3 Days of Orthopedics

A couple weeks ago, I was assigned to the orthopedic department for 3 days. I imagined myself taking patient histories, helping with office calls, and being told to do a lot of stuff I haven't learned yet. Well, I was right about the last one. Monday morning I was finishing writing my first official SOAP when an intern told me I would be going to surgery soon. This is awesome!! Then I find out who the clinician is and they are very intimidating and have a reputation of being extremely strict. Not so awesome!!
I meet with the clinicians as they're reviewing the radiographs and find out that we will be repairing a tibial fracture. While prepping the dog, I received some very good advice from an anesthesiologist: "Make sure you pee before the surgery." The surgery lasted 5 or 6 hours and I was glad I followed the advice. I was extremely tired that night not only because of the marathon surgery but also because in ortho surgeries, we apparently have to wear lead vests under our gowns because we are taking radiographs throughout the surgery. That night I went to dinner with the scary surgeon, the resident, and another clinician. The surgeon ended up buying my dinner and offering me a summer job. It was a nice change of pace to talk to these doctors about life and get advice on what I should be doing now to get where I want to be. While this surgeon is still somewhat intimidating, I realize they are not mean, and they do just want to make students into the best doctors possible. This was so much more than I expected from this holiday job!!
The next 2 days I learned a lot about caring for these dogs that were hit-by-cars and assisting with 2 more femoral fracture repairs. I have become very proficient at suctioning blood, holding a leg for very long times (which reminds me of Turk on Scrubs when he scratches his nose with some guy's toe during surgery), cutting suture, and cleaning instruments. I did get to practice suturing and stapling during the closure on the last dog. My last hour working was spent discharging one of the dogs with the resident to the owners. This was a very rewarding time to see this dog walking again and the owners so happy to have him back!!

It's Like Christmas

After classes ended, I wanted to start reading a book for fun and I had 2 to choose from that I bought back in August: "All My Patients have Tales" by Jeff Wells AND "Tell Me Where It Hurts" by Nick Trout. Yes, that's right I read about veterinarians for fun when I'm not studying. Talk about well-rounded. Anyways, Nick Trout is a surgeon so I started reading his book and was hooked. I highly recommend this book to any aspiring small animal vets and especially surgeons. He explains clinical diseases and techniques very clearly but not too simple since I was still learning more about procedures I was somewhat familiar with. He also has enough humor to keep it entertaining. In the first chapter, he talks about a dog with GDV (gastric dilatation and volvulus). Briefly, it usually occurs in deep-chested dogs after a big meal. During exercise, the stomach twists (volvulus) and the gas being produced during digestion? becomes trapped - dog is unable to burp - and results in a bloated stomach (gastric dilatation) with no way to release the pressure. Obviously, the dog does not feel good and time is important because the twisting can cut off blood supply to the stomach as well as the spleen.
Up until today, my job at the teaching hospital has been rather boring. We have 3-4 people giving treatments to 2 animals in the mornings. One day, I barely did anything because we have too many people doing too little work. Today, I got to take care of a German Shepherd with Myasthenia Gravis (animal's body makes antibodies to acetylcholine receptors ->dog gets stiff/tired after exercise) and possibly secondary megaesophagus. This dog looked terrible 3-4 days ago - not moving much, not eating much, salivating a ton. Today, the dog went for a walk outside, wasn't salivating much, and scarfed down a can of food. He may have even gone home today. It was fun talking to the doctor about myasthenia gravis and its treatment/prognosis. It's a good chance to see what I know and what I have to learn. There are a few drugs to treat myasthenia gravis, but the important thing to look for are acetylcholinesterase inhibitors.
I was also on-call for surgery today. My plan was to sit at home and watch movies all day until my phone rang and I was called into surgery for an emergency GDV. It was an answered prayer to scrub in on the surgery. I am still struggling with finding the arm holes for the gown, but the rest of the scrubbing and gloving went fine. I always find one arm hole and have no clue where the other is. I gowned up and was put in charge of suction. We immediately removed 1 liter of bloody fluid from the abdomen. At this point, I was thinking, "Oh great, my first real surgery I get to scrub in and it's going to bleed out." My thinking seemed to be confirmed when we could not find the source of the blood and 1 liter approached 2. Finally, we found a broken vessel and ligated it. The rest of the surgery went fairly smoothly and I can add retracting and cutting suture to my resume'. The surgery was a couple hours long due to all the complications.
In the middle of that last paragraph with 5 minutes left for being on call, I was called in again by the surgeon. He said he could get someone else, but I couldn't pass up another opportunity to scrub in. This one was a pyometra (pus in the uterus). I arrived to finish scrubbing the patient. Gowning went much smoother this time. Just before the surgery, I confirmed that the point of the surgery was to just remove the uterus which is what we did. The surgery only lasted 20-30 minutes. Tomorrow we meet to write the surgery report and discharge - things I was asked to do, but won't learn until next year.
To put the cherry on the top of my GDV and pyometra filled cake, I got paid for all of this that I would have done for free. I love my job!!!

3/8ths a vet

I just finished my 3rd semester of vet school, and I am very excited for it to be over. Finals were ridiculous - I was only getting 3-5 hours of sleep each night. In the middle of the week, our public health exam was extremely difficult. I thought I could have easily missed 20-30 questions out of 110. I did slightly better than I expected, but then Christmas came early this week when I received a higher grade in the class than I expected. Overall, the gpa dropped, but not as much as I anticipated. I need to get my act together for next semester since I will be busier with work and other extracurriculars than this last semester.

Over break, I am working in the teaching hospital. My "interview" occurred when I was unlocking my bike and the surgery tech asked if I wanted a job, and I was officially hired during final week. Yesterday was orientation and it looks like I should learn a lot doing the treatments over the holidays. I've already learned where more things are and some of the paperwork to fill out. The most difficult part of orientation was the emergency part. The tech kept asking clinical questions that we should technically know, but my brain was turned off after finals. Hopefully, I'll learn a lot this next week and be more prepared for clinics next year. I'm also on-call somedays and will get to scrub in if an emergency comes in. SOOOO, I hate to say it, but I hope some emergencies happen.

10 More Days

Last week, we had a lab that was really cool. I learned how to fix a pneumothorax (not that hard), place a chest tube, intubate a dog, and how to theoretically do transtracheal washes and tracheostomies. I was excited because I thought I was going to learn how take a pen and stab a choking dog in the throat (tracheostomy) and open an airway like the heroes do in the movies with people all the time. However, the emergency vet said he's seen 1 or 2 in the past 7 years which means I'll never do it and doing a blunt dissection to place the tracheostomy tube is much more likely, though less exciting. It was easily the best part of this semester.

I also had my Pathology final today. It feels so good to have another class done. I have no more tutoring for the semester. Everything is coming to an end.... not fast enough though. Now, I have classes the rest of this week and then finals all next week. The pain is about to begin. Oh, how I missed the taking a final, having 22 hours to prepare for the next one, and then repeat 4 times - all the while getting less sleep as the week progresses. Welcome back Finals Week!!

I'm trying to start studying hardcore, but the motivation is hard to find. I was talking to a 3rd year the other day who had some encouraging words: he was saying how I didn't pay attention this semester because there wasn't much worth listening to (I totally agree). Then next semester, he said the classes will be interesting, but it will just be too hard to pay attention in class. Next semester's final schedule is supposed to be the worst too. At least, I have something to look forward to.

Time to get back to respiratory diseases with a little bacteriology sprinkled on top.