Sunday, July 26, 2009

Rotation #6: SAM-A

My last rotation block was actually a vacation (which we still need to blog about too!). We spent half of it up north, and half out in Seattle. I got to attend two days of the AVMA national convention, which was gigantic and awesome and a little overwhelming. We got back Sunday night at midnight, and at 8 AM Monday morning, I was at school for my first day of Small Animal Medicine (SAM). Small animal track students have to take four rotation blocks in SAM. The first one is called SAM-A, where they give us a little more leeway in terms of how efficient we are, how thoroughly we take histories and physical exams, and how well we know our way around the hospital. The other three are called SAM-B, and the standards are higher for SAM-B students.

The Internal Medicine and the Surgery services see the bulk of patients that come into the teaching hospital. In a nutshell, if an animal's problem can be fixed surgically, it goes to see the Surgery department. If it's a nonsurgical issue that doesn't fit into some other specialty (like Cardiology, Dermatology, or Ophthalmology), it goes to the Internal Medicine department. Over the past two weeks, I worked with patients who had:

-Anaplasmosis, a tick-borne disease that infects white blood cells. The hallmarks of anaplasmosis are low platelets and a really high fever. These dogs can come in really sick and need hospitalization, but thankfully the treatment is a widely available, inexpensive antibiotic. Lots of people know that ticks carry Lyme disease, but Anaplasma is another nasty disease that can be prevented with good tick control (i.e. topical spot-on products like Frontline).

-Leptospirosis, a bacterium that is spread through urine. Most dogs get exposed by drinking water contaminated by wildlife that were infected with lepto. Lepto causes liver disease and renal failure. Dogs who make it through the initial infection but are never treated can become lifelong carriers and shedders of lepto. Lepto is a zoonotic disease (you can catch it from your pet), so careful handling and thorough treatment are important.

-Blastomycosis, a fungal disease endemic to Minnesota, Wisconsin, and the Mississippi and Ohio River Valleys. Both humans and dogs can be infected with Blasto, but dogs are about ten times more likely than humans to get infected (likely because the spores are in the soil, and dogs are about ten times more likely than humans to be snuffling around in the dirt). Blasto can infect the lungs, skin, bones, joints, eyes, brain, and just about anything else in the body. Many dogs diagnosed with blasto don't survive long enough to make it out of the hospital. Of those that do, their owners have to be willing to take on a long-term committment to very expensive therapy with an anti-fungal called itraconazole. For a large dog, itraconazole can cost $400-$500 a month, and therapy can last over a year. Blasto is evil.

-a puppy with more congential defects than I've ever seen in one animal. She had open fontanelles (her skull never closed completely), hydrocephalus (excess fluid in the brain), retained baby teeth, luxating patellas (the kneecaps slip out of place), and congenital hypothyroidism. About the only thing she didn't have was a heart murmur. There is no way to fix most of her problems. It was a good reminder that, no matter how cute that puppy in the window is, please don't buy a pet store puppy.

-diarrhea and vomiting. These two problems are truely the bread-and-butter of veterinary medicine, partly because they are uncomfortable for the pet but mostly because they are really inconvenient for pet owners. The list of what can cause diarrhea and vomiting is ridiculously wrong, from something as benign as eating a bag of potato chips to more serious problems like Exocrine Pancreatic Insufficiency or a Inflammatory Bowel Disease.

-cancer. I saw lots and lots of cancer. Dogs and cats can get all the same types of cancers that we can get (including those associated with smoking, if they live in a house with an owner who smokes). Often, cancer in pets starts with really non-specific signs like diarrhea or weight loss, so they come to see the Internal Medicine service. Oftentimes, an abdominal ultrasound is all we need to do to find a large mass somewhere in the abdomen. Some owners opt for more thorough imaging like a CT scan or MRI. If an animal has a single mass, we might send them over to surgery to have it removed. If there are multiple masses or if the mass is in a location where it can't be surgically removed, they visit with the oncology department to talk about options such as chemotherapy or radiation therapy. In animals, our goal with cancer treatment is never complete remission as it is in humans. The goal in veterinary oncology is to prolong quality of life rather than to extend quantity of life, so we generally use lower doses of chemotherapeutic drugs than is used for humans. Humane euthanasia is also often a very kind and reasonable choice for an animal with cancer.

All in all, SAM-A was a challenging but educational rotation. There were a lot of sad diagnoses, but less euthanasia and more happy endings than I saw in my emergency and critical care rotation. Next up, Dermatology!

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