Thursday, October 15, 2009

Rotations #8, #9, #10, and #11

My, how time flies when you're getting married! I've fallen far behind in my rotation recaps. Hopefully this post will make up for it....

Rotation #8: SAM-B

Students on the small animal track take four rotations in Small Animal Medicine (SAM). The first SAM (SAM-A) is a chance for us to get oriented and learn the basics of how to approach a medicine case. Clinicians will usually ask us what we think the animal's problem is and how we would proceed with diagnostics and treatment, but they generally lead us along through our first cases. The next three SAMs (SAM-B's) are progressively more hands-off by our clinicians. We're expected to make more decisions about which diagnostic tests to run, which specific drugs and doses to use, and how to manage hospitalized patients. Obviously they'd never let us decide to run a test that would be a waste of money, or use a drug that isn't indicated, but the goal is to make us feel more like the primary doctor on the case rather than just an assistant. We're also expected to know more about pathophysiology (the reasons why a disease affects the body the way it does) and spend more time looking into current literature about diseases and treatments.

Thankfully, even though there are higher expectations, my first SAM-B felt easier than SAM-A. I think it was mainly because I didn't need to spend as much time figuring out logistics (like how to submit a blood sample), so I had more time to research each case. I also got more efficient at taking a history and doing a physical exam, which also helped to streamline things. My cases were in general less intensive than the patients I saw on SAM-A- I saw a lot more patients who were being managed for long-term diseases, like diabetes and hyperthyroidism, and fewer infectious diseases like blastomycosis or leptospirosis. It was a good rotation for working on my basic clinical skills and building a little confidence.

Rotation #9: Vacation!

My 9th rotation block was my second of two vacation blocks. We got married (yay!) and relaxed up in the Boundary Waters. My last break will be in late October, when I get a week off (since our Public Health rotation is only one week long)... then it'll be straight through until graduation. Yikes!

Rotation #10: Anesthesia

I've gotten a nice gradual introduction to anesthesia, starting with being the anesthetist for one dog in sophomore surgery lab, then for six dogs and cats in ESAS. The difference between those experiences and the anesthesia rotation is that my previous patients have all been relatively young and healthy. Under the supervision of our anesthesiologists, our rotation was all about getting comfortable with anesthesia of less-than-healthy animals- for me, it included a geriatric cat in renal failure and a ruptured eye, a dog with a large bleeding tumor on his tongue, and a cat with a heart murmur and several fractured teeth. For the first time, I had to handle situations like low blood pressure, slow heart rate, fast heart rate, waking up on the table (not during surgery, thank goodness!!), and monitoring a patient who's inside a CT machine (where you have to be across the room instead of right next to them).

Also, unlike our other anesthesia experiences, we got access to all sorts of fancy equipment- things like mechanical ventilators, end-tidal CO2 monitors, EKGs, and blood pressure monitors. We were also encouraged to try out anesthestic drugs and protocols that we'd never had experience with, so that we could get comfortable with how each drug and combination affects a patient. Our anesthesiologist is famous for letting us experiment, even if we choose drugs or doses that she knows won't be particularly effective (never putting the patient at risk of course- just leaving them awake enough to lead to phrases like "And then I removed the cat from her face.")... since we learn more from our mistakes than from being corrected. She'd never let us flounder, but she didn't mind watching us sweat a little while we tried to troubleshoot monitors, drugs, or catheters. Anesthesia was easily one of the most valuable rotations I've had yet!

Rotation #11: Ophthalmology

Eyeballs. Aside from derm, I can't think of any specialty that makes people go "Ewwww" more often. It's understandable, considering ophthalmologists have to deal with things like melting corneal ulcers or proptosed eyeballs (warning: links for the non-squeemish only!). But, it's hard to ignore the draw of a specialty that gets to bring eyesight back to animals blinded by cataracts. Most of what we did as students on the ophtho rotation were routine eye diagnostic tests, like measuring tear production or testing the pressure within the eye. We also learned how to do a proper fundic exam, which is an important skill for any general practitioner.

The best days, though, were the surgery days. We got to see our ophthalmologists perform goniovalve implants, which is one of the same procedures done to treat glaucoma in humans. Glaucoma occurs when the fluid produced inside the eye isn't able to drain out normally. The pressure in the eye increases, eventually causing pain and making the eye to go blind (remember Kirby Puckett?). A goniovalve is an implant that looks a little like a computer mouse. The "tail" is a tube that goes into the front chamber of the eye, and the "mouse" is a hole-filled plate that attaches outside the eyeball and allows the fluid from the front part of the eye to drain. It's not a permanent fix, since eventually it gets plugged with cells and protein, but it can buy months of pain relief and sight for an animal with glaucoma.

We also got to see a lip-to-lid resection, a form of plastic surgery for a dog with a tumor on one of his upper eyelids. The lid was removed and replaced with tissue from his upper lip (hence the name lip-to-lid). The lip tissue wasn't able to be attached to the muscles that normally make the eyelid blink, so the dog ended up with a bit of a droopy lid- but the alternative was removing the tumor, eyelid, and eye, so a droopy lid is a small price to pay.

Ophtho was a little light in the hands-on sort of learning, but a fun rotation to see what's possible for animals with eye disease. I still think eyeballs are kind of gross, though... ;)


Tomorrow is my last day of Oncology... hopefully I'll stay caught up on my rotation reviews!

1 comment:

Nick said...

Hi Megan,

I love the little dog photo on the SamB post.
Did you take the photo?
It's a great illustration anyway...

Be well,

dad-nick