It's not all kitten and puppy cuddling

Today was the first time ever I cried about a patient.

He is a five and a half year old cat that isn't even particularly nice. He is trying to die and we have been trying our best to figure out what is wrong and to help him. $5500 in and we seem to have more questions than answers and nothing we are doing is working. The owners are devastated and are willing to do whatever is necessary to save him. We started a new treatment today, but it is pretty much a gamble. I can't even being to describe the sheer frustration of having an owner willing to go the distance, but being completely unable to help. I've always tried to retain a sort of objectivity while dealing with my patients because getting emotionally involved is extremely emotionally draining. However, I see the desperation in his owners in wanting to save their pet and I can't help but empathize. Sometimes I feel that this job is too hard to do. I then try to keep a even larger emotional distance from my patients. Someday I may find a good balance between investing myself too much and not enough.

This weekend marks the end of a 9 week rotation marathon. I haven't written anything since partway through my orthopedics rotation because I simply haven't had the time. After finishing up my orthopedic rotation, I jumped into my soft tissue rotation. The senior clinican on during my rotation is an expert in laryngeal diseases as well as reconstructive surgery. I've had the opportunity to see amazing wound reconstruction and huge defect closures. During this rotation, I also had the opportunity to go to a humane society and practice spaying a neutering dogs and cats. I did 4 dog spays, 2 cat spays, 2 dog neuters, and 2 cat neuters at the humane society. During my rotation at school, I also had the opportunity to perform 1 dog spay and 2 dog neuters. In addition to these basic surgeries, I was allowed to participate in a variety of amazing and life saving surgeries. All in all, I'm feeling much more comfortable with my surgical skills and had a blast in this rotation.

After my soft tissue surgery rotation, I went on to internal medicine. This rotation is the one that people refer animals to when they can't figure out what's wrong with them. I didn't think I would like this rotation much, but as it turns out, I love internal medicine. The patient is like a puzzle we have to work out. I have also been able to try so many new things on this rotation. I was allowed to take nasal biopsies, do joint taps, take bone marrow aspirates and biopsies, and place esophageal feeding tubes. The only part of internal medicine that I don't like is the amount of animals that we cannot cure. Even with the vast amount of new techniques and drugs that have been made available in veterinary medicine, there are still some diseases and conditions that we cannot do anything about, no matter how much an owner may want it.

Tomorrow, I start my primary care rotation. Other than my upcoming emergency and critical care rotation, all of my rotations starting tomorrow on should be much less stressful. I'm looking forward to having a bit more free time.

5 more days to go

It's two weeks into this rotation and I am definitely counting down the days until it is over. While I find orthopedics fascinating, one of the clinicians I have had to work with treats everyone worse than dirt, except for the one person he's playing favorites with. Despite the fact that he barely speaks to me, apparently I have almost inadequate knowledge about this subject, don't take enough responsibility for my cases, and give average patient care. Apparently my medical records are also subpar although no one tells me what is wrong nor do I get much correction when they go over what I've written. All in all, it's been a frustrating and emotionally draining week for me.

The next week is looking up because the clinician is no longer going to on my rotation and I will have a chance to work with some other people. The schedule for next week is also going to be lighter, so hopefully I'll be able to spend less than 12-13 hours at the hospital on some days.

If it walks like a seal....

Today has been day 3 of my orthopedic rotation and I am exhausted. Normally it is one senior clinician a week that sees appointments Mondays and Wednesday and does surgeries on Tuesdays and Thursday. Somehow my rotation got lucky and got dual services all three weeks. This means there are two senior clinicians on and we are seeing appointments Monday through Thursday and are doing surgeries Tuesday through Friday. On top of all that, one of the clinicians on this week and next week is notorious for overbooking and doing lots and lots of surgeries. Suffice to say that it has been a really long three days. 

My first two cases were both very interesting cases. One was a limping German Shepherd Dog that turned out to be a neurologic case. He had a nerve sheath tumor that has a pretty guarded prognosis. That was quite sad. My second case was a little Corgi that was walking in a palmigrade stance. Turns out the poor little thing had some sort of erosive arthritis in multiple of its joints.

Palmigrade. The front feet should not be in this position.
Now imagine this in a little Corgi and you have my patient

I have two other cases going into surgery tomorrow and on Friday. One is getting a TPLO (Tibial Plateau Leveling Osteotomy) and other is getting a bone plate removal. More info to come next time. 

Wrapping Up

Friday was the last day of this rotation and on this day I was FINALLY able to redeem myself and suture up a cow successfully. This cow also had a displaced abomasum and the doctor was going to let me perform almost the entire surgery. Unfortunately, the owner was in a hurry so that idea was shot down. She did let me reach in and deflate the distended stomach. That was a bit scary. We attach a large needle to a rubber tube, Then stick the needle into the stomach and turn on a vaccum hooked at the other end of the tube. Getting the needle in and out without lacerating other organs was a bit tricky, but I think I managed it.

Not perfect, but successful!

Nothing else was super exciting, but I got to spend some time in the small animal clinic placing catheters and drawing blood. 

A couple of photos from earlier on in the rotation:

On the first day of my rotation, I helped deliver my first baby calf ever

The weather during my three week rotation was not the most pleasant ever. This a photo taken during a snowstorm during a drive. Believe it or not, there is supposed to be a road right in front of us, it is just obscured by the heavy snow. The lack of visibility isn't my poor camera skills, but actually the snowfall.

Babies Part 2

Today was a pretty slow day. We went out in the morning to do some equine calls, vaccines and blood draws. Nothing too exciting.

Around noon we got a call about a sheep having difficulty giving birth. She was in labor and straining, but her cervix was closed. We had to manually dilate her cervix and pull the lambs out. So now I've seen a lambing as well.

Tonight, I'm packing up everything and getting ready to head back down home tomorrow. The three weeks have flown by and I'm actually a tiny bit sad. The family I'm staying with have all been so nice and welcoming and the doctors and staff at the clinic have been great. Despite the freezing cold, I've had a really fun time out here learning about large animal medicine. 

Life and Death

I started off the day with 4 cows in the clinic with LDAs. A LDA (left displaced abomasum) is when one of the cow's four stomachs, the abomasum, goes from the lower right side of the abdomen underneath one of the other stomachs (the rumen) to the upper left side of the abdomen.

To figure out this diagram, pretend you are looking through the cow from the rear end to the head

There are many ways to fix it, but the way we chose to fix it today is called Pyloromentopexy. This procedure involves opening up the abdomen, replacing the abomasum, and then suturing part of it to the abdominal wall to keep if from moving it again. The interesting thing about doing this surgery is that the cow is actually awake and standing the entire time. We do a local anesthetic block on the right side of the abdomen and then cut them open. So today I got to stick my arm into the abdomen of an awake cow and feel around the abdomen!

During the LDA surgeries earlier in the day, we took a break to do some mare reproductive activities that involves a rectal ultrasound and planning on when to artificially inseminate them. There were also 4 piglets that died suddenly earlier today that came in for sample collection. We collected brain, heart, small intestine, and colon to be sent off for tests. I got to show the doctors how to do a brain extraction with a cast cutter. Thank you skills from my pathology rotation! 

The doctor was going to let me close the incision for the last cow, however, right before closing an emergency came in and he just did a quick closure. Although I was disappointed in not being able to practice, it was an interesting emergency; a goat having a difficult birthing (aka kidding in this case). When we went to see the animal, the poor mama goat had a baby goat head hanging out of her backside. We pushed the head back in and ended up delivering 2 live baby goats.

The two cutie-pies

The proud mama

Huacayas vs Suris

The animal of the day is the alpaca. We went and saw three different alpaca herds today, and they are adorable! There are two main types of alpacas, Huacaya and Suri. They are a lot smaller than I expected. Definitely much smaller than a llama, and not as prone to spit or kick. Alpacas are most commonly kept for their fiber and meat. However, I don't believe we serve alpaca in America, so all of the ones seen today were bred for fiber. 

                                 

                                       Huacaya                                               Suri

At the first farm, we did an abdominal ultrasound followed by a rectal ultrasound on the first alpaca to check for pregnancy. Sadly, there was no fetus to be found. We did a rectal ultrasound and a vaginal exam on the second alpaca to evaluate for vaginal discharge, but all was well and good. Both of those alpacas will be shipped back down to Ohio to get bred. 

At the second and third farm, we mainly did physical exams to be able to issue health certificates for these alpacas to travel across state lines for shows. We did draw some blood for testing. The coat of the alpaca is so thick that there is no way to see the jugular vein. You have to find certain landmarks and just go for it. I got to try on the last alpaca, and I'm happy to say that I was successful in hitting the jugular blind! 

The third farm we visited actually had many of the top alpacas in the country. Some of the stud fees were $2000+. It was a wonderful experience to see these amazing animals. I also got a quick lesson on evaluating the quality of the fiber (their hair coat). 

Some fun alpaca vocabulary:

- Cria: alpaca baby

- Cush: a position in which the alpaca is sitting on the ground with all four legs tucked under its body

- Orgle: the sound a male alpaca makes during breeding

- Pronking: a bounding/leaping/springing movement

I finished off the day by helping dig a stuck car out of the snow. That is one experience that I hope to never have to repeat again, but it was my good deed for the day. Spring can't come fast enough!