposed to be doing. I found the anesthesia prep room as well as the rounds room completely unoccupied, so went to rejoin my classmates in our continuing exercise in patience.
At 8:30, nothing had changed, so I made the rounds again, and again found the prep room and rounds room with nary an anesthesia clinician or nurse in sight. Back I went to room D107D.
At 8:50 am, the surgical instructor who works with the spay/neuter cases seen on Community Practice came walking down our hallway, and we pretty much pounced on her to help us. Being a helpful person, she first let us into the room we were waiting in front of, and then paged the nurse who was supposed to be leading our orientation. The news she found out was that said orientation nurse had called in sick and advised whomever she talked to that she would be unable to lead junior orientation and they would have to find someone else to do it. Seems that message never got conveyed to anyone who might actually be interested in leading our orientation.
The kindly surgical instructor marched upstairs to where she knew all of the anesthesia faculty and nurses were listening to a guest lecturer give a presentation, hoping to snag one of them to come give us a hand. However, she returned at 9 am with the news that, despite having interrupted their meeting and advised them that a dozen juniors had been waiting for over an hour for the anesthesia orientation they had been commanded to appear for by an annoyingly highlighted orientation packet, the meeting was apparently so important and/or interesting that not a single person would be able to break away from it to come orient us. Word was that the meeting would be over at 9:30 am and orientation would commence at that point.
Fast forward after killing time for half an hour. We dozen students again await an instructor at 9:30 am. Finally, at 9:50 am (bearing in mind that we all showed up roughly 2 hours before this point), a couple of anesthesia nurses walked in nonchalantly with no apologies and proceeded to give us their version of "orientation" ("Keep in mind that we've never done an orientation before and we don't really know what they tell you... but we can show you where the equipment is"). An hour and 15 minutes later (including a 30 minute antiquated video of how to place an IV catheter and induce anesthesia, using protocols that probably haven't been used at the teaching hospital in the last 15 years), we had apparently received all of the orientation we needed.
The nurses asked if there were any questions, and we proceeded to spend another 30 minutes asking them about tons of relevant information they had neglected to mention during "orientation." We then went on our merry way, thoroughly confused about anesthesia rotation.
In discussing with some of my other classmates over lunch, almost all of them said their orientation was very thorough and had taken the full 4 hours allotted, sometimes even spilling over into the lunch hour, and leaving the juniors confident in how the following two weeks would go. Haha. I'm sure we didn't miss anything in our 75 minute "we don't know how to do orientation" orientation. Good thing it's not like anesthesia is a department in which patients' lives are at risk and juniors are expected to devise their own anesthetic protocols and run anesthesia on their own. Oh wait.
Long story short, we clinical juniors (6 of us, including me, spent the past week shadowing seniors on more complicated cases, while the other 6 were on 'surgery C' -- the humane society spay/neuter cases) figured out what we were doing after sort of muddling our way through it on the first day.
On Tuesday I had a 50kg female great Dane undergoing a laparoscopy-assisted gastropexy (preventative surgery for bloat/GDV). She was totally anxious and freaked out when her owner dropped her off (sexually intact because "I want to show her and breed her" -- good luck getting her into a show ring without biting anyone). She fortunately sedated well with her pre-meds, and went down easily at induction. The surgery and anesthesia were uneventful, but she totally flipped out in recovery, 110 lb of panicked, disoriented dog flailing around and trying to bite. Hooray for alpha2 agonists that knocked her right out again.
On Wednesday my case was another great Dane -- this time 80kg (176 lb) -- in through Community Practice for the removal of a couple of probably benign but totally gnarly-looking skin masses growing on stalks off of his elbows. He was somewhat friendlier than the previous day's Dane, but still nervous, and didn't sedate as well before induction. However, he went under smoothly and recovered smoothly, which was a huge relief after seeing the previous day's recovery.
On Thursday I followed along with a 9 year old Australian cattle dog cross undergoing surgical repair for an acutely ruptured ACL. She had a TPLO (a procedure in which the bone of the tibia is cut and a steel plate is put on it) as well as a lateral suture to add stability to her knee. Those are potentially very painful procedures, so it was lovely that she received a femoral and sciatic nerve block on the affected leg, which kept her from feeling anything at all during surgery and kept her anesthesia very smooth. Like Wednesday's Dane, this dog didn't sedate especially well with pre-meds, but did induce smoothly. Her surgery went on for a long time so I didn't get to see her recovery.
This week I'm heading into my surgery C cases. Monday and Friday will be case discussions and rounds all morning, and I'll manage my own cases (with no assistance from a senior student) on Tues-Wed-Thurs. Tuesday and Thursday are humane society animals that go back to be adopted; Wednesday is client owned animals. They should all be spays or neuters on relatively young, healthy patients, which can theoretically make the anesthesia more straightforward, but we're still learning and there are always plenty of things that can go wrong in any anesthetic case, so it will be a challenging but hopefully rewarding experience (and I'm trying to put out of my mind my classmate whose very first surgery C case last fall died under anesthesia and couldn't be recovered... la la la, I can't hear you!). The downside is that on surgery days, I'll have to have my anesthetic plan approved BY 7 am (which means I have to get to school in time to put away my stuff, change into scrubs, get my clinic smock/thermometer/stethoscope/watch/etc., and get downstairs to have the nurse look over my anesthetic plan by 7 am). Sleep is overrated. Or so I keep telling myself.
Monday, March 28, 2011
Canine rehabilitation, aka anatomy review
I have a pretty cool rotation this week -- Canine Rehabilitation, or for short, "rehab." No, it's not about those dogs that just couldn't give up their fentanyl when it was time to leave CCU, or who keep sneaking their owner's tramadol. It's actually physical therapy-type stuff, but because of legal reasons, you can't use the term "physical therapy" unless you're specifically trained as a human physical therapist.
The rehab course is only offered this week and was added as an elective option at the end of last semester. This year's seniors who took the class last year made it sound really great, so a bunch of us juniors dropped whatever elective rotation we were scheduled to have this week (cardiology, for me).
The first hour or so of class is a lecture about methods of and uses for rehabilitation in veterinary patients -- everything from goniometry (measuring the angles of the joints) to girthometry (measuring the circumference of a muscle group) to active and passive range of motion to balance exercises to underwater treadmills and other hydrotherapy.
Then we get a quick "bio break" (a term I don't particularly like), followed by about 20 minutes of discussion of whatever muscle groups we're going over for the day -- yesterday was thoracic limb muscles; today was epaxial, hypaxial, thoracic, cervical, and deep pelvic muscles.
One of the fun parts is that we then have 75-90 minutes to use muscle-colored modeling clay to "build" the muscles we just discussed onto a plastic dog skeleton model. You get blue or green clay to make tendons and ligaments.
The last 60-75 minutes of class are left for actual hands-on palpation practice with actual real live dogs (owned by the students in the course) who submit to such learning opportunities as palpating bony landmarks (like the acromion, scapular spine, styloid processes, patella, ischiatic tuberosity, etc.) as well as different muscles (biceps, triceps, deltoid, pectorals, etc.).
And while I'd love to learn about some of the rehabilitation exercises I can use in the future (near-ish future!) to help my canine (and cooperative feline) patients feel better after surgery or injuries, it is just as great at this point to be having a really intensive review of bony and muscular anatomy. It's truly amazing how much you can forget (well, not "forget" so much as "lock away in a nearly inaccessible dusty corner of your brain") in the 2 years following freshman anatomy class. I'm really optimistic that this week's lectures, labs, and exercises will help make me a better senior student doctor in just 6 weeks.
The rehab course is only offered this week and was added as an elective option at the end of last semester. This year's seniors who took the class last year made it sound really great, so a bunch of us juniors dropped whatever elective rotation we were scheduled to have this week (cardiology, for me).
The first hour or so of class is a lecture about methods of and uses for rehabilitation in veterinary patients -- everything from goniometry (measuring the angles of the joints) to girthometry (measuring the circumference of a muscle group) to active and passive range of motion to balance exercises to underwater treadmills and other hydrotherapy.
Then we get a quick "bio break" (a term I don't particularly like), followed by about 20 minutes of discussion of whatever muscle groups we're going over for the day -- yesterday was thoracic limb muscles; today was epaxial, hypaxial, thoracic, cervical, and deep pelvic muscles.
One of the fun parts is that we then have 75-90 minutes to use muscle-colored modeling clay to "build" the muscles we just discussed onto a plastic dog skeleton model. You get blue or green clay to make tendons and ligaments.
The last 60-75 minutes of class are left for actual hands-on palpation practice with actual real live dogs (owned by the students in the course) who submit to such learning opportunities as palpating bony landmarks (like the acromion, scapular spine, styloid processes, patella, ischiatic tuberosity, etc.) as well as different muscles (biceps, triceps, deltoid, pectorals, etc.).
And while I'd love to learn about some of the rehabilitation exercises I can use in the future (near-ish future!) to help my canine (and cooperative feline) patients feel better after surgery or injuries, it is just as great at this point to be having a really intensive review of bony and muscular anatomy. It's truly amazing how much you can forget (well, not "forget" so much as "lock away in a nearly inaccessible dusty corner of your brain") in the 2 years following freshman anatomy class. I'm really optimistic that this week's lectures, labs, and exercises will help make me a better senior student doctor in just 6 weeks.
Wednesday, March 23, 2011
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!
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!
Monday, March 7, 2011
Menagerie
This week's rotation is Shelter Medicine, which is 5 mornings of various activities at the county humane society.
This morning was wildlife care and rehabilitation. Here are some of the animals I helped care for:
- 65 adult squirrels
- 3 neonatal squirrels
- Wild rabbit
- Muskrat
- Rooster
- Mallard ducks
- Coyotes
- Pigeons
- Albino dove
- Robin
- Small songbird (can't remember what species)
- Turtles
- Anoles
- Geckos
- Salamanders
- Anoles
- Mice
- Parakeets
- Lovebirds
- Snakes
- Iguana
Yep, I am ready to get back to dogs and cats. I hope I never have to replace the water bowl in a snake's tank again!
(The 64 adult squirrels living in outdoor enclosures until they can be released in the spring were definitely the cutest... we prepared their daily diet [corn on the cob, fresh apples, grapes, nuts, and squirrel pellets] and it was totally adorable to watch them eat. The hardest part of wildlife rehab was that 95% of the animals are intended to be released back into the wild, so you're not supposed to play with them or talk to them...)
This morning was wildlife care and rehabilitation. Here are some of the animals I helped care for:
- 65 adult squirrels
- 3 neonatal squirrels
- Wild rabbit
- Muskrat
- Rooster
- Mallard ducks
- Coyotes
- Pigeons
- Albino dove
- Robin
- Small songbird (can't remember what species)
- Turtles
- Anoles
- Geckos
- Salamanders
- Anoles
- Mice
- Parakeets
- Lovebirds
- Snakes
- Iguana
Yep, I am ready to get back to dogs and cats. I hope I never have to replace the water bowl in a snake's tank again!
(The 64 adult squirrels living in outdoor enclosures until they can be released in the spring were definitely the cutest... we prepared their daily diet [corn on the cob, fresh apples, grapes, nuts, and squirrel pellets] and it was totally adorable to watch them eat. The hardest part of wildlife rehab was that 95% of the animals are intended to be released back into the wild, so you're not supposed to play with them or talk to them...)
Back to normal hours
After spending 34 hours between 5 pm and 2 am on my Urgent Care rotation last week, it is a relief to be back to normal daytime hours.
It was definitely interesting to work a swing-shift sort of thing. Certainly I now have a somewhat better idea of what to expect from some of my senior year rotations, including the 4 weeks I'll spend on CCU/Urgent Care, 2.5 weeks on After Hours Wards, and various on-call nights for Surgery and Anesthesia.
However, I pretty much dropped everything besides school from my life last week -- and it was even a good thing that I didn't have any homeworks or exams to do, because I wouldn't have had time to study. Basically no quality time w/CLH, no cooking, no cleaning, no handbells, no church, no choir, and I got horribly behind on emails. In exchange, I got a decent amount of sleep since I could sleep in late every morning and not get to class until 1-2 pm!
I would never have thought, though, that I would be excited to get back to an 8 am-12 pm clinical rotation...
It was definitely interesting to work a swing-shift sort of thing. Certainly I now have a somewhat better idea of what to expect from some of my senior year rotations, including the 4 weeks I'll spend on CCU/Urgent Care, 2.5 weeks on After Hours Wards, and various on-call nights for Surgery and Anesthesia.
However, I pretty much dropped everything besides school from my life last week -- and it was even a good thing that I didn't have any homeworks or exams to do, because I wouldn't have had time to study. Basically no quality time w/CLH, no cooking, no cleaning, no handbells, no church, no choir, and I got horribly behind on emails. In exchange, I got a decent amount of sleep since I could sleep in late every morning and not get to class until 1-2 pm!
I would never have thought, though, that I would be excited to get back to an 8 am-12 pm clinical rotation...
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