Monday, March 22, 2010

Rotations #20, #21, and #22

My fourth year is chugging along, and I suddenly only have a handful of rotations left! Here are my summaries of the past few rotations...

Rotation #20: Small Animal Surgery

I had my second (of two) SAS rotations just two blocks after my first SAS. One of the surgeons asked me how I felt about my second Surgery, and I said I was "doing a lot less pointless running around, and a lot more useful running around." The rotation was still demanding, but at least I had a better idea of what I was responsible for. I improved my orthopedic exam skills a lot, and finally palpated my first cranial drawer (an abnormal physical exam finding associated with a ruptured cranial cruciate ligament, the canine equivalent of a torn ACL). We got to see a few interesting cases, like a string of brachycephalic (short-nosed) dogs who needed their soft palates shortened to help improve their breathing, a naughty Goldendoodle who ate a rock that got stuck in his intestines, and a dog who was romping around his backyard and sliced through a tendon on his wrist when he slipped on a sharp piece of ice.

I did learn a lot on my SAS rotations, even though I likely won't be doing most of the more advanced surgeries personally... It's nice to have an idea of what surgeons are capable of doing and what's involved in the aftercare, since that's what I'll need to know to be able to advise clients in the future. That said, I can't say I'll miss the 6 AM to 8 PM treatment duties, writing up surgery reports, or getting called in at 1 AM on a Sunday for emergency surgery!!

Rotation #21: Cardiology

It's not hard to see how people fall in love with cardiology. Sitting in a dark room, watching an echocardiogram (ultrasound of the heart) display the intricate cycle of contract and relax, or watching the electrical impulses of the heart tick by on an electrocardiogram (ECG or EKG) is mesmerizing. It's even more amazing to give a drug and watch those rhythms change, or put in a device to occlude an abnormal shunt and watch the blood flow shift from turbulent to smooth. Cardiology sees a lot of pediatrics and geriatrics- babies with congenital abnormalities and seniors with congestive heart failure or other chronic degenerative heart disease. Some of the congenital cardiac diseases are really rewarding to treat because they can pretty much be fixed and the animal goes on to live a normal life. Patent Ductus Arteriosus (PDA) is a good example. A PDA is a defect in which the ductus arteriosus, a normal fetal vessel that shunts blood around the lungs, fails to close at birth. This results in abnormal blood flow through the heart and, left untreated, progresses to heart failure within the first year or two of life. At the U of MN, a device called an Amplatz Canine Duct Occluder (ACDO) was developed to allow minimally-invasive surgical correction of PDAs. One of the cardiology residents even helped to develop an ACDO that is small enough for patients under 3 kg (which many PDA patients are, as small breed dogs are predisposed to PDAs). With ACDO occlusion, PDA puppies grow up to be normal active adult dogs.

Other congenital defects aren't so fun- subaortic stenosis (SAS) is a disease seen in larger breeds like Golden retrievers. This is a condition in which there is an abnormal narrowing near the aortic valve, which causes the heart to pump harder than normal to push blood out into the aorta. Dogs with severe SAS can develop heart failure at a young age, whereas dogs with mild or moderate SAS can be asymptomatic for months or years. The sad thing about SAS is that we can't do much about it other than manage the congestive heart failure associated with it. Owners of dogs with SAS have to be prepared to face complications of the disease, which include the possibility of sudden death. No fun at all.

I learned a lot on this rotation about the most common heart diseases and how to manage them, and also developed a strong appreciation for veterinary cardiologists- I'm glad someone out there is brave enough to do heart surgery!!

Rotation #22: Externship!

I spent the end of February on externship at a local integrative medicine practice. I loved loved loved it- after all the complex diseases, awful fractures, poor prognoses, and zebra diagnoses that we see at the U of MN, it was so nice to see patients presenting for annual checkups and vaccinations. I got to neuter my first client-owned animals (and spent about 24 hours post-surgery worrying that things would go bad, until calling the owners and finding out that the dogs were recovering just fine). The techs at the clinic referred to me as "Dr. Schommer", which was both awesome and terrifying. It made me really excited to get out into practice! (note regarding the photo: despite popular opinion, vets really don't get to snuggle with puppies all day... but we do go a little crazy for puppies when we get to see them :) )

Rotation #23: SAM-B

This Medicine rotation was the fourth and final Medicine for all of the students on the rotation block. We all thought that maybe we'd feel a little smarter than we did on our first Medicine, and I'm sure we all were... But, Medicine being what it is, we still all ended up with patients who threw us for a loop. We saw animals with multiple concurrent disorders (diabetes and Cushings disease, hyperthyroidism and GI lymphoma, congestive heart failure and chronic renal failure). We saw animals that presented with one problem and got diagnosed with something completely different (like a dog with regurgitation due to a supposed esophageal stricture, except that he actually had a huge foreign body in his stomach). And then we had animals with diseases that should have been really serious go trotting out of the hospital the day after admission, and animals that had diseases that are usually self-limiting die due to really rare complications. I guess the theme of this SAM block was to keep any of us from getting too cocky or confident, and remind us that there's a reason they call it "medical practice" and not "medical perfect".

Next I'm on to Dentistry, then General Practice, then Companion Birds, then graduation!!

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