I passed!!!

Let us all now gather and dance a dance of joy!

Haha, seriously though, I passed the NAVLE. I found out a couple of weeks ago while on my internal medicine rotation. What a relief! Now all I have to do is get through the next few months of clinics and I'll be a real doctor once and for all!

The last few months have been very hectic for me both in my personal and professional life, hence the non-posting. I did get to spend quite a bit of time with my family over the holiday break, which was nice. Well, except for the giant fight we all got in before we even were in the same house together. But thats how my family rolls, we fight and yell but in that really loving sort of way. I also got to see my grandparents which was especially nice. My grandfather is not doing so great and we all are wondering how long it will be until something happens. I will say though, for a man who has two hip replacements, a pacemaker, lumbosacral disease, and blue legs (yes, you heard me, they're actually blue), he's doing pretty well.

My first rotation back on clinics was Orthopedic Surgery with a clinician who is notorious for keeping an insane schedule. On our busiest day (which was not much busier than a regular day) we saw 19 appointments between 9:30am and 12:30pm, 13 of which were new patient evaluations. That day I saw 5 evaluations, 4 of which ended up staying for surgery over the next two days. Yeah, I had 4 inpatients at once. Insane. Over those two weeks I had 8 surgeries that were mine, plus I scrubbed into several more that they needed help on. That's unheard of on this rotation. It was so much fun though. I love being busy and moving fast and I perform best when things are crazy. Plus I had an awesome team, Jimmy and Laura were so much fun and really on top of their game. Oh yeah, there were only 3 of us, no joke. I got to drill some stuff and I was even allowed to do the lateral imbrication on a medial patellar luxation repair. That was pretty neat since most of the time on Ortho you're not allowed to do anything. It was pretty sweet.

I moved onto vacation next. I took this time to travel up to the D.C. region to interview at some hospitals. It went well but I still don't know where I'm going and truthfully the whole story is a topic for another post. I'll just leave it at that for now.

As soon as I got back from interviewing I went straight to NAVC. As usual it was awesome. I stayed with a couple of girls from my class at a hotel provided by our SCAVMA. Apparently I've picked up some new sleep habits. I was sharing a bed with Gretchen and at one point I sat straight up in bed, yelled "I'll lick your face!", and then went back to sleep. I also got up and turned all the lights on at some point in the evening. The next night I got up and tried to get into bed with the other two girls in the room. I woke up as I was doing this and was totally freaked out. My nighttime antics have now become a running joke.

The conference itself was good though. I got to go to some good talks, saw my friend Stic, and had a great time at the evening activities. One of our soft tissue surgeons made me slap him in the face at our alumni reception. He made fun of me then told me he was bad and grabbed my hand to slap him in the face. It was weird. But hilarious.

Murray and Lexy stayed with my parents through most of January. And of course my mother left tons of stuff out for Murray to eat. He destroyed a sweater, sweatshirt, towel, blanket, gloves, and other items. The towel blocked him up for a while and my mom was so worried she would hover over the litter box waiting for him to poop. I knew he was going to be fine because he wasn't vomiting but my mother was sure it was going to be surgery #4.

The last two weeks have been spent on internal medicine. Which has been awesome. We were pretty busy and I took as many emergencies as I could get. I had a lot of interesting cases and my clinicians were amazing. I totally rocked out hardcore while on medicine and it didn't go unnoticed. Our clinician pulled me aside at the end of the rotation to tell me what a great job I did and how he expects to hear great things about me in the future. This particular clinician is the one who introduced me to Ettinger and one of the "godfathers" of internal medicine. He was part of the crew at AMC back in the '70's who went on to write all the books we know and love today. So to hear from him that he thought I was ready for practice really meant a lot.

Now I move on to dermatology. So I will have much more time to relax, post entries, and work on job stuff. I need to post some of the cases from my medicine rotation since they were so interesting. I know I'm a posting slacker, I hope you all will forgive me!

Life after La La Land

Someone once said, "Los Angeles is 72 suburbs in search of a city." That couldn't be more true.

L.A. is a horrible city filled with poverty, tourist attractions, pollution, and people with so much wealth it's sickening. Can you tell how much I liked it?

If I had only gone to visit and see the city I would probably say that I will never go back. But the truth is, I loved my externship. It's hard to describe but I seemed to fit in so perfectly at the practice. From the moment I started I had already made friends and found teachers. One of the cardiology residents took me under his wing for the two weeks I was there and taught me so much. Of course that was between all his sarcastic comments, anti-semitic jokes, and chauvinism (which was all a complete act, he really was a sweetheart!).

I got to see some amazing cases. There was a dog with severe immune-mediated thrombocytopenia, some blocked cats, a ridiculous number of dogs with mitral valve disease, a kitten with pulmonary stenosis, and even a cat with multiple myeloma. All of the clinicians, residents and interns tried to teach me as much as they could about each case. I even got comfortable with some of the cardiac drugs and how we use them (I am terrible at cardiology). It really was an all around amazing experience.

Probably the best thing came at the end though. One of the clinicians sat down with me to talk about my experience. I told her that I had a great time and really enjoyed the practice. She then told me that they were very impressed with me and would like to see me back for an internship. That blew me away. I am used to my teachers liking me but to hear that I was impressive to "real" people out in the "real" world was something else.

So what am I going to do? I'm not entirely sure. I still have the rest of the summer and two more externships until I have to start seriously thinking about post-graduation stuff. I'm sure I'll be thinking this out on my blog at a later date. Right now I'm exhausted. I flew in to Dallas yesterday and left for my parent's place today to help take care of Murry (the jackass had to have surgery again today . . . I'll explain later). I made it to Eutaw, Alabama. Yeah, long day of driving. Now it's off to bed for me . . . *yawn* . . .

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.

My cats live here, I'm just visiting.

That's how I feel these days. See, the last two weeks I've been on the small animal medicine rotation. Despite the fact that the service has been relatively slow I have been coming home only to eat dinner and sleep. This rotation is a little different from all the others because we are expected to act as the doctors. We are expected to make our own differential diagnoses and a plan. Then we report to our clinician with what we want to do only to have it promptly smacked down. The first few days were rough, I think we all felt as if we got thrown into the deep end of the pool and didn't know how to swim. I was dumb (or brave) enough to volunteer to be the very first to present at rounds. I didn't know enough about the interrogation I was facing to be scared. I presented a case about a vomiting cat with gall stones. I was not as prepared as I needed to be although I don't remember having that deep feeling of panic. Maybe I was just shell shocked. After that though I was inexplicably afraid to present again.

This past week my team has been on with Dr. Chase and I have been lucky enough to have her on my cases on both receiving days. Dr. Chase strikes fear into most students. She's tough, she'll try to lead you in the wrong direction, she'll let you talk until you back yourself into a corner, she'll make you play hangman if there's a word you can't think of and she'll keep asking questions until she trips you up. However, she's a fabulous teacher and forces you to challenge yourself. Personally, I love her.

My first long term in-patient was a 17 year old Jack Russell named Tas. Tas presented for chronic vomiting. We ran so many diagnostics on the little guy and kept him in ICU for days, we even had him on total parenteral nutrition. He was such a cute little guy, he liked to just wander around the hospital with his IV pole and one of the ICU techs in tow. We worked so hard to try and resolve his vomiting even though we couldn't explain why it was happening (my money is on GI lymphoma). Poor thing had to be euthanized last Saturday. The interesting thing about this story is that it was the first time I really felt like I saw an animal tell us it was time to go. He had been having more episodes of what we could only attribute to dementia (panicked barking, circling, panting, all around anxiety) but was still relatively stable. I thought he was worsening a little bit but when I took him outside and put him in his mom's arms I saw him close his eyes and I could almost feel him give up. I can't adequately describe it, I'm not sure anyone could. And it wasn't as if he gave up in a bad way, he was just telling us that he was old, he had a good life, and he was ready to rest. At that moment I really understood the gift of euthanasia. He was a great dog and he'll be greatly missed, but I know that he's happier now.

My other patients have not been nearly as intensive, or depressing. I actually did a re-check on a cat yesterday that survived a heartworm infection. Its been four months and yesterday he tested negative for heartworm antigen and is doing great. I also had Harvey, a former blood donor cat with chronic renal failure, who came in because he vomited and then passed out. Sounds horrible but he did very well in the hospital. He tried to maul me once or twice when I was messing with his catheter but other than that he was actually a really cool cat.

An interesting case. Yesterday I saw a young kitten (approximately 7 or so months old) with a chronic lymphocytosis (small cell, well differentiated). That's all that is wrong with her. Well, that and her cranial mediastinal mass which we're not quite sure what it is. We're actually going to do flow cytometry on her to differentiate her lymphocytes. Its a strange case because we can't really find an explanation. There have been reports of this in young kittens (random chronic lymphocytosis) but the look of that mediastinal mass is not promising. She has tested
FeLV negative three times already but who knows. Hopefully something cool will come back from the flow cytometery and we will know more.

All in all I'm liking medicine a lot. Its hard, its busy, I'm tired, and I have to work with Glen all day but for whatever reason, I'm really loving it.