Prime Time

Summer is always the busy time of year in veterinary medicine. Pets go outside more often and therefore get into trouble more often - snake bites, heat-related illnesses, plant foreign bodies like foxtails, cat fights, and so on. My appointments have been booked nearly full most days, which is great considering the other 2 (senior) doctors on duty get priority for appointment bookings.

I've met a lot of nice pets and nice people and am really enjoying this job (which is a relief considering the $106,000 in educational debt I still carry!) Yesterday is a good example of why I like general practice. I had a huge variety of cases such as:
- Annual exam and vaccine visit
- Inappetance
- Back pain
- Vomiting
- Eating dirt
- Euthanasia (very old pet with multiple chronic diseases)
- Foxtail in ear
- Snotty nose/upper respiratory infection
- Diarrhea

I know that probably doesn't sound exciting to a lot of people. I LIKE the "boring" visits where the pets are healthy and I can just chat with the owners and pet the dog or cat. It's gratifying to do a relatively simple procedure like removing a foxtail and watch the pet immediately feel relief. Although there are common themes the variety of things I see in any given day is great. I would be sooooo bored if I only saw GI cases all day, or cardiac, etc.

Who knows, maybe in 10 years I'll be totally sick of well pets and vomiting/diarrhea/itchy skin cases. If that's the case maybe I'll switch to emergency.

YC Fabulous

As it turns out my old lady cat has HCM (hypertrophic cardiomyopathy). It's mild, but it's enough to make her anesthetic risk WAY too high to perform an elective procedure like a dental. She's just about on life 9 1/2 at this point, I swear.

She came to our yard almost 8 1/2 years ago. It was pouring rain day after day and she huddled in the shrubs on the side of the house. She went into heat shortly thereafter and had many, um, suitors visit. I decided to trap her and get her spayed, and after that we started feeding her.* At one point she had a bad wound on the back of her neck but we couldn't catch her to get medical attention for her.
We named her Yard Cat, or YC.

Over the following months as summer came she would visit with our other cats through the screen door. Eventually we would crack the door and she would walk in - for a little while at first, then longer and longer. Around Thanksgiving time she decided to stay for good.


The first year or two we had a challenge catching her to take her in for exams and vaccines. Once she was diagnosed with chronic kidney disease she allowed us to pet her more - sometimes with both hands! At one point she developed Horner's syndrome from an unknown cause.









Then she was hospitalized when her kidney disease progressed. After that she required fluids every other day and she became even more friendly.


She's a great cat and I am dreading the day we will have to let her go.






*We believe in feeding stray cats as long as they are spayed or neutered - otherwise you end up with a cat population explosion!

Burned, Murph, and lots of neuters

Last week's surgeries went well. I performed 6 uncomplicated surgeries at the shelter on Tuesday morning and one uncomplicated spay on a fat 6-year-old dog at work on Wednesday! The one at work had me sweating quite a lot. When a dog is older and has a lot of fat in the abdomen it is very difficult to see important things like arteries. When you tighten your ligatures they disappear into the fat and it's disconcerting when you can't SEE your knots tighten nicely. Your gloves get covered with a slippery oily film so you have to keep wiping your hands on a towel. They have more vessels in the broad ligament you have to deal with. All in all it's a huge pain in the bee-hind.

Over the weekend we went to the Crossfit regionals. It was SO fun! Several of our coaches competed, and 2 of them are going to the Crossfit Games this summer, which is a big deal. Our region is a notoriously difficult one with a ton of good athletes so it's even more impressive. I ended up getting quite the sunburn while spectating, however. Should have applied another layer of sunscreen, I suppose.

Monday I had the day off and for Memorial Day we did a hero workout at Crossfit. This one was called "Murph":
1 mile run
100 pull-ups (I used an assistance band)
200 push-ups (I did them from the knees)
300 air squats
1 mile run
At the 40 minute mark they had us stop our pull-ups/push-ups/squats and go for the second run, so in 50 minutes I did:
1 mile run
95 pull-ups
190 push-ups
285 air squats
1 mile run
I'm a little bit sore today :)

Yesterday I went to the shelter again and lost count of how many kitten neuters I performed. We totaled 50 surgeries for the day, which is a record. They are trying to get as many surgeries as possible performed before this weekend because they are having a huge adoption event.

Fear

Last week I went back to the shelter again as a volunteer surgeon. It went well, except ... as I was closing my last spay a loop of the animal's small intestine popped up riiight as I threw a suture and my needle hit a mesenteric artery. It's a one-in-a-million thing (ok, maybe one-in-a-thousand?) but it freaked me the heck out. I pulled out that loop of intestine and applied pressure - fortunately the thing stopped bleeding and the intestine stayed nice and pink.

Now I'm scared about going in again this week. I KNOW it's not entirely rational. That doesn't matter. Every time I have a rather large issue like that it takes me several weeks to get back on the metaphorical horse.

I used to like surgery much more when I was still in school and not expected to do a good job at it.

In unrelated news, our group ski trip in February will be to Steamboat! I've already been ogling the trail maps.

Objectivity

Tomorrow I'm taking my old lady cat to the specialist. She is in desperate need of a dental (I'm talking black teeth here, people) but she has kidney disease and a heart murmur.

Let's see.
Kidney disease = you need lots of fluids to keep them hydrated
Heart murmur (heart disease) = don't fluid overload them because it's too hard on the heart

Basically the thought of her being anesthetized on my watch is too nerve-wracking so I'm sending her to a place with all the bells and whistles. The specialist is double boarded in dentistry and internal medicine, which is great. I'm actually nervous for the appointment tomorrow though! When it's one of our pets I have a much harder time being calm and objective.

Adding to the database

Veterinary school can only teach you so many things. You learn the basic pathophysiology behind diseases and how to treat them. However, you need a lot of clinical experience before you develop intuition - the art of practicing medicine.

To do this, you need to see case after case and keep mental notes for later. That's why a veterinarian who has been in practice for a long time may come up with differentials that don't (yet) occur to me. Yes, there is a danger of falling into a rut based on what you've seen before, so you need to be careful to not jump to a diagnosis too soon.

Right now I'm enjoying adding to my "file." Two recent cases in point:
- Young dog, started eating lots and lots of dirt recently. I recommended a fecal, which showed that the dog had Giardia (an intestinal parasite).
- Another young dog had partial hair loss that looked similar to Demodex (mite) cases I'd seen before, however a skin scrape showed no mites. Dr. Boss saw the case later and diagnosed bacterial infection based on impression smears - they said that they've seen short-haired dogs present like this and agreed that yes, at first glance it does look like Demodex. I'd never considered bacteria!

Spoiled

Last weekend I worked at a vaccine clinic. It made me extremely grateful for my current job!
Most of the clients were pretty nice, but several were just plain grumpy. I don't really see that anymore at my job. The assistants/techs were also nice but not very skilled at restraining pets. The techs at work, however, are rock stars.
This weekend I'm doing another vaccine clinic - hopefully it goes better this time, but I'm not holding my breath.