I'm starting to immitate the life of my cats.

So I haven't posted in a while and the main reason has been, well, there hasn't been much to post about. Because I'm only taking 7 credits of actual class this semester (I know, you hate me) I don't have class until Sept. 24 (which also happens to be my 25th birthday . . . but that's a whole other issue). Actually, I lied. I did do a couple of things.

I took an extra clinical rotation during two of the weeks I didn't have class. I decided to take Oncology again, and will probably take it for a third time when we go back into the clinic in January. I really like cancer. Maybe that came out wrong . . . I should say, I like treating cancer. The fact that we can help animals that would otherwise be condemned to death with drugs that we use in humans is pretty cool. Chemotherapy rocks my world. The best part is that you don't have to be a specialist to do chemo. You can do it in your general practice if you feel qualified. Somewhere in the future I would like to start a chemo clinic at whatever practice I'm at. Some of these patients need weekly chemo, why send them to a specialist that may be hours away if you can administer the drug yourself? Granted, it's slightly more complicated than that but as long as they still have white blood cells they're usually good to go.

Speaking of which, for the first time I lost a patient and had a moment of panic that it was my fault. A cat came in that was in clinical remission from lymphoma. He had had a reaction to vincristine (wooo peripheral neuropathy!) so he was set to get vinblastine instead. I calculated the dose, placed the catheter, and pushed the drug. Then I come in on Monday and find out that my little lymphoma kitty had died in the ICU the night before with a WBC count of 250 and a neutrophil count of 30. Yes, that's right 30 neutrophils running around his little body. So, naturally, I freaked out, checked my doses like 6 times and then came to the conclusion that it wasn't my fault and that is all part of the chemo game. Well, I found out later that he actually presented because he had neuro signs and the necropsy showed a rather large mass in the CNS. So maybe it wasn't the chemo that killed him. I still felt bad.

Okay so that was 2 weeks. What have I been doing since then? Well, to be honest, not a whole lot. I've been sleeping in, working out, and in general just being pretty lazy. I have started studying for boards (again, a whole other issue) and am working on my job search.

By the way, D-day is December 8th. The fateful day I take my board exam. Still a little weirded out by that.

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.

Oncology . . . cancer is keeping me busy

So I've been the only student on the oncology rotation this past week. Its been crazy. I've been staying mainly with the surgery side of the department for this week, next week I'll focus more on medicine. Its a great rotation, everyone is super nice and the department head, Dr. Miles, is hilarious. I walked in on him dancing to the song 'Gettin' Jiggy Wit It' the other day. I almost died of laughter. The cases are crazy. Some of these clients have been told there is no help for their pet and then they come here and we give them an option. A women came in with her dog, Tabasco, who had just been diagnosed with osteosarcomma. The dog has bad hips and stifles so the owner didn't want to do a limb amputation. We offered her stereotactic radiosurgery to treat the cancer. Turns out we're the only place in the world offering that for animals. How cool is that?

I had another crazy cat lady this week. Well, really, a crazy cat couple. The husband was scary. Dr. Fray likened him to Norman Bates. No really, he might murder us if the cat dies. The cat has a liver mass. Most likely its benign but the owners want us to take it out. Fair enough. Trying to get a history from these people though was like pulling teeth. I somehow managed to get the history of the cat's entire family. Don't even think about asking how many cats they have, they don't even know. The best part was when the wife taught me a song I had to sing to the cat when he got his asthma medicine. The entire oncology department has been trying to get me to sing it. Not going to happen. Later in the week I had to call them with the results of their ultrasound and fine needle aspirate (which the woman tried to tell me was the same thing as a biopsy . . . not so much). That was when I screwed up. She asked if we were going to do a clotting profile and cross matching on the cat prior to surgery. I said that I didn't think so but that we could do it if it would make her more comfortable. Apparently she was really upset by this and told the referring vet that she was losing confidence in us. Turns out, I found out later, that we always do a clotting profile on liver lobectomies. Luckily my clinicians weren't too upset with me because they think she's crazy anyway. I'm dreading when this cat comes in on Wednesday for surgery.

We had another dog come in, Rocky, who is a doberman with an oral sarcomma that takes up the front of his mandible. The other vets they went to see said they couldn't do anything for it. Our surgeons looked at him and told them that we could help them. Granted, he'll have to relearn how to eat but he'll be sarcomma free . . . at least for a little while. Its a very aggressive tumor and will most likely show up again in some form. It should be an awesome surgery, unfortunately I won't get to scrub in on it. Oh well, such is life I guess.

Our surgery day this week was ridiculous. We started off with Bart, who was supposed to have a liver lobectomy. Well, when we got in we realized the mass was too close to the hilus and next to some nasty large vessels. So we opted for not trying to kill the dog and tried to remove as much of the mass as possible without bleeding the dog out. Despite all our efforts he still bled a lot and needed a transfusion, he made it though. We still have him because he decided that peeing on his incision was a good idea and now has an infection. He's still having trouble with the whole peeing outside thing, which makes taking care of him kind of a pain in the ass. Plus, he won't eat for us. I think he needs to go home at this point. He'll eat there and his incision looks 100% better.

So after that surgery, which took longer than expected, and getting Bart settled into ICU, Dr. Cane told me to grab something to eat quick because we had to get started on the next surgery. I grabbed a bag of chips and was halfway through before Dr. Cane and Dr. Fray started moving into the OR. So much for lunch. So we started the next crazy surgery. Poor little Dexter had a peripheral nerve sheath tumor on his sciatic nerve that extended up to nerves L5, L6, L7, and S1. So we had to do a coxofemoral disarticulation, hemipelvectomy, and hemilaminectomy in order to remove the leg and the nerves at their origin on the spinal cord. It was such a cool surgery, they even let me use the cautery to transect the muscles of the hind leg! Dexter actually did really well after surgery. He recovered like a champ and was running around on his three little legs like nothing ever happened. It was awesome.

Not everything is so happy about oncology though. Not surprising. Molly is this sweet cat with these owners that are just the nicest people. She came in to start a new protocol to treat her GI lymphoma and hemangiosarcomma (very rare in kitties). We did an ultrasound before treatment and unfortunately found that her hemangiosarcomma grew despite the treatment we had been doing. Since HSAs are such resistant tumors we decided that it would not be in the best interest of the cat. We had to tell the owners that it was now about end of life care and providing a good quality of life while we can. It was so sad, the wife was crying and the husband was being so supportive. You could tell that he was trying to keep it together for her. It broke my heart.

There wasn't much time to be sad though because I had to wrastle Marmaduke, an ill-behaved Great Dane. It was like trying to wrestle a foal. Litterally. He was huge. We had to give him medetomidine before we could give him his chemo.

Next week should be busy since we have to fit five days of appointments into four. Stupid labor day. I still have to go in on Monday to take care of Bart, the amazing peeing wonder dog.