This morning, my patient disappeared from under my nose. We're supposed to show up before 8am to make sure our patients are checked, walked, given meds, etc before morning rounds. I was in the middle of taking this puppy's vital signs, when my classmate needed a hand to get a temperature on a wiggly dog. I put my patient back in her cage, we take the temperature, and when I turn around... she's gone.
A nurse had passed through, so we suspected she'd taken the puppy outside. My classmate took his dog out, and when he returned, I asked if he saw my patient out there. No. He hadn't.
It turns out anaesthesia had come and taken her. In the middle of treatments. One of the nurses flew in, snatched her away, and by the time I found her on the other side of the hospital, she'd been pre-medded and was half asleep. So much for her morning walk.
Monday 21 July 2014
Friday 18 July 2014
I Promise I Work in a Real Hospital
A sick rabbit came in today for not eating. We took some radiographs and figured out that it had intestines full of hair balls (trichobezoars). It got sent home with instructions to feed it pineapple juice.
PS: This may be an oversimplification for dramatic effect. We gave it metoclopramide and critical care diet mix, too.
PPS: The reason this is tagged for "neat facts" is that this is a common problem in rabbits and pineapple juice is a commonly suggested aspect of treatment. Apparently it's best if you blend the whole pineapple, since there's a lot of fibre in the core.
PS: This may be an oversimplification for dramatic effect. We gave it metoclopramide and critical care diet mix, too.
PPS: The reason this is tagged for "neat facts" is that this is a common problem in rabbits and pineapple juice is a commonly suggested aspect of treatment. Apparently it's best if you blend the whole pineapple, since there's a lot of fibre in the core.
Monday 14 July 2014
Maybe I CAN Actually Be A Doctor
I totally nailed a diagnosis yesterday.
Final year so far has involved a lot of struggling to remember details from the bazillions of lectures we had in the previous years, combined with the sudden need to actually apply these in a real world situation. Then you also add in all the hands on skills that you're kind of expected to know how to do, since they talked about them in lectures. You can guess how well that turns out.
One of these skills is abdominal palpation. The abdomen is this mysterious place full of soft squishy organs that seem rather indistinguishable from one another when you're trying to smoosh them between your hands. No amount of reading "palpably enlarged liver" will make you actually able to feel a liver, unfortunately. However, after most of a year of "yep, she has intestines," I finally had a patient where I made a diagnosis by feeling something. I felt a big hard mass near the front of the abdomen, and it was confirmed on xrays and ultrasound!
Another of these skills is the ability to hear a heart murmur. Anyone can figure out that a heart that sounds like a washing machine isn't normal, but anything less than that is starting to tax my vet student prowess. I spent a day with a cardiologist once, and every patient went something like me thinking, "That sounds normal," followed by him saying, "He has a murmur." Then the next day went something like me thinking, "Totally has a murmur," followed by him saying, "The heart sounds normal." And yet, I heard one all by myself yesterday. That's right, same patient!
A cat came in for losing her appetite gradually, and the two big things I found on physical exam (all by myself!) were an abdominal mass and a heart murmur. The intern, attending, radiologist, and anaesthetist all found the same things! Yay I got something right for a change. Take that, baffling world of abdomens.
Final year so far has involved a lot of struggling to remember details from the bazillions of lectures we had in the previous years, combined with the sudden need to actually apply these in a real world situation. Then you also add in all the hands on skills that you're kind of expected to know how to do, since they talked about them in lectures. You can guess how well that turns out.
One of these skills is abdominal palpation. The abdomen is this mysterious place full of soft squishy organs that seem rather indistinguishable from one another when you're trying to smoosh them between your hands. No amount of reading "palpably enlarged liver" will make you actually able to feel a liver, unfortunately. However, after most of a year of "yep, she has intestines," I finally had a patient where I made a diagnosis by feeling something. I felt a big hard mass near the front of the abdomen, and it was confirmed on xrays and ultrasound!
Another of these skills is the ability to hear a heart murmur. Anyone can figure out that a heart that sounds like a washing machine isn't normal, but anything less than that is starting to tax my vet student prowess. I spent a day with a cardiologist once, and every patient went something like me thinking, "That sounds normal," followed by him saying, "He has a murmur." Then the next day went something like me thinking, "Totally has a murmur," followed by him saying, "The heart sounds normal." And yet, I heard one all by myself yesterday. That's right, same patient!
A cat came in for losing her appetite gradually, and the two big things I found on physical exam (all by myself!) were an abdominal mass and a heart murmur. The intern, attending, radiologist, and anaesthetist all found the same things! Yay I got something right for a change. Take that, baffling world of abdomens.
Saturday 12 July 2014
Overseas Adventures
You might have noticed a lack of posts in May and June, and attributed it to the fact that I tend not to post for large periods of time. That actually wasn't the case, and in my defense, I never forget to post, I just get too busy or too tired. This time, I was overseas doing some externships at clinics in the northeastern US.
The first clinic I was at is a small animal general practice, so you'd think it would be pretty similar to my other weeks at local small animal practices. It wasn't.
I don't know how common this is in the states since I haven't been to as many practices there, but this place was doing high-end medicine. They don't just have digital xrays and ultrasound, they have chemotherapy, phsyical therapy (including a water treadmill), nutrition specialists, behaviour experts, endoscopy, and more. They do complex surgeries, not quite up to the level of a referral surgery service, but do perform many procedures that other practices would refer. The vets there are all extremely knowledgable. The practice also places a lot of emphasis on client communication and building client relationships, so they had lots of tips to share with me in the "soft skills" department as well. They even called up the Humane Society and had them send over a bunch of speys and neuters for me and my classmate! Our university doesn't even do that.
The other clinic I visited was a specialist clinic. They had multiple internal medicine specialists and boarded surgeons, as well as a regular oncologist, cardiologist, and a few other bits and bobs. That was a step away from the world of general practice, and delving into "What life is like as a specialist." I decided I probably don't want to be a specialist, but they do see some seriously cool stuff. The most memorable was a pair of 20-something-year-old Capuchin monkies that are trained to help blind people (and they do a LOT of neat things for them). It was interesting seeing the different personality types in the different specialties, and to go more in depth in the cases.
It's hard to form a post for a six week period. I did so many things its hard to remember them all, let alone pick some to write about. It was a mix of busy days and sightseeing. I reinforced a ton of my pharmacology and medicine, and got to do quite a few routine surgeries. One thing I noticed (I'm not sure if this is a regional difference, or just luck of the draw with cases), was the large number of pets on the same anti-anxiety meds as people, like Prozac and Xanax. There are different diseases and disease prevalences there, which was an interesting challenge. New Zealand doesn't have rabies, heartworms, ticks, or tick-borne diseases, which are all important in the US and part of standard medicine (eg annual vaccinations and testing). Also, the drugs they have are different, which is tough to remember sometimes.
The best thing about getting away and doing some externships was regaining joy and enthusiasm for veterinary medicine. Hospitals are run very differently to private practices, especially university hospitals. At school, we students are used as free labour for a lot of menial tasks that take away from our time and energy to focus on the medicine itself, things like doing redundant paperwork for the computer system or nursing care for all of our patients (which would be fine if I were at vet nursing school). The clinicians are so used to students, we're just "another one" to them, and they probably get tired of the same mistakes over and over. We have skills books that they need to sign, and we have to chase them down the halls on Friday afternoons before they'll finally, grudgingly give up a signature.
At a private clinic that doesn't see many students, they cared a lot more about my individual learning. They had the approach of, "What can we get you to do? What skills do you need signed off? Let's see if we can organise something for you." My spare time consisted of reading and discussing cases, instead of picking up poop and ice-packing surgical wounds. The biggest difference was that the vets treated me and my classmate like colleagues, rather than students. They asked our opinions on things and never talked down to us. It was a positive, collaborative atmosphere, and the things I did were a lot closer to "real" veterinary medicine than my rosters at uni. It was a great boost halfway through the year, because I'd been beginning to doubt my interest or commitment to the profession. Now I believe that's simply due to the warped perspective we get from spending all our time in a teaching hospital.
I feel like I'm not giving my trip decent justice, boiling down six weeks into those two paragraphs! I suppose most of the interesting stuff was case-related, which would involve getting more technical than the blog is intended to be, so I'll leave it at that.
The first clinic I was at is a small animal general practice, so you'd think it would be pretty similar to my other weeks at local small animal practices. It wasn't.
I don't know how common this is in the states since I haven't been to as many practices there, but this place was doing high-end medicine. They don't just have digital xrays and ultrasound, they have chemotherapy, phsyical therapy (including a water treadmill), nutrition specialists, behaviour experts, endoscopy, and more. They do complex surgeries, not quite up to the level of a referral surgery service, but do perform many procedures that other practices would refer. The vets there are all extremely knowledgable. The practice also places a lot of emphasis on client communication and building client relationships, so they had lots of tips to share with me in the "soft skills" department as well. They even called up the Humane Society and had them send over a bunch of speys and neuters for me and my classmate! Our university doesn't even do that.
The other clinic I visited was a specialist clinic. They had multiple internal medicine specialists and boarded surgeons, as well as a regular oncologist, cardiologist, and a few other bits and bobs. That was a step away from the world of general practice, and delving into "What life is like as a specialist." I decided I probably don't want to be a specialist, but they do see some seriously cool stuff. The most memorable was a pair of 20-something-year-old Capuchin monkies that are trained to help blind people (and they do a LOT of neat things for them). It was interesting seeing the different personality types in the different specialties, and to go more in depth in the cases.
It's hard to form a post for a six week period. I did so many things its hard to remember them all, let alone pick some to write about. It was a mix of busy days and sightseeing. I reinforced a ton of my pharmacology and medicine, and got to do quite a few routine surgeries. One thing I noticed (I'm not sure if this is a regional difference, or just luck of the draw with cases), was the large number of pets on the same anti-anxiety meds as people, like Prozac and Xanax. There are different diseases and disease prevalences there, which was an interesting challenge. New Zealand doesn't have rabies, heartworms, ticks, or tick-borne diseases, which are all important in the US and part of standard medicine (eg annual vaccinations and testing). Also, the drugs they have are different, which is tough to remember sometimes.
The best thing about getting away and doing some externships was regaining joy and enthusiasm for veterinary medicine. Hospitals are run very differently to private practices, especially university hospitals. At school, we students are used as free labour for a lot of menial tasks that take away from our time and energy to focus on the medicine itself, things like doing redundant paperwork for the computer system or nursing care for all of our patients (which would be fine if I were at vet nursing school). The clinicians are so used to students, we're just "another one" to them, and they probably get tired of the same mistakes over and over. We have skills books that they need to sign, and we have to chase them down the halls on Friday afternoons before they'll finally, grudgingly give up a signature.
At a private clinic that doesn't see many students, they cared a lot more about my individual learning. They had the approach of, "What can we get you to do? What skills do you need signed off? Let's see if we can organise something for you." My spare time consisted of reading and discussing cases, instead of picking up poop and ice-packing surgical wounds. The biggest difference was that the vets treated me and my classmate like colleagues, rather than students. They asked our opinions on things and never talked down to us. It was a positive, collaborative atmosphere, and the things I did were a lot closer to "real" veterinary medicine than my rosters at uni. It was a great boost halfway through the year, because I'd been beginning to doubt my interest or commitment to the profession. Now I believe that's simply due to the warped perspective we get from spending all our time in a teaching hospital.
I feel like I'm not giving my trip decent justice, boiling down six weeks into those two paragraphs! I suppose most of the interesting stuff was case-related, which would involve getting more technical than the blog is intended to be, so I'll leave it at that.
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