Thursday, November 15, 2007

can you say hemilaminectomy?

today was my 2nd day in the neuro ward. it was a longish day, starting at 6:45 and ending at around 6:00p. i got to see 2 surgeries today - a dorsal laminectomy and a hemilaminectomy. i hope i'm spelling those right! these surgeries exist to treat herniated discs in what we like to call 'back dogs.' back dogs are dogs that become paraplegic, quadriplegic, ataxic, or otherwise severely incoordinated in their limbs due to a neurological problem. it usually happens because the little 'disc' inside the vertebrae starts to bulge out of its snug little spot and press upwards on the spinal cord. this causes pain and pressure, as well as a loss of function. so - a laminectomy is when the surgeon goes into the back from above, cuts open everything, exposing the vertebral spines. they then cut a little window into the bone (in a hemi, this is done on one half the vertebrae, in a dorsal -the window penetrates both sides of the vertebrae) and pull the disc out. this fixes the pressure - effectively decompressing the nerves.

i observed both a dorsal and a hemi today. the dorsal went as expected. the hemi was much more exciting. the doctor opened up the dog, cauterized vessels, etc - and got to the offending vertebrae. BUT - there was no bulging disc. instead - there was a purplish streak ascending the spinal cord, under the dura mater (protective covering of spinal cord). this was utterly baffling to the resident surgeon, as well as the surgeon on staff. ther were many hmmms...and ahhhs...and ... WTFs? they then performed a durotomy, which is opening up the dura. the purple material was removed and sent off to pathology. at this point, they (i should capitalize the they) suspect either trauma leading to a hematoma or a mass of some sort. apparently the dog tried to fly from the front porch- and failed. it was really neat to watch (the surgery, not the dog flying off the porch). i was also relatively useless. the only function i served was to run out of the surgery suite looking for vet techs to retrieve important instruments - like the oddly named Gelpi. the other thing i did was push the doctor's magnifying/microscope lenses back up everytime they slid down his nose. he was in a rush and forgot to screw the thing on tight. i almost offered to get the screwdriver and do it myself - but when the words "i can screw" almost came out of my mouth, i recanted of the notion. probably a good thing.

standing for 2-3 hours is hard on the knees and legs. i'm always amazed by surgeons and the stamina it takes to do these kinds of things. the technology at school seemed impressive to me as well - but then - i have no real exposure to this sort of thing. i do know that i saw 2 surgeries today, both costing the owners in excess of $2500. and these are fairly common at school.

i feel like i asked too many questions today though. i was extremely inquisitive. i feel - on the one hand - that it was annoying. but on the other hand i figure - i'm paying a lot to get this DVM/education. i sure as hell better be able to ask questions. i feel like i'm learning a lot in some ways. i also feel like a big fat nuisance that's in the way of all the 4th years, residents, and attendings. it's making me feel excited about being a 4th year - and less apprehensive about it then i thought. but interacting with so many people all day is also making me slightly neurotic about my personality, mannerisms, and social skills. i'll either have to just get over that or start medicating myself. does everyone have this kind of social anxiety? or only freaks like me?

my vocabulary seems to be degenerating. i used the word feel in that paragraph 4 times. as if vet school is making me more feel-y. i feel things very deeply. yes...

i question everything i say, every joke i make, every facial expression. and i know that's excessive. i realized that i asked some things i shouldn't have today - but that's good, because i won't ask them tomorrow. but it seems that i'm more prone to making verbal mistakes than most. why couldn't i have just kept my mouth shut in the first place? i feel like god should have given me a verbal delay so that my brain has time to think it through before my mouth falls open and a question plops out (did i use the word FEEL again?) ahh, the neuroses.

my final grade in anesthesiology was a B+.

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