Thursday, July 23, 2009

Internal Medicine, or a Crash Course in Ultrasound Interpretation

I've been released from the DOD rotation (daytime emergencies) and have spent the last 10 days or so with one of the internal medicine services. This one is called Akron Veterinary Internal Medicine and Oncology Practice (shortened to AVIMP for obvious reasons) and it has been a positive experience so far. The doctors (one oncologist, one boarded internist, two "practice limted to internal medicine" vets, and a resident) are very easy and fun to work with. They all seem to have a well-developed sense of humor, so I'm fitting in pretty well. That said, they are very, very good at what they do and I'm amazed on a daily basis at how much they know and how thorough their understanding of physiology and disease processes is.

Most of my time is spent assisting (read: holding the patients) for ultrasounds. Abdominal ultrasonography is performed on almost every patient and, seeing the changes, both subtle and not so, in all of these pets is both fascinating and a little scary because I worry about what all I was missing by not ultrasounding this much. Routinely, definitive diagnoses are reached in patients that, in general practice, I'd have been left guessing on. I find this to be highly rewarding and satisfying. Again, it helps that most of the clients don't balk at the $600-$800 work ups, but medicine is a little easier when one is allowed to gather all the information at hand.

The other nice thing about the AVIMP rotation is slightly better hours than before. I tend to get to work earlier, because part of my responsibilities is "TPRing" the patients and walking them in the morning before rounds; however, we are usually done and leaving by 6 pm, as opposed to 9 or 10 like a couple of weeks ago. The weekends, as well, are a little better. This is a welcome change as it allows more opportunity to spend some time with Cindy. The distance is wearing on me a little bit, especially if something is amiss at home and I can't do anything to help. Luckily, Cindy has been great and our friends have been extremely helpful in maintaining my peace of mind.

Unfortunately, due to the way my internship is scheduled, I'll be moving to a new service (specialty surgery) on Monday. The upside is there's always something new to look forward to, the bad part is I move on just as I'm getting into the groove of the routine. Oh well, just the nature of the beast, I suppose.

So, one month down, 11 to go and, so far, it has been pretty much what I expected. I'm tired, but dealing okay, and I really think I'll look back on this as a positive experience. Stay tuned for more updates.

Everyday is a day at the zoo

One very interesting aspect of working at Metropolitan Veterinary Hospital is one of the member doctors is a big-time exotics vet and is the vet for the Akron zoo. What that means for me is we see all comers, whether that is dog, cat, bunny, ferrets, tortoises, etc. I also "get" to see wildlife to a certain extent. Technically, we're not supposed to treat owned wildlife, but we routinely receive "Good Samaritan" drop offs. In the past couple of weeks, we've had 10 or 11 "orphaned" baby bunnies (I put orphaned in quotes because they're not really orphaned, but momma wild rabbits don't sit on the nest like people think they do so people assume the babies have been abandoned), 3 wood peckers, a weasel, and a double crested cormorant (a big, blue bird that looks like a crane only with duck feet.) By far, though, the coolest wildlife has been the two raptors that have come in. We received a Peregrine falcon from the local police...he was found in a garage and seemed disoriented, but was fine, and a Barred Owl who sat in his cage and clicked at me everytime I walked by. Birds like that are unbelievably impressive up close and, although I didn't do much but get them checked in and call the exotics folks, it's cool to think that I was part of rehabbing them.

I wouldn't begin to pretend that I've become even marginally competent in treating exotics, but I'm slowly getting, at least, comfortable with examining them and having an idea of what needs to be done. Sadly, most of the exotics don't do well...generally, by the time a bird or other prey animal shows that it is sick, it is REALLY sick and there's not much that can be done. Occasionally, though, we make a difference and it is definitely a learning experience.

If nothing else, I enjoy walking through the exotics ward and checking out all the animals I wouldn't get to see otherwise.

Saturday, July 11, 2009

(Almost) 2 Weeks Down...

Wow. I knew the internship was going to be a lot of work but, by a rough estimation, I've spent 170 hours at the hospital over the past 13 days. The rotation I'm on now is called "DOD" or "Doctor on Days" or "Doctor on Duty" or something like that. What this entails is me being at the hospital at 7:45 am to round with the overnight intern on all the hospitalised cases then taking over care of those cases as well as seeing any emergencies that come in between 8 am and 8 pm (or so). Basically, my job is to keep an eye on the patients and notify the primary doctors' on the case if something goes awry. I also have to see patients and either treat and release them, or route them to the appropriate specialty service. This last part often becomes a game of hot potato for the services depending on how bad the case is and how annoying the owners are, with me in the middle playing the go between. Even more frustrating is when there are, essentially, no cases all day until 6 o'clock, then (like happened Thursday) a dog is admitted in status epilepticus with a 107.9 fever, and 10 minutes later a Lab puppy with a front limb de-gloving hit-by-car injury shows up 5 minutes before a hit-by-car Bichon with a large tissue defect wound on its right hip. On days like that, the 8 pm end time is mythical and I get home closer to 10 pm or 10:30 pm...just in time to throw food in the general direction of my mouth, collapse into bed, and start the whole thing over again.


What's even stranger than the schedule, though, is...I'm having a good time. I'm tired but, for the most part, I feel like I'm actually getting to participate in practicing medicine. I definitely still have "money cases" and whacko's to deal with, but at least 50% of the clients I see are willing to see a specialist and try to identify a problem, even if it is not a positive outcome. For example: Monday morning a 6 year old Rottweiler scheduled for bilateral total hip replacement later in the week came in unable to use it's rear legs. In general practice, I would have discussed a transfer to a neurologist, the owners would have declined, I would have given the dog steroids and euthanized it a few days later without knowing if anything could have been done. On this dog, the neurologist went over the exam with me and confirmed my findings, took the dog to MRI and I got to see the previously silent spinal tumor in the images. Still not a great outcome for the patient, admittedly, but the process of making decisions based on evidence gleaned from diagnostics was allowed to take place. How novel.


It helps, as well, that the vast majority of the specialists LOVE what they do. They are excited and enjoy working up the cases and helping you see it the way they do. I've yet to get the feeling that I'm annoying the surgeons or the internists when I bug them about a case I saw and admitted to their service. Maybe this is still all the "honeymoon" period with the new interns, but I'm hoping it stays this way...with maybe a few less hours, though.