Thursday, May 3, 2007

what i've learned in 2 weeks

as my first 2 week rotation draws to an end, i'd like to take this moment to reflect on what small store of knowledge i've accumulated in that time. so here are my thoughts on the ophthalmology rotation:

1) eyes rock!

2) a properly prepared vet student should ALWAYS have the following on hand at any given moment:
-a pencil - because for SOME reason, clin path likes the order numbers for cytologies written on the slides with pencil only - everybody else looks at you like you're crazy for owning one
-a ball point pen - because you're writing crap down constantly
-a Sharpie - for all those blood tubes for which a pencil OR pen won't suffice
-a calculator for quick drug calculations
-a small reference card with all drug information written on it so that you're actually capable of calculating said drugs
-the small animal nerdbook - which while small - is surprisingly heavy - and if not properly counterbalanced will cause a definite tilt toward the side of the pocket where it is located
-a hemostat, because you just never know when you're going to need to pinch an animal's toes (for deep pain perception, not because pinching animal toes is particularly amusing)
-a leash - or two - which are worth more at the vet school than a million dollars - lay one down, and you will NEVER see it again. EVER. and if you do - around another vet student's neck, you'd better have DNA evidence to prove it was once yours
-a stethoscope - for taking rectal temperatures. doh. i'd hope you'd know what a stethoscope was for without me telling you
-bandage scissors - because what good hospital doesn't bandage it's patients? getting an eye exam? here - have a bandage! and somebody has to cut those bad boys off!
-post-it notes to stick all over everything, including your forehead so that you don't forget the 15,941 things you have to do in the next hour and a half before fluffy's owner shows up 3 hours early to take fluffy home
-your picture vet ID and your student ID so that you don't find yourself on emergency duty at 10pm, banging on the door leading to the courtyard, hoping desperately someone hears you and you DON'T have to scale the chain link fence, walk through the construction site (of the new vet school addition), and climb the other chain link fence to again reach humanity (or alternately, sleep outside for the night until the doors unlock at 7am)
-the mental fortitude of a triathlete. because - my god - you'll be in one treatment area with 15 other vet students, 7 vet techs, 2 vet assistants, 8 doctors, and 43 animal - all exhibiting some sort of neurological and/or dermatological and/or ophthalmological and/or critical emergency type problem (and i'm not just referring to the animals here). and god help you if you can't a) move fast b) think fast and c) locate things when you had no prior knowledge of either their existence or whereabouts. as in 'yes dr vick, i know exactly what an Oppenheimer-Weizelsteffen micrometer is - and i'll get it right to you' - and finally, do all
this with a smile so that you don't piss of a) your classmates b) the techs c) the doctors d) the techs e) the techs f) the techs - and of course, you have to do it while the building shakes because these last few weeks have been the weeks during which pile driving of huge, 100 foot foundation spikes are being driven into the ground, a mere 13 feet from the hospital and further, these weeks have been marked by 2 power outages - one lasting 7 hours (how exactly do we run a hospital without central power? you'd be surprised - you don't really need much light for ophtho exams).

SOOOO. anyway. it's been a great rotation, in all seriousness. and in all seriousness, i do carry all of that stuff with me everywhere i go. i think if i were to weigh myself, i'd be at least 5 lbs heavier with all my gear. it's pretty funny. especially seeing myself in the mirror.

3) i DO NOT like being the 'low-man' on the totem pole, so to speak. the outgoing 4th years (tomorrow is their last day) are still with us currently, helping us adjust to the clinics and learn how to do paperwork. and we have 3 especially nice 4th years with us - who obviously know more than we do about everything - and yet, i have a huge chip on my shoulder about anyone trying to tell me anything. i tend to get short and snippy when i feel like someone is explaining something to me that i already know how to do or find. and it's a really unattractive character trait. even though tomorrow is their last day, i'm going to try really hard to keep that chip hidden for the day. i really don't like it about myself.

4) i feel really comfortable in clinics - but that might change with rotations.
so my week - overall - was fairly interesting. i had 3 great cases, one very sad, one interesting and mystifying (i had a bunch of other cases, too - but none hospitalized - and more run of the mill cataracts and glaucomas and ulcers 0h my!).

on tuesday, we saw a jack russell terrier - 10 years old. his owner complained that he'd had a sudden onset of cloudiness and redness in his right eye. he came in on emergency, and i stayed to help dr m deal with it. interestingly enough, it was another anterior lens luxation -in which the lens in the eye comes forward and hangs out under the cornea. this lens had a mild cataract, so it was much more obvious than smoky's (see previous post). what made this case interesting is that first, the JRT was 10 years old. this is an inherited problem in these dogs, and they often have lens luxations. however, it's typically at a young age - and this dog was pretty old for it. but what made it really exciting was that the owner elected to have surgery to remove the lens. however, when we went to prep the dog the morning - we found a curious thing. the lens was gone from the front of the eye. when we looked in with a transilluminator, it became apparent that the lens had fallen back into the posterior segment of the eye. it wasn't "fixed" - it was just in a different location -one not amenable to surgery. we were quite surprised, as this is a little unusual (though not unheard of). we could see the lens moving around back there. it was pretty nifty to see. it's not the greatest thing, as its presence in the back of the eye could lead to retinal detachment, so the owner is watching the eye and is prepared to come back at a moment's notice so that we can constrict the pupil - in an attempt to keep the lens forward - and do surgery.

my next case that stayed in the hospital was really sad. we saw a young black lab (4.5 years old). he was massively fat and had difficulty breathing because of his weight. but no matter, that's fixable, right? when i did my eye exam on him, i saw a disease called anterior uveitis. this is a really impressive eye disease to see because it can make the eye really pretty and visually appealing. however, it is almost always indicative of systemic disease. around here, blastomycosis (a fungal infection dogs get by inhaling spores) is a known culprit. we were fairly confident that in a dog this age with the signalment (mild fever, feeling ok otherwise, anterior uveitis) that blasto would be our underlying cause. the dog was very sweet natured, but he did NOT like having his eye examined. AU is really painful - it's basically inflammation of 2 structures deep in the eye - called the ciliary body and the iris. all kinds of secondary changes occur in the eye, including something with the flashy name of iris bombe (pronounced bombay) - in which the lens and the iris stick together, making the pupil all funky looking. (See the picture). one of our first diagnostics was chest xrays, as these can locate fungal granulomas - since blasto likes to hang out in the eye and lungs. xrays obviously can find lung metastatic cancer too. but we expected blasto. we also aspirated the two GIANT prescapular lymph nodes that dr m found on palpation (that i missed because the dog was a spaz). guess what this sweet, only 4 year old black lab had? yeah. no blasto. cancer. everywhere. not only was it cancer, but the cytology on those lymph nodes came back saying that it was some kind of crazy cancer that the cytologist, who has been a cytologist for 30 years, did not recognize. they said it much more medical jargon-y than that, but that was the gist...

so that blew. a 4.5 year old dog.

my other case was ANOTHER lab with AU. but i'll fill you in on that one later.... right now, i have to study. as usual.

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