Thanksgiving.

So Dr. Gray was really nice and let us split up coming in over the Thanksgiving holiday. I only had to go in Friday to do 8am and 2pm treatments. My sister came into town. She drove from Charleston on Wednesday and we had a nice time. We saw a couple of movies, hung out, I gave her a tour of the vet hospital, and through it all we didn't really fight. We had Thanksgiving dinner with my synagogues cantor and his wife and their two sons. It was a great night. The food was awesome, we had good conversation and my sister got to talk to their son about doing Teach for America. It was nice having a good visit with my sister. We used to never get along and the thought of us hanging out for 3 days was unthinkable. We've come a long way. Well, I've come a long way at least. She is still hard to deal with sometimes but I was able to let go of my pride and let things slide off my back. Who knew I was capable of such things? It was also a nice break from the vet school thing. Having her around meant I had someone to talk to about different things like what's going on in the world, family, movies, whatever. It was a great visit and I'm glad she came.

Slowest rotation ever.

Large animal surgery has officially started and it is slow. Painfully slow. We found out on the first day that our attending clinician just decided to not come in for the first two days. That means we can't do surgery this week. Not much of a point to being on a surgery rotation and not be able to do surgery. At least my team is great. I'm on a team with two girls who are are really chill and drama free. The other team is a compilation of the most annoying students from my class. Ugh. I would have shot myself if I was on that team. I'm friends with Heather but her know-it-all attitude really drives me nuts. After my LA medicine experience with her I don't think I'll be able to work with her again. So my team and I have spent the first couple of days just trying to keep ourselves from going crazy with boredom. Our resident, Dr. Gray, is nice enough. She moves a lot slower than the other residents so it takes forever to get anything done. But all in all we have a good team.

We do have a couple of inpatients. I have a mare named Stop Whining who had a failed laryngeoplasty and now has a draining tract. They had to remove the sutures and now she is useless as a racehorse. Poor girl, she's just going to be a broodmare now. Now that her tracheostomy tube is out she's going to go home to heal up and then thrown out in a field to have babies for the rest of her life. I also had an emergency come in today, a horse named Cracker. We were told that Cracker ran into a car but after talking to the owner it seems she found him in the field with his injury. He had an open wound just distal to his stifle. The middle patellar ligament was torn and flapping in the wind and there was a piece of bone floating around that we discovered was his tibial crest. Kind of an important insertion point for some muscles, like, oh I don't know, the biceps femoris for one. Yeah, not so good. We took out the dead bone and sewed his leg back up then prayed. The best part of the story was that the owner had another piece of bone that she found on the car (we can only assume there was a car in the field that he ran into . . . go figure) and wanted to know if we needed it. Umm, not so much.

So hopefully we'll get some cooler surgeries and the rotation will pick up. My sister is coming into town for Thanksgiving, should be interesting.

Ahhh, the joys of Movember.

Yes thats right. I said Movember. You see, something strange has taken over the small animal hospital. The sweet aroma of mustaches is in the air. The romantic tingle of facial hair has captured all of us. This year some of the surgery residents and clinicians, along with several students, techs and several people from other departments has taken up Movember. A month long celebration of the mustache in an effort to raise money for prostate cancer awareness. The men started the month of November clean shaven and at the end of the month they need to have a full blown mustache. People are asked to donate money to their favorite Mustache Man and whoever raises the most money is the winner. This has led to some strange facial hair. Dr. Coomes has a nice handlebar mustache, Phil has a moderate Fu Manchu, Dr. Black has . . . well no one can really define his mustache. The creativity some of the guys are showing is amazing. I will have to post pictures at the end of the month. The best part is that all of these guys are seeing clients while looking absolutely ridiculous. It is awesome.

Neuro has come and gone. Lulu finally went home today. Even though I am now on large animal surgery I went up to meet her owners and say good-bye. Her owners were so grateful for all that I had done that they almost cried when they met me. They tried to convince me to stay in Florida and work for their son (who is a vet) when I graduate. They even bought me Angel perfume for being their own angel. Lulu is doing great. I think she'll be up and walking in a month or so. I'll miss her though, she was a great dog and I got really attached to her.

The last week in neuro was interesting. We had Captain Satellite. No really, that's what's printed on his name badge. He's out there. Way out there. Half of what comes out of his mouth makes no sense. This man taught one of our classes freshman year dressed in a pink bunny suit. Sounds like a cool guy to work with, right? Not so much. He was argumentative, rude, and just an all-around annoyance. He called one of my classmates a scum-sucking loser. Not in a serious way but it wasn't funny either. Not that that particular student was on my good side this rotation (he acted like he didn't even want to be in vet school), but still, he's not scum-sucking. I did have my first back dog though. Charlie. Charlie was this fat dachsund with a ruptured disc at T11-T12. The surgery was awesome. We took so much disc material from the spinal canal. It was like pulling out loads of cheese. Then the resident let me close completely, all the layers! It was so cool!

Speaking of cool. I can't forget to mention the heartworm removal I got to see last week. Cardio pulled 27 heartworms out of this dog through the jugular vein. It was quite possibly the best thing I have ever seen.

Its a weiner wonderland.

I've just spent the past week in the neurology lab. No, it wasn't to evaluate my head, or my cat's (who I'm pretty sure thinks he is a Labrador puppy). I'm actually really enjoying this rotation. Of course, it helps that one of our attending clinicians is hot, has an awesome sense of humor, is fun to hang out with and is super nice. Did I mention that he was hot? I've actually been learning quite a lot and having fun doing it. Oddly enough we've only seen one wiener dog with a ruptured disc this week. Its been incredibly slow.

Well, sort of.

See, the first day I volunteered to take Lulu as my case. Lulu was a mess. Lulu is still a mess. And there is next to nothing we can do for her. See, Lulu came in for hind-end weakness. Some sort of spinal problem right? Not so much. She had already been started on steroids to no avail. An MRI showed increased contrast uptake in the muscles around both hip joints. Odd. She was started on antibiotics to treat for any possible infectious cause of myositis. It would have been all well and good, well, if she would have responded to treatment. They took muscle biopsies from the biceps femoris which just came back as atrophy (which was of course from the near immuno-suppressive doses of steroids she was on). So another MRI was taken. This time the inflammation in the muscles around the hip joints was even worse. The odd thing was that it was uniformly bilateral and only really affecting certain muscles. Over the next few days we managed to rule out every cause of focal myositis that we could think of. Infectious . . . no, titers came back negative. Autoimmune . . . no, there was no response to high steroid doses with azothioprine. Neoplasia . . . maybe, but doubtful because it was so uniformly bilateral. Metabolic disease . . . no, she was too old (3 years) to start showing signs and the rest of her body was unaffected. Then we went in surgically to take specific biopsies of the affected muscles. After waiting for days we finally got our answer.

Lipid storage myopathy.

So we were wrong. Very wrong. It was a metabolic disease. One which has only been documented in 25 dogs. Ever.

And now here's the problem. She has no muscle mass left from being recumbent and on high doses of steroids. She is still incredibly painful. And, worst of all, there is no definitive treatment for this disease. We're not even sure what causes it. All that's in the literature is supplementation with riboflavin, co-enzyme Q10, and l-carnatine. And even that is questionable since its been so rarely documented. So now we have Lulu on a crash course of steroid weaning (since they're probably worsening the problem) and we're praying and hoping she doesn't go into an Addisonian crisis. Maybe, just maybe, if we can get her through this she might be able to make it. But who knows. We're not sure if any case of this has even been successfully treated. Its just a waiting game now.

Lulu is a great dog. She is a sweetie and a real trooper. I've gotten rather attached to her and I don't know how I'll handle things if it looks like she's not going to make it. Its hard enough when you can treat a disease and owners choose not to, but when even the best you can do may not be good enough, well, to me that's even worse. She doesn't deserve this. She deserves a cure and a happy healthy life. But no matter how hard we try our medicine will not be good enough. All we can do is wait. And pray.

I'm not completely sure what happened this past month.

Wait a second, I seem to remember there being a month called October somewhere in there. Where did it go? Oh right, I was on small animal medicine. Seriously though, I have no idea what happened to this last month of my life. It just flew by. Medicine was probably one of the cooler rotations I've been on. They actually force you to think like a doctor and make you come up with diagnostic and treatment plans and then defend them. The first two weeks were incredibly rough, I felt like I was always at the edge of cliff and if it wasn't for my books I would go tumbling down into the oblivion. Then I got my mid-rotation review and guess what, they liked me. They thought I was doing a good job. Amazing. That gave me the confidence boost I needed and the last two weeks went great. I felt like I knew what I was doing (at least a little bit anyway) and, even better, I felt as if I was getting respect from the clinicians and residents. It was amazing. I barely slept and I only came home to eat and pass out, but despite that I think I'm going to miss it. I feel like this was the rotation that was going to make or break me and it sure as hell didn't break me. That's a good feeling.

The social dynamics were interesting. I managed to spend a whole month with Glen and not flip out on him. His true colors came out the last day though when he case-dodged and pissed the hell out of Dr. McCarthy. He felt that him going to the city this weekend was more important than taking a case even though it was his turn to take one. Whatever. I managed to deal okay with James and Kimmi being all buddy-buddy. I think I'm jealous of Kimmi because she is getting his attention now even though I don't like him anymore. Boys are stupid. I developed a little crush on Goodwin this month, even though he's leaving soon, he's not Jewish and he apparently has a crush on my old roommate. Again, boys are stupid. Dr. Lemming managed to only piss me off once by yelling at me for no reason. That was exciting. Dr. Slick had a big Halloween party and I went as Dorothy and had a really awesome time. SCAVMA prom also happened while we were on medicine and that was interesting. Kimmi got so sick because she was determined to get wasted and drink away her sorrows of breaking up with her boyfriend of 7 years. Not a good idea. I ended up taking care of her. After washing her up and getting her in bed I stayed at her place so that she would be able to get to school to take care of her in-patients the next morning. Poor Kimmi, she's still obsessed with Damien and he's nothing but a giant asshole. All in all a lot of fun was had on this rotation.

Some pretty cool cases came my way too. Mad Max was one of my favorites. Just another everyday case of ideopathic immune-mediated hemolytic anemia but this little dog was so cool. He was this little dachsund/jack russell cross and he couldn't have been cuter. His mom was a sweet heart too. She just wanted little Max to get better and she was willing to anything as long as it was within reason (which is why I liked her so much). Mad Max did eventually start to get some red blood cells back and he's doing a lot better. It was pretty rewarding and made me feel good to help out such a happy pair.

My last case though was not so happy. Probably one of the most interesting things I'll see in my entire life though. Timon is an Alaskan Malamute who came in for evaluation of swelling of the nose and between the eyes. Well, when he came in this is what I saw:
Well, needless to say, this was not normal. At first I thought, 'how could these people let this get like this?' But then I heard the whole story. The whole thing started a year and a half ago as just some green lacrimal discharge from the right eye and a small swelling. As soon as they saw something wasn't right they took Timon to the vet and started trying to figure out what was going on. They did everything: cultures, biopsies, antibiotics, steroids, even NSAIDs. They even went to a specialty practice which told them it was a tooth root abscess and they pulled 2 premolars. Well up until about 3 months ago the swelling stayed relatively small and then all of a sudden it grew into the elephant nose that I was seeing. This poor dog was a mess. We immediately knew we had to get a CT and biopsy the shit out of it. Once we saw the CT we knew this was bad. He no longer has any bone on the right side of his face. Both of his nasal cavities are completely occluded. There is an oral mass (which when we biopsied it popped like a zit only it wasn't pus that came out, it was necrotic tissue). And we could see why it was so hard to get a good biopsy/culture sample. It had tons of pockets of necrosis and fluid. Luckily we were able to do a CT-guided biopsy that will hopefully give us the answer. Right now we are banking on cancer. And unfortunately, due to the location and size of the mass and the fact that he has very little bone left, this may not be treatable. At most we'll probably be able to give him a few more comfortable months. Its such a tragedy. All the right things were done but the nature of the disease prevented a diagnosis. Myself and Dr. McCarthy were beyond frustrated.

Actually, I seemed to be the Nose Queen this rotation. I had 3 nasal cases including Timon. The other two were both chronic unilateral nasal discharge, woo hoo! One of them turned out to Aspergillus (fun good times) the other one we're still waiting on tests but my money is on fungal or chronic foreign body. Sill long-nosed breeds sticking their noses where they don't belong!

My final review was awesome. The doctors said they had a really good time working with me. They thought my knowledge level was good for where I am in the program. They also thought I was very enthusiastic and liked that I jumped on taking cases. Overall they think I am doing great and I should be getting ready to be my own vet. A very scary concept.