In small animal medicine, especially in summer, a ridiculous proportion of your patients are dogs with skin allergies. There's a big spiel about how to figure out the problem step by step, doing food trials and what have you, but a shocking number of them stop after the first step.
For almost every skin patient I've seen recently, the issue was fleas.
Do you use flea medicine? Yes.
What do you use? Some obscure product made out of a chemical no one's heard of.
How do you apply it? On their backs. Right where they can lick it off. Also I take them for a swim in the river right afterwards.
How often do you use it? Oh, now and again. Maybe every other month.
Do you have other pets in the household? Yes. The cats have fleas. But I'm sure the dog doesn't.
I know you don't believe me, but let's try this flea treatment plan and see if the dog improves...
It does.
Tuesday 28 January 2014
It's Actually A Walk-In Freezer
The air conditioning for the computer lab in the hospital is a source of some contention. The occasional person gets too hot and turns it on, and that transforms the room into an arctic survival training scenario. Even if you turn it back off, it inevitably gets turned back on again when you aren't looking.
One of the biggest culprits for the arctic warfare is a Canadian student. Someone printed out a Canadian flag and posted it above the rheostat, with text that reads: Welcome to Canada, where the temperature is always sub-optimal.
One of the biggest culprits for the arctic warfare is a Canadian student. Someone printed out a Canadian flag and posted it above the rheostat, with text that reads: Welcome to Canada, where the temperature is always sub-optimal.
Medicine: A Sampler Platter of Patients
Patient 1: Vomiting dog.
Me: Does she have access to anything, something she might have gotten into?
Owner: We have fruit trees, but we thought we picked up all the plums. And we're renovating the fence, but we keep the dogs away from it.
Me: What about rubbish?
Owner: Just what drunk people throw over the fence. That's why we're renovating it.
Patient 2: Old dog in for a "health check."
Presenting problems:
- Going blind
- Sore "stomach" but actually sore around her entire hind end
- Drinking more lately
- Pants all the time
- Tires quickly after walks
- Limps on front leg
- There's a skin lump, but the owner can't find it again
Add onto this the fact that I pretty much couldn't examine her because she started getting mouthy as soon as I touched anywhere near her back end. Or anywhere, really. In fact, I started to wonder if it was more behavioural than pain.
Also the owner mentioned that her husband didn't want to take the dog to the vet after the motorbike accident, because "he's just bruised."
Because of cataracts and possible polydypsia (drinking too much), it became my job to follow owner + dog around outside with a soup ladle to try and catch a urine sample. Everyone was quite pleased to find that she is not, in fact, diabetic.
Not My Patient: Dog with bloodshot eyes.
On the schedule, a new appointment popped up with the note "bloodshot eyes after staying in the kennel."
"Bloodshot eyes?"
"Maybe it's just conjunctivitis, and they saw the reddened membranes and are just calling it bloodshot eyes."
Nope. The sclera (white part) was actually blood-red.
Top differentials:
PS: These are just from today.
Me: Does she have access to anything, something she might have gotten into?
Owner: We have fruit trees, but we thought we picked up all the plums. And we're renovating the fence, but we keep the dogs away from it.
Me: What about rubbish?
Owner: Just what drunk people throw over the fence. That's why we're renovating it.
Patient 2: Old dog in for a "health check."
Presenting problems:
- Going blind
- Sore "stomach" but actually sore around her entire hind end
- Drinking more lately
- Pants all the time
- Tires quickly after walks
- Limps on front leg
- There's a skin lump, but the owner can't find it again
Add onto this the fact that I pretty much couldn't examine her because she started getting mouthy as soon as I touched anywhere near her back end. Or anywhere, really. In fact, I started to wonder if it was more behavioural than pain.
Also the owner mentioned that her husband didn't want to take the dog to the vet after the motorbike accident, because "he's just bruised."
Because of cataracts and possible polydypsia (drinking too much), it became my job to follow owner + dog around outside with a soup ladle to try and catch a urine sample. Everyone was quite pleased to find that she is not, in fact, diabetic.
Not My Patient: Dog with bloodshot eyes.
On the schedule, a new appointment popped up with the note "bloodshot eyes after staying in the kennel."
"Bloodshot eyes?"
"Maybe it's just conjunctivitis, and they saw the reddened membranes and are just calling it bloodshot eyes."
Nope. The sclera (white part) was actually blood-red.
Top differentials:
- Trauma - No signs of trauma. No history of trauma. Perfectly happy puppy.
- Distemper - You may go your entire career without seeing this disease, depending on where you work. Comes with fever, snotty nose, eye discharge, etc - i.e., not perfectly happy puppy.
- Rat bait poisoning - Tends to cause bleeding on the mucous membranes as well as other signs. Literally the only sign in this dog was the red eyes.
PS: These are just from today.
Monday 27 January 2014
The Universe Doesn't Want Me To Have Patients
Every case I put my name on disappears.
Yesterday I signed up for a consult at 10:30 and 1:30. The 1:30 disappeared. Then the 10:30 didn't show, and reappeared on the schedule for 1:30. Then it turned out we had an ophthalmology practical that no one told us about at 1:00, so I didn't get to do the consult.
Today I put my name down for a 1:30 and a 3:00. The 1:30 disappeared. Again. A new one popped up at 3:30, so I signed up for that one instead. Then that one disappeared. Turns out it only moved to the 1:30 spot.
Whether I actually get to see any consults today remains to be seen.
Yesterday I signed up for a consult at 10:30 and 1:30. The 1:30 disappeared. Then the 10:30 didn't show, and reappeared on the schedule for 1:30. Then it turned out we had an ophthalmology practical that no one told us about at 1:00, so I didn't get to do the consult.
Today I put my name down for a 1:30 and a 3:00. The 1:30 disappeared. Again. A new one popped up at 3:30, so I signed up for that one instead. Then that one disappeared. Turns out it only moved to the 1:30 spot.
Whether I actually get to see any consults today remains to be seen.
It Matches Her Coat
Today I turned someone's dog orange.
Fortunately, it was a classmate, not a client, and it was during an ophthalmology practical lab. Which, by the way, no one told us we had until the ophthalmologist actually walked through the door into the hospital and we're like, "Uhhh, I guess we do have a prac this afternoon." It was finally confirmed that it was supposed to take place at 1pm (confirmed at 1pm), and as we all rush to arrive--including a number of students off on lunch--we suddenly realised we also had no idea where the prac was. Also it was very inconveniently timed and I had to miss my only consult for the day, rendering my day rather useless.
Anyway, back to the point--orangeness. Amongst other things, we were given a bunch of fluorescein dye to put in the dogs' eyes. It sticks to ulcers, glows under UV light, and just drains out through the tear ducts and into the nose. Usually you squirt it into the eye with a syringe or dropper or something, but for some reason we had a bazillion little strips with dye-coated tips. I used one of those. Why not?
There were only three dogs. One had some eye pathology so was constantly surrounded by a cloud of students and had lights shined into both eyes for pretty much the entire duration of the lab. One was teeny tiny and at that moment also being examined by others. So I selected the remaining dog, my classmate's, considering people were just sitting by her, talking. I should mention that this dog has white fur.
I went ahead and stuck the strip in like normal, but the dog squinted her eye shut around it really tightly, to the point that the eyelid rolled inward. After about 10 seconds, it became clear that orange was seeping out around her eye. I removed the strip and she opened the eye. She suddenly had a giant spot all around her eye, bright orange. It seemed to be an inordinately large spot considering the procedure, and it was contrasted nicely by the sheer whiteness of the fur around it.
To be fair, I did get the fluorescein into her eye. I don't think she has an ulcer.
(To add insult to injury, no one was paying much attention to the fluorescein strips, and I'm pretty sure some of my classmates thought something had gone horribly wrong with the syringe/dropper method.)
Fortunately, it was a classmate, not a client, and it was during an ophthalmology practical lab. Which, by the way, no one told us we had until the ophthalmologist actually walked through the door into the hospital and we're like, "Uhhh, I guess we do have a prac this afternoon." It was finally confirmed that it was supposed to take place at 1pm (confirmed at 1pm), and as we all rush to arrive--including a number of students off on lunch--we suddenly realised we also had no idea where the prac was. Also it was very inconveniently timed and I had to miss my only consult for the day, rendering my day rather useless.
Anyway, back to the point--orangeness. Amongst other things, we were given a bunch of fluorescein dye to put in the dogs' eyes. It sticks to ulcers, glows under UV light, and just drains out through the tear ducts and into the nose. Usually you squirt it into the eye with a syringe or dropper or something, but for some reason we had a bazillion little strips with dye-coated tips. I used one of those. Why not?
There were only three dogs. One had some eye pathology so was constantly surrounded by a cloud of students and had lights shined into both eyes for pretty much the entire duration of the lab. One was teeny tiny and at that moment also being examined by others. So I selected the remaining dog, my classmate's, considering people were just sitting by her, talking. I should mention that this dog has white fur.
I went ahead and stuck the strip in like normal, but the dog squinted her eye shut around it really tightly, to the point that the eyelid rolled inward. After about 10 seconds, it became clear that orange was seeping out around her eye. I removed the strip and she opened the eye. She suddenly had a giant spot all around her eye, bright orange. It seemed to be an inordinately large spot considering the procedure, and it was contrasted nicely by the sheer whiteness of the fur around it.
To be fair, I did get the fluorescein into her eye. I don't think she has an ulcer.
(To add insult to injury, no one was paying much attention to the fluorescein strips, and I'm pretty sure some of my classmates thought something had gone horribly wrong with the syringe/dropper method.)
Saturday 25 January 2014
Vet School is a Constant Challenge
Before we were allowed to start in the small animal hospital, we had to take a quick online quiz about how the hospital operates and what we're expected to do. We have "purple books" which describe important info for all the rosters, and this was basically a quiz to check that we'd read it.
Would you pass vet school?
When an animal has been given a pre-med, any water in the cage should be:
Select one:
a. Removed.
b. drunk
c. poured over the animal
d. left so that the animal can slump into it and drown
After examining or handling an animal on a table I should
Select one:
a. clean up any obvious mess from the table top with chlorhexidine
b. lick the table clean
c. brush off any visible debris
d. leave the table for someone else to clean. What are the nurses paid for?
e. cover the table with 70% ethanol then light a match
f. clean and disinfect the table, even if there is no obvious mess.
When removing an animal from a cage you should
Select one:
a. Assume it is friendly, otherwise why would it be allowed in the clinic anyway?
b. Scruff it and drag it out?
c. Enlist classmates to help wrestle it into submission - bites and scratches are a badge of honour!
d. Assess it's behavior and response to your approach, and ask a staff member for assistance if the animal is potentially aggressive.
Do you need to fill out a SOAP form for every patient admitted to the hospital overnight?
Select one:
a. Yes
b. What’s a SOAP form?
Cell phones are not to be used in the clinic
Select one:
a. except when I need to phone my flat mates
b. unless there is nothing to do
c. except for texting
d. except when my boyfriend calls
e. except when my girlfriend calls
f. except when my boyfriend calls to tell me he has heard I have a girlfriend
g. Never!
The following items are dispensable, paid for by my fees, and I am therefore entitled to help myself and take from the clinic:
Select one:
a. thermometers
b. reflex hammers
c. surgical instruments
d. text books
e. ophthalmoscopes and otoscopes
f. lubricant
g. an education, and enough fond memories to last me a lifetime
Cornerstone history and physical examination notes should be
Select one:
a. written on a pieces of paper towel and left lying around the hospital.
b. Entered at the time of consultation, or immediately afterwards.
c. entered some time in the day before I go home.
d. left blank, the clinician in charge of the case will do that if I forget.
e. left for later - there is a much more interesting case being admitted now.
When I walk a dog outside, I must
Select one:
a. hope that no one else sees the dog defaecating so I can blame it on another student
b. keep the dog on a lead and always take a plastic bag with me so as to capture and remove any faeces that the dog passes.
c. keep the dog on a lead but make sure that the dog defaecates behind a tree so that noone sees it.
d. let it wander around off its lead to do its business when and as it sees fit
e. allow it to eat the faeces strewn around, since that is normal for dogs
Then, of course, there are a handful of these thrown in there, and you need 100% correct, so I had to take the test twice.
What possible organisms implicated in infectious tracheobronchitis (Kennel Cough) can we vaccinate against?
Select one:
a. Bordetella bronchispetica and Strep. zooepidemicus.
b. Parainfluenza, CAV-2 and Bordetella Bronchiseptica.
c. Mycoplasma and CAV-2
d. Canine Herpes and parainfluenza.
Would you pass vet school?
When an animal has been given a pre-med, any water in the cage should be:
Select one:
a. Removed.
b. drunk
c. poured over the animal
d. left so that the animal can slump into it and drown
After examining or handling an animal on a table I should
Select one:
a. clean up any obvious mess from the table top with chlorhexidine
b. lick the table clean
c. brush off any visible debris
d. leave the table for someone else to clean. What are the nurses paid for?
e. cover the table with 70% ethanol then light a match
f. clean and disinfect the table, even if there is no obvious mess.
When removing an animal from a cage you should
Select one:
a. Assume it is friendly, otherwise why would it be allowed in the clinic anyway?
b. Scruff it and drag it out?
c. Enlist classmates to help wrestle it into submission - bites and scratches are a badge of honour!
d. Assess it's behavior and response to your approach, and ask a staff member for assistance if the animal is potentially aggressive.
Do you need to fill out a SOAP form for every patient admitted to the hospital overnight?
Select one:
a. Yes
b. What’s a SOAP form?
Cell phones are not to be used in the clinic
Select one:
a. except when I need to phone my flat mates
b. unless there is nothing to do
c. except for texting
d. except when my boyfriend calls
e. except when my girlfriend calls
f. except when my boyfriend calls to tell me he has heard I have a girlfriend
g. Never!
The following items are dispensable, paid for by my fees, and I am therefore entitled to help myself and take from the clinic:
Select one:
a. thermometers
b. reflex hammers
c. surgical instruments
d. text books
e. ophthalmoscopes and otoscopes
f. lubricant
g. an education, and enough fond memories to last me a lifetime
Cornerstone history and physical examination notes should be
Select one:
a. written on a pieces of paper towel and left lying around the hospital.
b. Entered at the time of consultation, or immediately afterwards.
c. entered some time in the day before I go home.
d. left blank, the clinician in charge of the case will do that if I forget.
e. left for later - there is a much more interesting case being admitted now.
When I walk a dog outside, I must
Select one:
a. hope that no one else sees the dog defaecating so I can blame it on another student
b. keep the dog on a lead and always take a plastic bag with me so as to capture and remove any faeces that the dog passes.
c. keep the dog on a lead but make sure that the dog defaecates behind a tree so that noone sees it.
d. let it wander around off its lead to do its business when and as it sees fit
e. allow it to eat the faeces strewn around, since that is normal for dogs
Then, of course, there are a handful of these thrown in there, and you need 100% correct, so I had to take the test twice.
What possible organisms implicated in infectious tracheobronchitis (Kennel Cough) can we vaccinate against?
Select one:
a. Bordetella bronchispetica and Strep. zooepidemicus.
b. Parainfluenza, CAV-2 and Bordetella Bronchiseptica.
c. Mycoplasma and CAV-2
d. Canine Herpes and parainfluenza.
Friday 24 January 2014
Said in Surgery Rounds
Surgeon: What's a "cherry eye"?
Me: The gland of the third eyelid is prolapsed.
Surgeon: No. What's the gland called?
Students: Nictitating gland?
Surgeon: Yes. And what's wrong with it?
...
Surgeon: It's PROLAPSED
Surgeon: What's a type I open fracture mean? What does the fracture do?
Student: Do?
Surgeon: Where does the bone go?
Student: Uh...?
Surgeon: From the inside to the outside!
Student: How else would the bone go?!
Surgeon: What's the third type of plate?
Students: It makes a bridge.
Surgeon: Yes but what's it called?
Students: A... bridge plate?
*Surgeon starts drawing*
Surgeon: Picture Notre Dam. These things off to the side that support it.
*Draws big arches*
Students: Arches? Scaffold?
*Surgeon writes B _ _ _ _ _ _ _*
Students: Bridge! Bulwark! A! E! O!
*Head shaking*
Students: U!
*Writes B U _ _ _ _ S S*
Students: Buttress!
Surgeon: What type of screws would you use?
Student: Small ones.
Me: The gland of the third eyelid is prolapsed.
Surgeon: No. What's the gland called?
Students: Nictitating gland?
Surgeon: Yes. And what's wrong with it?
...
Surgeon: It's PROLAPSED
Surgeon: What's a type I open fracture mean? What does the fracture do?
Student: Do?
Surgeon: Where does the bone go?
Student: Uh...?
Surgeon: From the inside to the outside!
Student: How else would the bone go?!
Surgeon: What's the third type of plate?
Students: It makes a bridge.
Surgeon: Yes but what's it called?
Students: A... bridge plate?
*Surgeon starts drawing*
Surgeon: Picture Notre Dam. These things off to the side that support it.
*Draws big arches*
Students: Arches? Scaffold?
*Surgeon writes B _ _ _ _ _ _ _*
Students: Bridge! Bulwark! A! E! O!
*Head shaking*
Students: U!
*Writes B U _ _ _ _ S S*
Students: Buttress!
Surgeon: What type of screws would you use?
Student: Small ones.
Thursday 23 January 2014
Itchy Vet Syndrome
Today I had a patient whose fur turned vet student skin into red, itchy, bumpy, awfulness. It was a shar-pei, with a short, rough, prickly coat. The coarse little hairs would climb up my lab coat sleeves and cling to my black pants, and even the sticky de-furrer rolly thing couldn't get any of the hairs off. Every time I touched my patient, my skin freaked out for the next ten minutes. At one point, I had to help hold him on his side so the vet could assess the joints in his hind limbs, and both my forearms turned bright red.
Tuesday 21 January 2014
A Client Liked Me
Today saw the end of surgery and the beginning of medicine. Hoorah! I like medicine.
Well, except for the part where we sat around for an hour before anyone came up with anything for us to do. We're on "drop-off medicine" this week, which are day patients that come in for treatments or diagnostics. This translates to us sitting in the treatment room until an animal arrives, the four of us crowding around to find that it just needs a vaccination and microchip, someone doing the vaccination and microchip, then we go back to sitting and waiting again.
My patient was a border collie in for some skin stuff, lumps and itchiness. The obvious step was to stick a needle into the lumps and do cytology, but since the poor attending clinician was the only vet on for three rosters (drop-off and consult medicine, and first-opinion surgery), my day involved a lot of chasing after him and waiting as nurses, students, interns, and vets snatched him this way and that. First I had to wait for him to check over my patient and confirm what we were going to do, then we had to get set up, do it, and talk to the client. In between every step was a lot of "Let me do this one thing," and then him disappearing.
And I mean disappearing. He steps through a door and then he's gone. As in literally nowhere to be found in the hospital. I suspect this has to do with going around in circles and entering rooms just as he leaves them, but I can't be sure. Sometimes he goes off in one direction, only to appear in a consult room on the other side of the hospital. I don't really know how he does it. I'm not even annoyed by the continual "I'll be right back this time for real, I promise" because I don't understand how it's even physically possible for him to be in so many places at once and do so many things at the same time.
After six hours of this, we finally got around to doing the fine needle aspirate, which involved both pokey-pokey and suckey-suckey maneuvers. We sent some off to the lab, and I stained the others. I didn't see anything on the slides and when I was describing them to the clinician, the best I could come up with was, "I couldn't see any cells. There's a bunch of... blobs." I got my classmate to look, and she confirmed my diagnosis of "blobs." He laughed at me, saying something like "is that your morphological diagnosis, blobs?" and then went on to observe, "oh yeah, there's your blobs." There really wasn't anything else on the slide to see.
The client was actually someone who works in the same building, which was very convenient because all I had to do was walk down the hallway to give her an update on her dog or ask her a question. The clinician also went down to talk to her a few times about treatments and diagnostics, so she got a pretty steady stream of information about her dog. I did up the discharge form, grabbed the meds, and went over everything with her before she took her dog home. When I asked her if she had any questions she said both I and the clinician had been very thorough and she felt very up-to-date and like she could easily come ask us any questions if they came up in the future. She thanked me for being so clear with everything and taking good care of her dog; she felt very well taken care of. To be fair, I mostly parroted everything the clinician told me to tell her, but I still consider it a success! She's my favourite kind of client: friendly, pleasant, and wants the best possible for her animal.
I can count my client interactions on one hand just about. So here it is, for the record: my first client to express that they liked my care of their animal!
Well, except for the part where we sat around for an hour before anyone came up with anything for us to do. We're on "drop-off medicine" this week, which are day patients that come in for treatments or diagnostics. This translates to us sitting in the treatment room until an animal arrives, the four of us crowding around to find that it just needs a vaccination and microchip, someone doing the vaccination and microchip, then we go back to sitting and waiting again.
My patient was a border collie in for some skin stuff, lumps and itchiness. The obvious step was to stick a needle into the lumps and do cytology, but since the poor attending clinician was the only vet on for three rosters (drop-off and consult medicine, and first-opinion surgery), my day involved a lot of chasing after him and waiting as nurses, students, interns, and vets snatched him this way and that. First I had to wait for him to check over my patient and confirm what we were going to do, then we had to get set up, do it, and talk to the client. In between every step was a lot of "Let me do this one thing," and then him disappearing.
And I mean disappearing. He steps through a door and then he's gone. As in literally nowhere to be found in the hospital. I suspect this has to do with going around in circles and entering rooms just as he leaves them, but I can't be sure. Sometimes he goes off in one direction, only to appear in a consult room on the other side of the hospital. I don't really know how he does it. I'm not even annoyed by the continual "I'll be right back this time for real, I promise" because I don't understand how it's even physically possible for him to be in so many places at once and do so many things at the same time.
After six hours of this, we finally got around to doing the fine needle aspirate, which involved both pokey-pokey and suckey-suckey maneuvers. We sent some off to the lab, and I stained the others. I didn't see anything on the slides and when I was describing them to the clinician, the best I could come up with was, "I couldn't see any cells. There's a bunch of... blobs." I got my classmate to look, and she confirmed my diagnosis of "blobs." He laughed at me, saying something like "is that your morphological diagnosis, blobs?" and then went on to observe, "oh yeah, there's your blobs." There really wasn't anything else on the slide to see.
The client was actually someone who works in the same building, which was very convenient because all I had to do was walk down the hallway to give her an update on her dog or ask her a question. The clinician also went down to talk to her a few times about treatments and diagnostics, so she got a pretty steady stream of information about her dog. I did up the discharge form, grabbed the meds, and went over everything with her before she took her dog home. When I asked her if she had any questions she said both I and the clinician had been very thorough and she felt very up-to-date and like she could easily come ask us any questions if they came up in the future. She thanked me for being so clear with everything and taking good care of her dog; she felt very well taken care of. To be fair, I mostly parroted everything the clinician told me to tell her, but I still consider it a success! She's my favourite kind of client: friendly, pleasant, and wants the best possible for her animal.
I can count my client interactions on one hand just about. So here it is, for the record: my first client to express that they liked my care of their animal!
Saturday 18 January 2014
You Didn't Need To Use These, Right?
In a skillful display of coordination and foresight, someone decided that the best time to change over all the computers in the hospital would be starting in the morning on a Wednesday, in the middle of the Small Animal Hospital Core roster.
During the late morning, someone from reception comes in to tell us it's scheduled for that day, and if it's okay for them to tell IT to come and do it now. Everyone shrugs and nods, thinking we'd have a bit of time to finish up what we were doing and disperse. However, there must have been some sort of time-space distortion because the computer guy showed up literally a minute later. I'm pretty sure computer guys as a rule never show up one minute after they are asked to come down.
We got kicked out. During the day, I wandered back to see how it was going. First, everything was logged out as the guy got to them one computer at a time. The next time, all the screens were black and covered in white text, updating or something. Then, they were all frozen at the login, with the keyboard and mouse not working (every computer was like this). Finally, we could log in and get to a desktop, but there was no internet browser or hospital database.
We use the computer constantly. We need the hospital database to look up patient histories, type in updates and reports, make up prescriptions, and a thousand other things. There are a total of five groups of four people (you do one of five different things each week with your roster group), and now only six computers in the hospital that are for student use, plus two more if the nurses aren't busy.
It just so happens that it was a slow day for my roster, which means the only thing to do is work on assignments. On the computer.
Fortunately, there are other computer labs around. There's the computer lab in equine, and when we went down there all the computers were gone. There's the anatomy museum upstairs, which is locked with a key code. The undergrad office gave me the wrong code, plus the thing is finicky about how you type it in, so getting in turned into something of an ordeal. When we finally made it through the door, we were faced with the same black screen and white text as the hospital computer lab! Finally we went to the Farm Services building next door, where the computer lab smelled like cow poo.
During the late morning, someone from reception comes in to tell us it's scheduled for that day, and if it's okay for them to tell IT to come and do it now. Everyone shrugs and nods, thinking we'd have a bit of time to finish up what we were doing and disperse. However, there must have been some sort of time-space distortion because the computer guy showed up literally a minute later. I'm pretty sure computer guys as a rule never show up one minute after they are asked to come down.
We got kicked out. During the day, I wandered back to see how it was going. First, everything was logged out as the guy got to them one computer at a time. The next time, all the screens were black and covered in white text, updating or something. Then, they were all frozen at the login, with the keyboard and mouse not working (every computer was like this). Finally, we could log in and get to a desktop, but there was no internet browser or hospital database.
We use the computer constantly. We need the hospital database to look up patient histories, type in updates and reports, make up prescriptions, and a thousand other things. There are a total of five groups of four people (you do one of five different things each week with your roster group), and now only six computers in the hospital that are for student use, plus two more if the nurses aren't busy.
It just so happens that it was a slow day for my roster, which means the only thing to do is work on assignments. On the computer.
Fortunately, there are other computer labs around. There's the computer lab in equine, and when we went down there all the computers were gone. There's the anatomy museum upstairs, which is locked with a key code. The undergrad office gave me the wrong code, plus the thing is finicky about how you type it in, so getting in turned into something of an ordeal. When we finally made it through the door, we were faced with the same black screen and white text as the hospital computer lab! Finally we went to the Farm Services building next door, where the computer lab smelled like cow poo.
Friday 17 January 2014
Immovable Object vs Vet Student
My current patient is a British Bulldog named Rosie, a very solid, snortle-y, smooshed-face genetic mess with a bizarre corkscrew tail, misaligned teeth, and patches of hair loss from a skin disease. She's smelly, has grungy skin folds, and makes a constant stream of noise just by breathing.
She also likes to lie, sit, or simply stand and stare into space. I had to take her for a walk this morning.
First, we made some slow progress out of the ward and into the hallway, with her waddling along in a rather funny gait that could be because she doesn't understand how to use a leg with an IV catheter in it, or because she just walks funny. The unfortunate part of taking dogs for walks is that to get to the fenced-off grass, you have to go past the dog runs for the large dogs. For some reason they are also the barkiest. Earlier in the morning, you could hear a chorus of howling from at least three different dogs, like the song in Lady and the Tramp. I guess one had started and the others all jumped on the bandwagon.
Rosie, I think, is very afraid of giant noisy dogs. The reason I say "I think" is that because when we reached them, she stopped moving. There was no obvious expression of fear, but it's possible that between her flat wrinkly face and short melded-into-her-butt tail, she may be incapable of any expressions at all. But she wouldn't move.
She's too small to push or herd, but too heavy to really carry. Also I was on one side of the threshold, keeping the door open, while she sat firmly on the other side. The icing on the cake is that flat-faced dogs tend to have collapsing tracheas, so I really didn't want to tug much on her leash or collar, in case I strangled her. So I spent at least 5 minutes alternating between trying to bait her forward with an excited voice, and shoving her butt or placing one paw in front of the other. I finally got her onto the other side of the doorway and closed it behind her. After a moment of delayed reaction, she scurried past the big scary dogs and made a beeline for the gate outside.
The return journey wasn't any easier. As soon as we reached the gauntlet of barking dogs, she actively pulled back and refused to continue. I repeated my efforts of pushing and pulling, to even less effect. Eventually, I put my arms around her and scooped her up, her stubby little legs flapping about in the air, and hauled her the five steps to the doorway before plonking her back down.
Then I had to do it all again in the afternoon.
She also likes to lie, sit, or simply stand and stare into space. I had to take her for a walk this morning.
First, we made some slow progress out of the ward and into the hallway, with her waddling along in a rather funny gait that could be because she doesn't understand how to use a leg with an IV catheter in it, or because she just walks funny. The unfortunate part of taking dogs for walks is that to get to the fenced-off grass, you have to go past the dog runs for the large dogs. For some reason they are also the barkiest. Earlier in the morning, you could hear a chorus of howling from at least three different dogs, like the song in Lady and the Tramp. I guess one had started and the others all jumped on the bandwagon.
Rosie, I think, is very afraid of giant noisy dogs. The reason I say "I think" is that because when we reached them, she stopped moving. There was no obvious expression of fear, but it's possible that between her flat wrinkly face and short melded-into-her-butt tail, she may be incapable of any expressions at all. But she wouldn't move.
She's too small to push or herd, but too heavy to really carry. Also I was on one side of the threshold, keeping the door open, while she sat firmly on the other side. The icing on the cake is that flat-faced dogs tend to have collapsing tracheas, so I really didn't want to tug much on her leash or collar, in case I strangled her. So I spent at least 5 minutes alternating between trying to bait her forward with an excited voice, and shoving her butt or placing one paw in front of the other. I finally got her onto the other side of the doorway and closed it behind her. After a moment of delayed reaction, she scurried past the big scary dogs and made a beeline for the gate outside.
The return journey wasn't any easier. As soon as we reached the gauntlet of barking dogs, she actively pulled back and refused to continue. I repeated my efforts of pushing and pulling, to even less effect. Eventually, I put my arms around her and scooped her up, her stubby little legs flapping about in the air, and hauled her the five steps to the doorway before plonking her back down.
Then I had to do it all again in the afternoon.
Until Blood Started Mysteriously Pooling Out of Nowhere
The curriculum's vision of "spey class" doesn't align well with the reality.
1. There are often not enough speys in a week for all four students.
2. People seem to cancel these appointments at an alarming rate.
3. The animals we do get aren't exactly young and healthy.
Earlier in the week, my classmate's spey was some several hour ordeal that involved many stacks of blood-soaked gauze and a uterus as thick as hose pipe. My spey got cancelled completely because of a UTI. My friend shared her spey with me, which turned out to be a 4-year-old shelter dog that came off of heat a week ago.
Now, when they're in heat, their uterus gets huge and very vascular. This complicates things because the usually teeny vessels become a lot bigger and you have to worry more about tying them all off, and as you can imagine, a big hose pipe is harder to clamp off than a small one. Despite this, everything was going mostly hunky-dory--at least, until blood started mysteriously pooling out of nowhere.
It started as a general oozing, an unusual amount of fluid down in the body cavity. Gradually, the pinky-orangey fluid deep down turned into really-quite-red fluid all over my side of the dog.
When you do a spey, you tie off the vessels that connect the ovary to the body, then cut the ovary off; this leaves you with a pedicle of tissue and tied-off vessels that you drop back into the body. You check this to make sure you really got the vessels all closed off, or else they just keep bleeding forever. If you accidentally drop the pedicle before you're ready, or the ligature is too loose and comes off, it's called a "dropped stump" and is what gives fledgling vet students night terrors. No matter how many times your professors explain the steps to find and retrieve your dropped stump, it's still a tiny fleshy blob in the middle of a bunch of other fleshy blobs, all submerged beneath an ocean of blood with a rapidly rising tide. It hasn't happened to me, but I saw a vet deal with it once.
This isn't what happened today, but now you can understand why I became alarmed that my severed pedicle was suddenly sitting in a pool of blood. The vet teaching us took some time to check out the stump, search around in the body cavity, and couldn't find the source, so he was like, "Nevermind that, we'll worry about it later," and my friend finished her ovary and we went on to the uterine body.
As time went on, the oozing-become-pooling didn't subside, and the vet kept checking but then deciding we'd "worry about it later." Since he couldn't figure out what was going on (my stump wasn't what was bleeding, phew), he had the nurses page the surgical resident. She joined us, and even she couldn't figure out where all the blood was coming from. They hooked up suction and diathermy, packed the abdomen with laparotomy sponges, and threw in a whole bunch of ligatures onto various fleshy blobs, but it didn't seem to change much. The blood was coming from everywhere and nowhere.
Eventually, they got it from "pooling" back to "oozing" and decided to close up the wound, but when discussing medications with me, made the point that she could require a second emergency surgery if it turned out she kept bleeding on the inside. Fortunately there are a bazillion people in the ICU whose job it is to keep an eye on patients like this one. However, as four hours of sore feet can attest, the vet made the very good point that dogs on heat are not very good cases for student spey classes.
1. There are often not enough speys in a week for all four students.
2. People seem to cancel these appointments at an alarming rate.
3. The animals we do get aren't exactly young and healthy.
Earlier in the week, my classmate's spey was some several hour ordeal that involved many stacks of blood-soaked gauze and a uterus as thick as hose pipe. My spey got cancelled completely because of a UTI. My friend shared her spey with me, which turned out to be a 4-year-old shelter dog that came off of heat a week ago.
Now, when they're in heat, their uterus gets huge and very vascular. This complicates things because the usually teeny vessels become a lot bigger and you have to worry more about tying them all off, and as you can imagine, a big hose pipe is harder to clamp off than a small one. Despite this, everything was going mostly hunky-dory--at least, until blood started mysteriously pooling out of nowhere.
It started as a general oozing, an unusual amount of fluid down in the body cavity. Gradually, the pinky-orangey fluid deep down turned into really-quite-red fluid all over my side of the dog.
When you do a spey, you tie off the vessels that connect the ovary to the body, then cut the ovary off; this leaves you with a pedicle of tissue and tied-off vessels that you drop back into the body. You check this to make sure you really got the vessels all closed off, or else they just keep bleeding forever. If you accidentally drop the pedicle before you're ready, or the ligature is too loose and comes off, it's called a "dropped stump" and is what gives fledgling vet students night terrors. No matter how many times your professors explain the steps to find and retrieve your dropped stump, it's still a tiny fleshy blob in the middle of a bunch of other fleshy blobs, all submerged beneath an ocean of blood with a rapidly rising tide. It hasn't happened to me, but I saw a vet deal with it once.
This isn't what happened today, but now you can understand why I became alarmed that my severed pedicle was suddenly sitting in a pool of blood. The vet teaching us took some time to check out the stump, search around in the body cavity, and couldn't find the source, so he was like, "Nevermind that, we'll worry about it later," and my friend finished her ovary and we went on to the uterine body.
As time went on, the oozing-become-pooling didn't subside, and the vet kept checking but then deciding we'd "worry about it later." Since he couldn't figure out what was going on (my stump wasn't what was bleeding, phew), he had the nurses page the surgical resident. She joined us, and even she couldn't figure out where all the blood was coming from. They hooked up suction and diathermy, packed the abdomen with laparotomy sponges, and threw in a whole bunch of ligatures onto various fleshy blobs, but it didn't seem to change much. The blood was coming from everywhere and nowhere.
Eventually, they got it from "pooling" back to "oozing" and decided to close up the wound, but when discussing medications with me, made the point that she could require a second emergency surgery if it turned out she kept bleeding on the inside. Fortunately there are a bazillion people in the ICU whose job it is to keep an eye on patients like this one. However, as four hours of sore feet can attest, the vet made the very good point that dogs on heat are not very good cases for student spey classes.
Wednesday 15 January 2014
The Longest Day Ever
Three posts in one day, what is this?! So much happened, so many stories!
I'm going to admit a secret. I'm not actually writing this on wednesday. As you can imagine, three posts' worth of stories also meant I was completely exhausted that day. It may be a blogging faux pas, but I quite often write posts and sneak them into the archives 1984-style. I guess it's because the blog also functions as a diary and I like to keep things in a mostly chronological order. It's very likely that posts will continue to pop up "in the past" as I write them and then pretend nothing's changed.
I almost didn't write this one, because I already told the major "stories" (my wuss of a patient and the rabbit castration) and this is going to be more rambly. However, I decided I couldn't not mention my first real surgery.
Somehow, I went from having zero patients, to one medicine patient (that I kind of commandeered from the medicine student) and two surgeries. One of my roster-mates was scheduled to do both a spey and a castration today, so she suggested trading her castration today for my castration on friday. This was after the clinician offered the rabbit castration to me, so I accepted both quite happily. I also wanted to stick with my original patient and find out what the results of her urinalysis were, which naturally led into me also doing up her meds and discharge.
The castration was interesting because the dog is participating in a study looking at the effects of bupivicaine, a local anaesthetic, in the injection site. He was one of the controls, so didn't get any bupivicaine, but he still got hooked up to an EEG all during the surgery. I also got to work with a vet that I haven't seen before or since, who turned out to be a really nice guy and an amazing help. My friend did her surgery with him as well, and we agreed he had the perfect balance of explaining what to do, but allowing us to actually do it ourselves. He was thorough, patient, and supportive. (To be fair, almost all the vets are like that, except for one surgeon that I have been calling eats-students-for-breakfast in previous posts). But this guy is mysterious because, like I mentioned, no one has seen him around the hospital except for that one day.
The reason I called this the longest day ever isn't because of the actual hour total. Last week on referral surgery I had a few 12-14 hour days. But this day was so exhausting. I did my dog castration, my rabbit castration, chased a vet all over the hospital to talk about all three of my patients--including what meds to do and for how long, specifics on the discharge information and home advice, and writing up the surgery report. What really sent me over the edge was a big practical lab in the afternoon, about dentistry.
These labs apparently happen every wednesday afternoon and are mandatory. As usual, I was late, because I had to do all those things for all my patients. The lab started at around 4pm, and I had been standing and moving around all day, so I was already tired. I don't find dentistry particularly exciting, and this lab was exactly the same as the lab in fourth year (severed heads and all), our dead dogs a few weeks ago, and the actual dentals we did on monday. Clean teeth, extract teeth, queue up for the drill. Zzzzzzz. Ten or fifteen minutes into it, I was sagging on my stool, while the person next to me kept nodding off. Important as it is, a lab like this really needs to be in the morning, not 4pm. I ran off to discharge my rabbit patient before I completely fell asleep.
I'm going to admit a secret. I'm not actually writing this on wednesday. As you can imagine, three posts' worth of stories also meant I was completely exhausted that day. It may be a blogging faux pas, but I quite often write posts and sneak them into the archives 1984-style. I guess it's because the blog also functions as a diary and I like to keep things in a mostly chronological order. It's very likely that posts will continue to pop up "in the past" as I write them and then pretend nothing's changed.
I almost didn't write this one, because I already told the major "stories" (my wuss of a patient and the rabbit castration) and this is going to be more rambly. However, I decided I couldn't not mention my first real surgery.
Somehow, I went from having zero patients, to one medicine patient (that I kind of commandeered from the medicine student) and two surgeries. One of my roster-mates was scheduled to do both a spey and a castration today, so she suggested trading her castration today for my castration on friday. This was after the clinician offered the rabbit castration to me, so I accepted both quite happily. I also wanted to stick with my original patient and find out what the results of her urinalysis were, which naturally led into me also doing up her meds and discharge.
The castration was interesting because the dog is participating in a study looking at the effects of bupivicaine, a local anaesthetic, in the injection site. He was one of the controls, so didn't get any bupivicaine, but he still got hooked up to an EEG all during the surgery. I also got to work with a vet that I haven't seen before or since, who turned out to be a really nice guy and an amazing help. My friend did her surgery with him as well, and we agreed he had the perfect balance of explaining what to do, but allowing us to actually do it ourselves. He was thorough, patient, and supportive. (To be fair, almost all the vets are like that, except for one surgeon that I have been calling eats-students-for-breakfast in previous posts). But this guy is mysterious because, like I mentioned, no one has seen him around the hospital except for that one day.
The reason I called this the longest day ever isn't because of the actual hour total. Last week on referral surgery I had a few 12-14 hour days. But this day was so exhausting. I did my dog castration, my rabbit castration, chased a vet all over the hospital to talk about all three of my patients--including what meds to do and for how long, specifics on the discharge information and home advice, and writing up the surgery report. What really sent me over the edge was a big practical lab in the afternoon, about dentistry.
These labs apparently happen every wednesday afternoon and are mandatory. As usual, I was late, because I had to do all those things for all my patients. The lab started at around 4pm, and I had been standing and moving around all day, so I was already tired. I don't find dentistry particularly exciting, and this lab was exactly the same as the lab in fourth year (severed heads and all), our dead dogs a few weeks ago, and the actual dentals we did on monday. Clean teeth, extract teeth, queue up for the drill. Zzzzzzz. Ten or fifteen minutes into it, I was sagging on my stool, while the person next to me kept nodding off. Important as it is, a lab like this really needs to be in the morning, not 4pm. I ran off to discharge my rabbit patient before I completely fell asleep.
My Patient, the Wuss/The Urine Sample Ordeal
I was supposed to do a spey today, but because my patient has a zillion problems, it was cancelled last night. However, when I arrived at school this morning, anaesthesia had already given my patient her pre-meds and was about to take her down to the surgery theatres. Two students told me the vets had decided she would definitely not have surgery, but the clinicians themselves were nowhere to be found. Que confusion, and anaesthesia becoming very unhappy.
The unfortunate thing about the morning is that the clinicians have this habit of all disappearing right when you have the most questions. Usually it's because they do rounds, and you can see them all standing there discussing the in-patients, but can't interrupt. But occasionally they all disappear for meetings, and it's always the worst timing possible. So today when I had no clue what was going on with my patient, it was very unhelpful that I couldn't find a free clinician to even tell me if the surgery was going ahead or not.
Eventually, I confirmed that she has other problems to worry about, behaviour issues not being the least of them, and we would investigate the UTI rather than doing the spey. She got transferred to a medicine student, but since I no longer had anything to do that morning, I followed her around and did all the stuff anyway. Since she was already sedated, the vet wanted to use a quick ultrasound to perform a cystocentesis (jab the bladder with a needle). I mentioned in my post yesterday that this dog is a giant wuss, but I completely underestimated that fact. Just putting the ultrasound probe against her belly caused a riot of screeching and whining and struggling. To an outside observer, it might have sounded like we were stabbing her to death. And just a reminder, this is a heavily sedated dog.
There was some confusion about when, exactly, she had been sedated, so vet #1 said we should give it another half hour for the meds to hit their peak effect. Vet #2 got around to it in about an hour, and as it turns out, the sedatives were given much earlier than either vet had realised, and now completely worn off. I went to get her out of her cage, only to be greeted by an alert, tail-waggy-but-whiny puppy.
They zonked her out again, and this time gave her an extra large dose, considering what happened last time. Vet #2 mentioned that it was twice what he would normally use.
Unfortunately, zonking them out relaxes all their muscles, so as soon as the nurse lifted the dog out of the cage so we could get a urine sample, the relaxed bladder emptied itself all over the blanket. Vet #3 made a frowny face as she felt the now-empty bladder. Crap.
Well, maybe there's enough still in there that the imaging people can get a cysto sample using the proper ultrasound.
We wheeled our patient down to imaging, where an actual ultrasonographer was waiting, and fortunately, this time the dog was out like a light. A tense couple of minutes followed, as the ultrasonographer poked his needle into the bladder over and over again to no avail. You could see on the image just how thick the bladder wall was. The needle was pushing against it, but not breaking through into the organ itself. He redirected, poked in quickly, pushed in slowly (even to the point that you could see the needle going through and pushing on the far wall), used a different needle--still nothing. Finally, by some miracle, on what may have been the last attempt, vet #3 pulled the plunger and urine! She handed me the syringe and said, "Guard this with your life."
We then typed up the forms for the lab, and I got sent on a Quest: bring these items to the pathology lab!
That's pretty much the end of the story, but to tie things up I should mention that when we checked the results later, there was a lot of bacteria. We put her onto a course of antibiotics and sent her home.
The unfortunate thing about the morning is that the clinicians have this habit of all disappearing right when you have the most questions. Usually it's because they do rounds, and you can see them all standing there discussing the in-patients, but can't interrupt. But occasionally they all disappear for meetings, and it's always the worst timing possible. So today when I had no clue what was going on with my patient, it was very unhelpful that I couldn't find a free clinician to even tell me if the surgery was going ahead or not.
Eventually, I confirmed that she has other problems to worry about, behaviour issues not being the least of them, and we would investigate the UTI rather than doing the spey. She got transferred to a medicine student, but since I no longer had anything to do that morning, I followed her around and did all the stuff anyway. Since she was already sedated, the vet wanted to use a quick ultrasound to perform a cystocentesis (jab the bladder with a needle). I mentioned in my post yesterday that this dog is a giant wuss, but I completely underestimated that fact. Just putting the ultrasound probe against her belly caused a riot of screeching and whining and struggling. To an outside observer, it might have sounded like we were stabbing her to death. And just a reminder, this is a heavily sedated dog.
There was some confusion about when, exactly, she had been sedated, so vet #1 said we should give it another half hour for the meds to hit their peak effect. Vet #2 got around to it in about an hour, and as it turns out, the sedatives were given much earlier than either vet had realised, and now completely worn off. I went to get her out of her cage, only to be greeted by an alert, tail-waggy-but-whiny puppy.
They zonked her out again, and this time gave her an extra large dose, considering what happened last time. Vet #2 mentioned that it was twice what he would normally use.
Unfortunately, zonking them out relaxes all their muscles, so as soon as the nurse lifted the dog out of the cage so we could get a urine sample, the relaxed bladder emptied itself all over the blanket. Vet #3 made a frowny face as she felt the now-empty bladder. Crap.
Well, maybe there's enough still in there that the imaging people can get a cysto sample using the proper ultrasound.
We wheeled our patient down to imaging, where an actual ultrasonographer was waiting, and fortunately, this time the dog was out like a light. A tense couple of minutes followed, as the ultrasonographer poked his needle into the bladder over and over again to no avail. You could see on the image just how thick the bladder wall was. The needle was pushing against it, but not breaking through into the organ itself. He redirected, poked in quickly, pushed in slowly (even to the point that you could see the needle going through and pushing on the far wall), used a different needle--still nothing. Finally, by some miracle, on what may have been the last attempt, vet #3 pulled the plunger and urine! She handed me the syringe and said, "Guard this with your life."
We then typed up the forms for the lab, and I got sent on a Quest: bring these items to the pathology lab!
That's pretty much the end of the story, but to tie things up I should mention that when we checked the results later, there was a lot of bacteria. We put her onto a course of antibiotics and sent her home.
First Solo Surgery Was A Rabbit Castration
Since my spey today was cancelled, the vet running our roster suggested I scrub in for the rabbit coming in. I saw one last week; the student had scrubbed in, but the vet did the surgery. Thus I was not expecting to be the sole surgeon on this rabbit.
After anaesthesia got the rabbit asleep, I went ahead and scrubbed and gowned. I didn't think it was strange that the vet hadn't scrubbed yet, because they often wander around doing other things and scrub in quickly at the last minute. However, as I stand there awkwardly with my hands clasped in front of me, peeking into the anaesthesia room, the vet turns to me and says, "Okay, come in in and we'll get started. You can go ahead and drape." Que question marks over my head--isn't she scrubbing in, too?
No. It was just me. She directed me, but I was the only person scrubbed in for the first time ever, and it was a rabbit. Rabbit castrations are done just in the anaesthesia room, rather than the operating theatre, which is quite a tiny space. I guess that is fitting for quite a tiny patient. We set up my instruments just on a stool, and I was given the warning, "Don't knock this over," as the stool seat is exactly the same width as the box holding the instruments. I also had an awkward time draping, since the table was up against a wall--how do you get around the other side? I ended up doing three drapes in a triangle rather than four in a square.
And then we were off. Rabbit balls are long and kidney-bean shaped, and they also sometimes get sucked back into the abdomen. This happened as I was working on the first one, and the anaesthesia student had to reach under the drapes and press on the abdomen to pop the testicle back out. Another difference is that they are actually adhered to the skin, so you have to dissect them free (and not drop them into the abdomen while doing it). But overall, it was fairly simple, and I got out both balls without a hitch.
My only mistake is that I'm not used to working on live animals, and no one has really taught us about tissue handling, so I kept clamping the instruments on too tight. You see, I have haemostats at home to practice with, and I just clamp and unclamp them, plus they are difficult to operate so I got good at squeezing them really hard. Even in labs it's never mattered whether you do one, two, or three clicks. So I just squeeze my hand and get whatever amount of clicks I end up getting, without really thinking about it. But as I learned, three clicks is way too many for poor, delicate rabbit skin and tissues, affirmed by the vet's repeated wincing.
After anaesthesia got the rabbit asleep, I went ahead and scrubbed and gowned. I didn't think it was strange that the vet hadn't scrubbed yet, because they often wander around doing other things and scrub in quickly at the last minute. However, as I stand there awkwardly with my hands clasped in front of me, peeking into the anaesthesia room, the vet turns to me and says, "Okay, come in in and we'll get started. You can go ahead and drape." Que question marks over my head--isn't she scrubbing in, too?
No. It was just me. She directed me, but I was the only person scrubbed in for the first time ever, and it was a rabbit. Rabbit castrations are done just in the anaesthesia room, rather than the operating theatre, which is quite a tiny space. I guess that is fitting for quite a tiny patient. We set up my instruments just on a stool, and I was given the warning, "Don't knock this over," as the stool seat is exactly the same width as the box holding the instruments. I also had an awkward time draping, since the table was up against a wall--how do you get around the other side? I ended up doing three drapes in a triangle rather than four in a square.
And then we were off. Rabbit balls are long and kidney-bean shaped, and they also sometimes get sucked back into the abdomen. This happened as I was working on the first one, and the anaesthesia student had to reach under the drapes and press on the abdomen to pop the testicle back out. Another difference is that they are actually adhered to the skin, so you have to dissect them free (and not drop them into the abdomen while doing it). But overall, it was fairly simple, and I got out both balls without a hitch.
My only mistake is that I'm not used to working on live animals, and no one has really taught us about tissue handling, so I kept clamping the instruments on too tight. You see, I have haemostats at home to practice with, and I just clamp and unclamp them, plus they are difficult to operate so I got good at squeezing them really hard. Even in labs it's never mattered whether you do one, two, or three clicks. So I just squeeze my hand and get whatever amount of clicks I end up getting, without really thinking about it. But as I learned, three clicks is way too many for poor, delicate rabbit skin and tissues, affirmed by the vet's repeated wincing.
Tuesday 14 January 2014
She's perfectly healthy. Well, except...
This week we spey and neuter live, non-sheep animals, by ourselves, for the first time. At the beginning of the week we allocated patients to every student in an effort to have one spey and one castrate per person. The surgeries are on wednesday and friday, so the patients get admitted the day before.
My patient is a mixed-breed retriever/labrador-y thing with a ridiculous three-word name. She was scheduled to get dropped off at 10am, so from 8 to 10 I sat around with pretty much nothing to do. Now, there is a mandatory practical session for us to review suture techniques before we are allowed to do surgery tomorrow. My understanding is that the person running the prac suggested we all head on over to the wetlab if we weren't busy. At 10am. My roster-mates happily agreed and jaunted off to the prac without me, just as my patient arrived. This stressed me out as, so far, I've consistently missed all our scheduled tutorials because of other obligations. Roster-mates are unconcerned as they say "Oh well, we'll just tell her you'll be late."
So I cross my fingers that this will be a quick, routine admittance that shouldn't take more than 10 minutes. After all, my classmate admitted her castrate a half hour earlier without a hitch. Alas, I was out of luck.
The owner was not concerned at all, but this dog has pretty much every problem there is. It's standard procedure to ask after coughing, itching, or vomiting and diarrhoea. Normally the answer is "Oh no, no no, perfectly fine." This time, the answer to every one was "Oh yeah, every day." This dog coughs regularly, is itchier than their other dog, and has diarrhoea on a daily basis. Regarding that last one, I learned that she is fed fruit all the time--like, an apple or banana every day--so that made me roll my eyes, but less worried about the dog. And as for the coughing, at least the lungs were perfectly clear sounding. But then the owner mentions that the dog seems to have a UTI, has had one before and was on meds for it, and seems to be having another episode. Alarm bells go off that this could be a problem, and I need to talk to a clinician before I admit this patient.
To add insult to injury, I tried to finish my physical exam with the temperature, and this dog just would not have it. She whined and screamed and writhed. I asked the owner to hold her, and I still couldn't get the thermometer to stay in. What's worse, the owner's three young children were all there watching, and started complaining that it was hurting her. So I explained that it doesn't hurt, she's just a wuss, and we'd try to get a temperature later. Then I bolted for the exit and tried to find a clinician.
Naturally, there was only one clinician around, and because of it, he was completely swamped. The medicine students were pulling him left and right for the medicine consults and day patients, and I had to camp outside a consult room to try and catch him. He was too busy to really think about it, and just gave some hurried instructions as he walked around the hospital.
I ended up admitting the patient as if we would go ahead with the desexing, but prepared for the eventuality that we may need to change the plan if we find a problem. The owner was okay with this so I bring the dog into the hospital, at which point a nurse asks me to do the urine tests, and I am just like "I need to be at a tutorial 45 minutes ago, bye."
I did make it to the suture prac, where my roster-mates were sewing up disembodied dog legs, and had to get all the instructions repeated to me. I ended up rather rushed, but I'm a lot more comfortable with suturing than my classmates seem to be, so it didn't put me off too much. I got some good advice on subtleties about pulling the knots and what to do with your hands, but I'm already comfortable with the suture patterns, fortunately.
In the evening, my friend on after-hours treatments texted me to tell me my patient's spey is cancelled. She has too many other problems; apparently the word "vaginitis" was thrown around. So after all that, I don't even get to do my surgery.
My patient is a mixed-breed retriever/labrador-y thing with a ridiculous three-word name. She was scheduled to get dropped off at 10am, so from 8 to 10 I sat around with pretty much nothing to do. Now, there is a mandatory practical session for us to review suture techniques before we are allowed to do surgery tomorrow. My understanding is that the person running the prac suggested we all head on over to the wetlab if we weren't busy. At 10am. My roster-mates happily agreed and jaunted off to the prac without me, just as my patient arrived. This stressed me out as, so far, I've consistently missed all our scheduled tutorials because of other obligations. Roster-mates are unconcerned as they say "Oh well, we'll just tell her you'll be late."
So I cross my fingers that this will be a quick, routine admittance that shouldn't take more than 10 minutes. After all, my classmate admitted her castrate a half hour earlier without a hitch. Alas, I was out of luck.
The owner was not concerned at all, but this dog has pretty much every problem there is. It's standard procedure to ask after coughing, itching, or vomiting and diarrhoea. Normally the answer is "Oh no, no no, perfectly fine." This time, the answer to every one was "Oh yeah, every day." This dog coughs regularly, is itchier than their other dog, and has diarrhoea on a daily basis. Regarding that last one, I learned that she is fed fruit all the time--like, an apple or banana every day--so that made me roll my eyes, but less worried about the dog. And as for the coughing, at least the lungs were perfectly clear sounding. But then the owner mentions that the dog seems to have a UTI, has had one before and was on meds for it, and seems to be having another episode. Alarm bells go off that this could be a problem, and I need to talk to a clinician before I admit this patient.
To add insult to injury, I tried to finish my physical exam with the temperature, and this dog just would not have it. She whined and screamed and writhed. I asked the owner to hold her, and I still couldn't get the thermometer to stay in. What's worse, the owner's three young children were all there watching, and started complaining that it was hurting her. So I explained that it doesn't hurt, she's just a wuss, and we'd try to get a temperature later. Then I bolted for the exit and tried to find a clinician.
Naturally, there was only one clinician around, and because of it, he was completely swamped. The medicine students were pulling him left and right for the medicine consults and day patients, and I had to camp outside a consult room to try and catch him. He was too busy to really think about it, and just gave some hurried instructions as he walked around the hospital.
I ended up admitting the patient as if we would go ahead with the desexing, but prepared for the eventuality that we may need to change the plan if we find a problem. The owner was okay with this so I bring the dog into the hospital, at which point a nurse asks me to do the urine tests, and I am just like "I need to be at a tutorial 45 minutes ago, bye."
I did make it to the suture prac, where my roster-mates were sewing up disembodied dog legs, and had to get all the instructions repeated to me. I ended up rather rushed, but I'm a lot more comfortable with suturing than my classmates seem to be, so it didn't put me off too much. I got some good advice on subtleties about pulling the knots and what to do with your hands, but I'm already comfortable with the suture patterns, fortunately.
In the evening, my friend on after-hours treatments texted me to tell me my patient's spey is cancelled. She has too many other problems; apparently the word "vaginitis" was thrown around. So after all that, I don't even get to do my surgery.
Sunday 12 January 2014
Dental Day
Week two of the small animal hospital has me still on surgery, but only "first opinion" and not "referral" surgery. And all of a sudden, there's heaps of time and not much to do.
Today we did dentistry. While there are some nuances and complexities, basically dentistry is dentistry and we didn't do anything that I hadn't already done on our dead dogs a few weeks ago. It was a pleasant difference to work on a live dog, this time.
There were two dentals and four students on the roster, so we each got to do half a mouth. First you clean the tartar off, which is very rewarding because these teeth can look horrid and covered in dark brownish crap, then a few seconds later look sparkly white again. There are three ways to accomplish this: tartar removing forceps for breaking away giant chunks, hand scalers for more delicate work, and the ultrasonic scaler for the majority of the time. It uses vibrations to clean the calculus away, and sprays water at the same time--I got the dog's face, the towel underneath, and myself all completely soaked.
After cleaning the teeth, I got to extract two teeth, which was pretty quick and simple since they were already so loose. I pretty much just pulled them straight out. Then you polish the teeth to remove any microdamage to the enamel from scaling, and you're pretty much done.
Not much happened for the rest of the day. Some people still have to take care of their referral patients from last week, and the new referral surgery group is completely overwhelmed and stressed out. It took us absolutely ages to sort out who was going to do which after-hours treatments this week. But other than that, I just did some of our extra learning objectives--we have to do a presentation on thursday, a newsletter article for a client, plan a fracture repair for the "fracture game" on friday, and have a look at some online medicine scenarios. I also have a thousand emails from a discussion forum about current medical cases. Even though that sounds like a long list, there seems to be quite a bit of down time this week.
Today we did dentistry. While there are some nuances and complexities, basically dentistry is dentistry and we didn't do anything that I hadn't already done on our dead dogs a few weeks ago. It was a pleasant difference to work on a live dog, this time.
There were two dentals and four students on the roster, so we each got to do half a mouth. First you clean the tartar off, which is very rewarding because these teeth can look horrid and covered in dark brownish crap, then a few seconds later look sparkly white again. There are three ways to accomplish this: tartar removing forceps for breaking away giant chunks, hand scalers for more delicate work, and the ultrasonic scaler for the majority of the time. It uses vibrations to clean the calculus away, and sprays water at the same time--I got the dog's face, the towel underneath, and myself all completely soaked.
After cleaning the teeth, I got to extract two teeth, which was pretty quick and simple since they were already so loose. I pretty much just pulled them straight out. Then you polish the teeth to remove any microdamage to the enamel from scaling, and you're pretty much done.
Not much happened for the rest of the day. Some people still have to take care of their referral patients from last week, and the new referral surgery group is completely overwhelmed and stressed out. It took us absolutely ages to sort out who was going to do which after-hours treatments this week. But other than that, I just did some of our extra learning objectives--we have to do a presentation on thursday, a newsletter article for a client, plan a fracture repair for the "fracture game" on friday, and have a look at some online medicine scenarios. I also have a thousand emails from a discussion forum about current medical cases. Even though that sounds like a long list, there seems to be quite a bit of down time this week.
Friday 10 January 2014
The Harrowing Tale of Hip Fracture Friday
This morning was rather stressful because apparently all the instructions for today were given at afternoon rounds yesterday, which I missed because I was in surgery. All the cases for today had been divvied up, leaving me with no options.
The nurse put my name down for a lame labrador. It seemed fairly interesting, so I didn't mind too much. About five minutes later, another student approaches me and tells me he'd actually claimed that case last night, but didn't put his name into the system. I find out later that this student was supposed to find me after rounds yesterday and talk about the remaining cases, find out which one I wanted and sort out what was going to happen this morning. He didn't do that. He picked a case and went home.
At first, I put up a defense. "I haven't had a chance to do an orthopaedic exam yet," I explained, basically thinking you should have put your damn name on it, it's mine now. He agreed he would just come in on the consult and we would share the case. I go off and read all the patient notes, and eventually learn that he's started studying up on a completely different case and I may have successfully stolen this case for myself. I was a bit relieved, because it's unfair that my day would have been entirely screwed up and it was all his fault for not finding me yesterday afternoon while I was in theatre.
Then, as I'm reading the patient notes, a popup says one of my classmates is looking at that file on another computer. He's not on surgery this week, so I go ask him what's up, and he says it's a medicine case. We scratch our heads over this until we figure out the consult is scheduled under both medicine and surgery. I investigate, and long story short, it's a medicine case. No more case for me.
Just as I was about to get stressed out again, a new, urgent case pops up. A puppy fractured its femur. A case! Turns out it was not really the best case to have on a friday.
I did the consult when they arrived, and was pleased to find that I'm slightly less bumbly than I was in the first one. I was also pleased to find that the clients were willing to pay for the expensive fancy surgery. Thus the patient came under my care and dominated my entire day. Mostly that meant setting up a cage for him and then doing tons of paperwork.
In the afternoon, we went into surgery. It was interesting, but the hip area is challenging and the surgeon had a difficult time pinning the fracture back together and making sure he got all the pieces in the correct position. I became very glad that I was with the chillax surgeon, because eats-students-for-breakfast tends to get frustrated quickly and start throwing instruments around the room (not even joking). This guy was basically like "Aw, damn it," in a completely relaxed manner as he casually mentions he can't see anything and has no idea if his pins are in the correct place. After three hours of digging around in the hip joint trying to reduce the fracture and hold it together, he sews up a bazillion muscles, closes the wound, and we're off to radiology. However, if the pins aren't in the correct place, we have to come back in, take everything out, and do the alternate procedure where we just remove the femoral head rather than trying to hold it together with pins.
Guess what we found on xrays?
The sad thing is that the femoral neck, our goal during surgery, was very nicely aligned. He had fixed that part of the fracture perfectly. It just turns out that there was another fragment that must have come from somewhere else. Therefore, we had to go back in, re-scrub, undo all the skin staples and all the sutured muscles, and dive back down to the joint. At this point it's 6pm and we're looking at probably 2-4 more hours.
Before committing to the femoral head osteotomy, he tried to find that extra fragment, but couldn't. As far as he could tell, the joint surface was undamaged, though it was possible the fragment was too deep for us to reach. He called in the other surgeon, because once you take out the femoral head there's no going back--there's no chance of future improvements if the patient doesn't do well, like you can't do a total hip replacement when the puppy gets older. So we wait around for the other surgeon to arrive, and then they peer at it and poke at it for a good twenty minutes, discussing the pros and cons and what they think about what they see. The entire time, I'm thinking leave it, leave it, leave it. As much as I would like to see an FHO performed, I really didn't want to be there until 10pm on a friday. Finally, after much deliberation, they decided the best standard of care would be to leave the repair in place, and come back for a second operation if an FHO becomes necessary in the future. Phew!
I still had to write a surgery report, sort out some extra post-op meds, and do all the puppy's paperwork for the weekend, but at least I got home while it was still light out.
The nurse put my name down for a lame labrador. It seemed fairly interesting, so I didn't mind too much. About five minutes later, another student approaches me and tells me he'd actually claimed that case last night, but didn't put his name into the system. I find out later that this student was supposed to find me after rounds yesterday and talk about the remaining cases, find out which one I wanted and sort out what was going to happen this morning. He didn't do that. He picked a case and went home.
At first, I put up a defense. "I haven't had a chance to do an orthopaedic exam yet," I explained, basically thinking you should have put your damn name on it, it's mine now. He agreed he would just come in on the consult and we would share the case. I go off and read all the patient notes, and eventually learn that he's started studying up on a completely different case and I may have successfully stolen this case for myself. I was a bit relieved, because it's unfair that my day would have been entirely screwed up and it was all his fault for not finding me yesterday afternoon while I was in theatre.
Then, as I'm reading the patient notes, a popup says one of my classmates is looking at that file on another computer. He's not on surgery this week, so I go ask him what's up, and he says it's a medicine case. We scratch our heads over this until we figure out the consult is scheduled under both medicine and surgery. I investigate, and long story short, it's a medicine case. No more case for me.
Just as I was about to get stressed out again, a new, urgent case pops up. A puppy fractured its femur. A case! Turns out it was not really the best case to have on a friday.
I did the consult when they arrived, and was pleased to find that I'm slightly less bumbly than I was in the first one. I was also pleased to find that the clients were willing to pay for the expensive fancy surgery. Thus the patient came under my care and dominated my entire day. Mostly that meant setting up a cage for him and then doing tons of paperwork.
In the afternoon, we went into surgery. It was interesting, but the hip area is challenging and the surgeon had a difficult time pinning the fracture back together and making sure he got all the pieces in the correct position. I became very glad that I was with the chillax surgeon, because eats-students-for-breakfast tends to get frustrated quickly and start throwing instruments around the room (not even joking). This guy was basically like "Aw, damn it," in a completely relaxed manner as he casually mentions he can't see anything and has no idea if his pins are in the correct place. After three hours of digging around in the hip joint trying to reduce the fracture and hold it together, he sews up a bazillion muscles, closes the wound, and we're off to radiology. However, if the pins aren't in the correct place, we have to come back in, take everything out, and do the alternate procedure where we just remove the femoral head rather than trying to hold it together with pins.
Guess what we found on xrays?
The sad thing is that the femoral neck, our goal during surgery, was very nicely aligned. He had fixed that part of the fracture perfectly. It just turns out that there was another fragment that must have come from somewhere else. Therefore, we had to go back in, re-scrub, undo all the skin staples and all the sutured muscles, and dive back down to the joint. At this point it's 6pm and we're looking at probably 2-4 more hours.
Before committing to the femoral head osteotomy, he tried to find that extra fragment, but couldn't. As far as he could tell, the joint surface was undamaged, though it was possible the fragment was too deep for us to reach. He called in the other surgeon, because once you take out the femoral head there's no going back--there's no chance of future improvements if the patient doesn't do well, like you can't do a total hip replacement when the puppy gets older. So we wait around for the other surgeon to arrive, and then they peer at it and poke at it for a good twenty minutes, discussing the pros and cons and what they think about what they see. The entire time, I'm thinking leave it, leave it, leave it. As much as I would like to see an FHO performed, I really didn't want to be there until 10pm on a friday. Finally, after much deliberation, they decided the best standard of care would be to leave the repair in place, and come back for a second operation if an FHO becomes necessary in the future. Phew!
I still had to write a surgery report, sort out some extra post-op meds, and do all the puppy's paperwork for the weekend, but at least I got home while it was still light out.
Thursday 9 January 2014
Wrist Day
Since all my other patients have gone home, today was predominated by wrist-cat. This sweet little girl was found limping and it turns out she destroyed the ligaments in one of her wrists, probably from jumping down a big height and landing too hard on it. This is the same cat I admitted yesterday and we took more x-rays yesterday afternoon, confirming the need for surgery today.
The surgery is a salvage procedure where we fuse the carpal joints together so they don't end up becoming all degenerated and painful due to the instability from the ligaments. It was pretty much the coolest surgery I've seen. We opened up the wrist, destroyed all the cartilage with a burr, harvested bone from the shoulder and put a bone graft into the wrist, and then put on this absolutely tiny plate with even tinier screws. The idea is that the joints all heal into a big solid stretch of bone that is no longer flexible (fused into a normal standing position so she can still walk normally). There was lots of drilling and gadgets and metal implants and it was all very exciting. It was also my first time working with the really chillax surgeon. You see, there are two surgeons, one who eats students for breakfast, and one who jokes around and is very pleasant.
Unfortunately I missed afternoon rounds, because the surgery was long and started about they same time they did. This was slightly defeating because on monday, eats-students-for-breakfast gave us homework to present on thursday rounds, and all week I'd struggled to fit in my research and make notes. Turns out it didn't matter at all.
While I was waiting for the afternoon surgery, I adopted a fun patient that came in for an emergency Caesarian last night, and now had three brand new puppies. I watched over her, we did a bit of bloodwork, then I did the discharge with the client. She was a sweet little white fluffy dog, and her puppies were so tiny and silly and adorable.
In other news, we had a communications tutorial yesterday afternoon, talking about why clients leave practises and some common mistakes vets and vet students make. The lady shared some funny stories with us about students calling up the wrong client, and giving them a wonderful update about an animal that isn't theirs. She says there are mistakes every year: every year, animals get overdosed because of decimal places being in the wrong place, subcutaneous injections get given IV, forms get messed up and things don't go through. One time, a form didn't go through for an animal to get cremated, and this vet had seriously debated whether they should give the client some random ashes and pretend. They didn't actually do that, and she was very glad they admitted their mistake, because the first thing the client said was "I'm so glad you didn't try to pass off some other animal's ashes!" The vet said she was glad that conversation happened over the phone, because her face went bright red.
The surgery is a salvage procedure where we fuse the carpal joints together so they don't end up becoming all degenerated and painful due to the instability from the ligaments. It was pretty much the coolest surgery I've seen. We opened up the wrist, destroyed all the cartilage with a burr, harvested bone from the shoulder and put a bone graft into the wrist, and then put on this absolutely tiny plate with even tinier screws. The idea is that the joints all heal into a big solid stretch of bone that is no longer flexible (fused into a normal standing position so she can still walk normally). There was lots of drilling and gadgets and metal implants and it was all very exciting. It was also my first time working with the really chillax surgeon. You see, there are two surgeons, one who eats students for breakfast, and one who jokes around and is very pleasant.
Unfortunately I missed afternoon rounds, because the surgery was long and started about they same time they did. This was slightly defeating because on monday, eats-students-for-breakfast gave us homework to present on thursday rounds, and all week I'd struggled to fit in my research and make notes. Turns out it didn't matter at all.
While I was waiting for the afternoon surgery, I adopted a fun patient that came in for an emergency Caesarian last night, and now had three brand new puppies. I watched over her, we did a bit of bloodwork, then I did the discharge with the client. She was a sweet little white fluffy dog, and her puppies were so tiny and silly and adorable.
In other news, we had a communications tutorial yesterday afternoon, talking about why clients leave practises and some common mistakes vets and vet students make. The lady shared some funny stories with us about students calling up the wrong client, and giving them a wonderful update about an animal that isn't theirs. She says there are mistakes every year: every year, animals get overdosed because of decimal places being in the wrong place, subcutaneous injections get given IV, forms get messed up and things don't go through. One time, a form didn't go through for an animal to get cremated, and this vet had seriously debated whether they should give the client some random ashes and pretend. They didn't actually do that, and she was very glad they admitted their mistake, because the first thing the client said was "I'm so glad you didn't try to pass off some other animal's ashes!" The vet said she was glad that conversation happened over the phone, because her face went bright red.
Wednesday 8 January 2014
Keeping Clients "In the Dark"
Today I did my first consult ever. It was kind of awkward and confusing because there is a form on the computer system that we're supposed to fill out, with boxes to tick off or fill in as we take the history and perform the physical exam. I had never used it before, and it's also more designed for medicine (and I am on referral surgery). History taking for referral surgery is kind of like "Dog jumped out of car window, broke leg. Vet sent us here for surgery." The form, however, has a thousand spaces for every detail of diet and lifestyle and what have you, and some of them seem redundant. Combine that with fumbling my questions because I'd never actually spoken to a client alone before, and you can imagine how awkward it was.
On top of that, it was pretty light out and I don't have a very high light requirement threshold, so I didn't even notice that the lights were off. I left the client in the room and went to go get the surgeon, who is very elusive and it took me like twenty minutes to find him, and the entire time she was sitting in this room in the dark. It wasn't until one of the interns was talking to me and mentioned "Oh is that the client sitting in the dark in consult room one?" that I figured it out. To be fair, she could have turned the light on pretty easily.
The other awkward thing about it was that there was some difficulty finding the xrays, and I hadn't thought to ask about them. So once I finally find the surgeon, he wants to know if the client brought the xrays with her, and sends me to ask. She says no, the referring vet promised they would be here this morning. I go back to the surgeon and report this, and he asks if they were digital or film. I don't know, because I didn't ask, so I get sent back to find out. So imagine you're this client, sitting in the dark, and this vet student keeps popping her head in every five minutes to ask details about these obviously missing xrays. It turns out the films got couriered to radiology rather than surgery, and the surgeon eventually found them and the consult proceeded as normal.
On top of that, it was pretty light out and I don't have a very high light requirement threshold, so I didn't even notice that the lights were off. I left the client in the room and went to go get the surgeon, who is very elusive and it took me like twenty minutes to find him, and the entire time she was sitting in this room in the dark. It wasn't until one of the interns was talking to me and mentioned "Oh is that the client sitting in the dark in consult room one?" that I figured it out. To be fair, she could have turned the light on pretty easily.
The other awkward thing about it was that there was some difficulty finding the xrays, and I hadn't thought to ask about them. So once I finally find the surgeon, he wants to know if the client brought the xrays with her, and sends me to ask. She says no, the referring vet promised they would be here this morning. I go back to the surgeon and report this, and he asks if they were digital or film. I don't know, because I didn't ask, so I get sent back to find out. So imagine you're this client, sitting in the dark, and this vet student keeps popping her head in every five minutes to ask details about these obviously missing xrays. It turns out the films got couriered to radiology rather than surgery, and the surgeon eventually found them and the consult proceeded as normal.
Tuesday 7 January 2014
Second Day of Surgery Was Also Butt
Apparently I get all the butt-dogs, and it's pretty much my own fault for signing up for those cases. Today's butt-dog was actually a vag-dog, but that's close enough.
I don't know why, but I was on top of it today. Man, I was getting everything done, immediately, which is totally not how yesterday went. It's also not how today went for my classmates on my roster, but I think that has to do with the timing of the various surgeries. Instead of describing my day like a story, I'm going to try a different approach.
My Patients
- Butt-dog: Yesterday's surgery (they stay the night in hospital), this guy was a huge sweetie. He was always friendly and cheerful, wagged his tail and sat down when I approached with a leash, and never tried to eat any of the other patients.
- Vag-dog: Came in for emergency (same-day) surgery due to a vaginal prolapse. Ouchie. Despite her situation, surprisingly also a sweetie. She was pregnant with puppies worth $10,000 each, so even though they usually get speyed to help prevent recurrence of the prolapse, that was not going to happen here. We had to confirm that was the case, so we did a quick ultrasound, and found at least two live puppies by their heartbeat. We only checked one side, so there are likely several more puppies.
- Fluff-ball spinal-dog 1: There are actually two small fluffy dogs that are spinal patients (both have paralysed hind limbs), and one of them is mine. I actually confused them when I signed up so got the less-cute one, but she's still very silly. I have to walk her with a sling under her hind end, like a wheelbarrow. It's kind of bizarre walking a spinal dog and then a normal dog right after, because you get used to managing the spinal dog's disability.
Responsibilities
(1. Do the consult - I haven't done any yet)
2. Perform physical exam and write up paperwork for findings
3. Fill in "patient management sheet," which is basically setting out a plan of what needs to be done when, like walking, feeding, meds, etc, for that day and the next day
4. Scrub in on the surgery
5. Decide and calculate post-op analgesia
6. Call owners
7. Write a surgery report explaining the procedure
8. Write a discharge sheet for the client, explaining what happened in hospital, what/how to give meds, and home care
9. Take care of walking, feeding, meds, physiotherapy etc during the day, as well as the next morning (surgery patients stay overnight)
10. Meet with client by yourself, go over everything and send animal home
In Between
- Rounds every morning and every afternoon, where we meet as a group and tell each other about our patients, and usually discuss aspects of those diseases
- Homework - we're supposed to present some topics on thursday
- Explain things to other roster students that you've figured out, like how to work the computer system
- Get assigned new patients
Apparently some of the other rosters, like the non-referral medicine, don't have much to do and just sit on their thumbs all day. I had absolutely no idea that the rest of my classmates are not nearly as busy as the four of us on referral surgery.
I don't know why, but I was on top of it today. Man, I was getting everything done, immediately, which is totally not how yesterday went. It's also not how today went for my classmates on my roster, but I think that has to do with the timing of the various surgeries. Instead of describing my day like a story, I'm going to try a different approach.
My Patients
- Butt-dog: Yesterday's surgery (they stay the night in hospital), this guy was a huge sweetie. He was always friendly and cheerful, wagged his tail and sat down when I approached with a leash, and never tried to eat any of the other patients.
- Vag-dog: Came in for emergency (same-day) surgery due to a vaginal prolapse. Ouchie. Despite her situation, surprisingly also a sweetie. She was pregnant with puppies worth $10,000 each, so even though they usually get speyed to help prevent recurrence of the prolapse, that was not going to happen here. We had to confirm that was the case, so we did a quick ultrasound, and found at least two live puppies by their heartbeat. We only checked one side, so there are likely several more puppies.
- Fluff-ball spinal-dog 1: There are actually two small fluffy dogs that are spinal patients (both have paralysed hind limbs), and one of them is mine. I actually confused them when I signed up so got the less-cute one, but she's still very silly. I have to walk her with a sling under her hind end, like a wheelbarrow. It's kind of bizarre walking a spinal dog and then a normal dog right after, because you get used to managing the spinal dog's disability.
Responsibilities
(1. Do the consult - I haven't done any yet)
2. Perform physical exam and write up paperwork for findings
3. Fill in "patient management sheet," which is basically setting out a plan of what needs to be done when, like walking, feeding, meds, etc, for that day and the next day
4. Scrub in on the surgery
5. Decide and calculate post-op analgesia
6. Call owners
7. Write a surgery report explaining the procedure
8. Write a discharge sheet for the client, explaining what happened in hospital, what/how to give meds, and home care
9. Take care of walking, feeding, meds, physiotherapy etc during the day, as well as the next morning (surgery patients stay overnight)
10. Meet with client by yourself, go over everything and send animal home
In Between
- Rounds every morning and every afternoon, where we meet as a group and tell each other about our patients, and usually discuss aspects of those diseases
- Homework - we're supposed to present some topics on thursday
- Explain things to other roster students that you've figured out, like how to work the computer system
- Get assigned new patients
Apparently some of the other rosters, like the non-referral medicine, don't have much to do and just sit on their thumbs all day. I had absolutely no idea that the rest of my classmates are not nearly as busy as the four of us on referral surgery.
Monday 6 January 2014
First Day of Surgery Was Butt
I wish I could tell you that my first day of referral surgery involved the emergency splenectomy of the dog with a cancerous spleen that had ruptured and was bleeding into its abdomen.
It didn't. It involved butt.
After the orientation, in which they casually mentioned that we would be in charge of doing all our own consults (full history and physical exam, alone with the client), we were assigned cases. I got no-show and butt-dog.
No-show turned out to be a relief. Since this is referral surgery, the reason we have the case at the hospital is that some vet out in practice sent it to us. I read the referral letter, and it was a horribly complicated orthopaedic case with a number of problems on x-ray and CT scan, but no consistent pain response or localising signs to indicate a specific disease. So my first consult ever (ever) was going to be a confusing mess of me having to do a complete neurological and orthopaedic assessment, to come up with a list of differentials and treatment plan, for a case that had a real life vet scratching their head. Mind you, we're still at the stage where we have to think for five minutes to remember the basic questions, like "how long has he had this problem." Understandably, I was quite happy to find out that they had not turned up. I was especially happy because if they had turned up, I would have gotten no lunch today.
My other case was butt-dog. Some poor labrador whose anal sacs have been irritated for 3 frickin' months. He wasn't responding to medical treatment, so off to surgery to have said anal sacs removed. Incidentally, they were removed by the surgeon who is well reputed to feast on students' tears, which made day 1 slightly more stressful than it needed to be. I survived mostly unscathed, after about an hour or two of him saying "Swab" and me trying to get my hand in to swab the blood before too many seconds passed and he got annoyed.
Despite a surprisingly slow morning, after surgery, the day really did feel like butt. I had to sort out all the post-op meds, including pain relief and antibiotics, and get them from the pharmacy and set up all the forms, and like a thousand other things. Only, I had to do that with minimal help. It's sensible enough, we need to be able to do that, but on day 1, picking your own drugs, dose rates, and the other hairy details is a bit overwhelming. Between trying to get people to explain what on earth to put in the forms, double check my choices, and getting sent from one nurse to another to another to answer simple questions, it took me 2 hours to do something that should have taken 10 minutes.
Actually, allow me to backtrack. After surgery, I started to figure out the meds, had all those problems, but only 15 minutes before rounds started. In the middle of scratching out and re-writing and re-scratching out my calculations, my pager (yes, pager) goes off and we get sucked away to get grilled by the head surgeon on what we learned today. I didn't get to finish my post-op duties until afterwards, and then I got reprimanded for not having the form in to the pharmacy before 5pm. Surgery ended at 4:15, rounds started at 4:30.
Well, after my 12 hour day, I have about two hours to live my life before going to bed, because I have to get up ridiculously early to get all my in-hospital patients walked, fed, and examined before morning rounds start at eight. And by "live my life" I actually mean "do the research homework for the presentation on thursday."
It didn't. It involved butt.
After the orientation, in which they casually mentioned that we would be in charge of doing all our own consults (full history and physical exam, alone with the client), we were assigned cases. I got no-show and butt-dog.
No-show turned out to be a relief. Since this is referral surgery, the reason we have the case at the hospital is that some vet out in practice sent it to us. I read the referral letter, and it was a horribly complicated orthopaedic case with a number of problems on x-ray and CT scan, but no consistent pain response or localising signs to indicate a specific disease. So my first consult ever (ever) was going to be a confusing mess of me having to do a complete neurological and orthopaedic assessment, to come up with a list of differentials and treatment plan, for a case that had a real life vet scratching their head. Mind you, we're still at the stage where we have to think for five minutes to remember the basic questions, like "how long has he had this problem." Understandably, I was quite happy to find out that they had not turned up. I was especially happy because if they had turned up, I would have gotten no lunch today.
My other case was butt-dog. Some poor labrador whose anal sacs have been irritated for 3 frickin' months. He wasn't responding to medical treatment, so off to surgery to have said anal sacs removed. Incidentally, they were removed by the surgeon who is well reputed to feast on students' tears, which made day 1 slightly more stressful than it needed to be. I survived mostly unscathed, after about an hour or two of him saying "Swab" and me trying to get my hand in to swab the blood before too many seconds passed and he got annoyed.
Despite a surprisingly slow morning, after surgery, the day really did feel like butt. I had to sort out all the post-op meds, including pain relief and antibiotics, and get them from the pharmacy and set up all the forms, and like a thousand other things. Only, I had to do that with minimal help. It's sensible enough, we need to be able to do that, but on day 1, picking your own drugs, dose rates, and the other hairy details is a bit overwhelming. Between trying to get people to explain what on earth to put in the forms, double check my choices, and getting sent from one nurse to another to another to answer simple questions, it took me 2 hours to do something that should have taken 10 minutes.
Actually, allow me to backtrack. After surgery, I started to figure out the meds, had all those problems, but only 15 minutes before rounds started. In the middle of scratching out and re-writing and re-scratching out my calculations, my pager (yes, pager) goes off and we get sucked away to get grilled by the head surgeon on what we learned today. I didn't get to finish my post-op duties until afterwards, and then I got reprimanded for not having the form in to the pharmacy before 5pm. Surgery ended at 4:15, rounds started at 4:30.
Well, after my 12 hour day, I have about two hours to live my life before going to bed, because I have to get up ridiculously early to get all my in-hospital patients walked, fed, and examined before morning rounds start at eight. And by "live my life" I actually mean "do the research homework for the presentation on thursday."
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