Yep. Still hate internal medicine.

The other day I had a seemingly endless stream of patients with internal medicine problems. Here are some examples:

• A patient with previously diagnosed (and documented) hypothyroidism under treatment, previously diagnosed (but I couldn’t find ANY past lab work to support the diagnosis) Cushing’s disease under treatment, and historical ridiculously high liver values with diarrhea and inappetance. Hmm – if the dog is under treatment for Cushing’s disease and doesn’t really have Cushing’s disease, she could be Addisonian now. Commence freak-out.
• A patient with persistent diarrhea despite multiple work-ups and past therapies.
• A patient who developed lethargy, abdominal pain, and inappetance after starting NSAID therapy for osteoarthritis.

It takes me FOREVER to deal with these cases. My process goes something like this:

1. Panic. Remind myself that I got crappy grades on my internal medicine rotations and that it’s a subject that I just can’t seem to “get.”
2. Scour the patient’s medical record.
3. Curse the previous doctors who didn’t document drug doses, lab tests, or much of anything on the case.
4. Look things up in my Clinical Veterinary Advisor.
5. Look things up on VIN.
6. Make up a treatment plan of some sort.
7. Talk to the clients and try to seem confident.

I can usually cobble together something that makes sense – it just takes about 3 times longer than any other case I see (ophtho, derm, heck – even surgeries!)