Another year older

First off..happy birthday to me…27!!!! Well, I have had two extremely busy days at the clinic. I have gotten swamped!! Have been working the 2a-2p (2p-8a is actually the shift!!) which means as you all know that I am on the receiving floor. Tuesday night I saw almost all the cases that came in…I have been working with the new intern so I feel for her…know I know how hard it was for the others to work with me when I first started. The one good thing? The Wrath has turned its fire on her, so working, although busy as heck, has been more pleasant the past two days…amazing how that works….job can actually be quite enjoyable and fun when someone is not degrading you the whole time…THIS is why I am here. So yes, spirits are a little better…have been seeing so many cases it’s amazing…I get excited thinking about how much I am going to know at the end of this internship…and darnit all…you knew it would happen.,…you start to enjoy it, get the hang of things and what happens….hmmm….the word Residency once again starts to take on meaning in your mind. Still a no, but if I enjoy this anymore I’m afraid I might be applying for another 3 years of slavery!! Stay tuned…! Ok, so what have I seen the past two days? Another wildlife bird with an open wound on its back-did I humanely euthanize-nope, you guessed it-pain meds and supportive care overnight and wait for wildlife to pick it up in the morning…I do have to say though, this one was not an ugly sparrow, it was a pretty gray with a spike that was black and red and white on the wings, not sure what kind (I know Kevin is cringing right now because he probably knows the species!!!)…in my defense, I did not have time to eat dinner let alone try to figure out what kind of bird it was—doesn’t change my treatment plan—doesn’t really matter then. Saw a cat with a large ventral cervical (neck) mass that came in as a Triage stat..vomiting up foam/food, gasping for air…intubated (with difficulty), suctioned the airway—got a lot of vomit—not good for the lungs—then found the large mass—highly likely malignant neoplasia that is already compressing esophagus and trachea (thus the vomiting and gasping)—poor prognosis—unfortunately humanely euthanized, but probably best choice, cat was suffering and suffocating in its own vomit—sad though—kitties are hard for me—I get too attached—and I see Webbie and Patchie each time I see a kittie. Another kitty comes in, open-mouth breathing, salivating, exaggerated swallowing. On PE, lungs sound harsh and there is a severe expiratory effort (this means lung parenchyma involvement…likely pneumonia or some other process). Also upper respiratory congestion (this explains the exaggerated swallowing—post nasal drip=he is swallowing his snot down the throat because of the extreme congestion . My plan: thoracic radiographs to include cervical region, sedated oral exam (in case of laryngeal mass that I am missing), hospitalization on fluids in oxygen cage overnight..$700-900. What I did? Sent the cat home on oral antibiotics in case of URI (upper respiratory infection—usually viral in kitties, but they usually get secondary bacterial infections so that’s why the antibiotics) and pneumonia…and explained to the owners that their cat may die in the car ride home…he needs oxygen and supportive care…he is working very hard to breath…but I think they may take to rDVM tomorrow, I hope. Wife would have done everything, darn hubbie said not spending that much on a cat!!! Men!!! Saw a vomiting cat, placed a nasogastric tube to suction the stomach, set up to get endoscopy today. Saw a collapsing Golden Retriever…remember what disease this is? Hemangiosarcoma, that’s right, big abdominal mass, anemia…but owners want to talk with their vet prior to making any decision so I actually did a blood transfusion on this one and supportive care overnight…final decision was to be made this morning…Poor prognosis..absolutely no treatment, only prolonging life so owners can have more time…sometimes I am not ok with that..sometimes it is time to say goodbye…and sometimes your animals are telling you that…you gotta listen and let them go play in that big dog park in the sky! Saw a Persian who was run over by her owner (yes I don’t know either why you are letting you Persian walk around outside!!)..ran over tail, large degloving laceration (skin pulled away from tail down to vertebral column)…extremely painful in tail and hip region (uh oh…fractures?)…well I don’t know because owners didn’t want to spend the money on radiographs and wanted to discuss with their vet in the morning and transfer there for care. Ok, but then night goes on and bloodwork: anemia (bleeding somewhere? Who knows don’t have money to check), elevated renal values and no urine produced despite being on fluids…very tiny palpable bladder (Big Uh OH…ruptured bladder, damaged kidney?..Ruptured ureter? Once again I don’t know…but this will kill the cat first…hope they made a quick decision this morning)…my best guess? The cat needs surgery…STAT. Saw a couple suture removals, those are quick and easy. Saw a dog with acutely painful abdomen…bloodwork absolutely normal, radiographs normal, send home to monitor. Could be gastritis or early foreign body…recommended taking to rDVM this morning for repeat radiographs and possible ultrasound if continues. Other thing I worry about,,,they fed him some hot dogs…pancreatitis? Don’t know…we’ll see. Another dog…painful abdomen, trying to bite my hand off. Once again normal radiographs…didn’t do bloodwork because too expensive…owners will watch and take to rDVM if continues…sent home with NSAIDS for pain (yes checked renal values…they were ok). Allergic reaction dog—swollen muzzle, swallowing exaggerated (likely swollen throat), hives…gave injection of diphenhydramine (benadryl), sent home with benadryl. I can’t even remember what else I saw…there were a bunch more, lots of vomiting animals—some people go for the whole shebang (bloodwork, metabolic work-up, radiographs, hospitalization) other choose radiographs and at home supportive care, others choose to withhold food and try bland diet…saw some diarrhea cases—same treatment as vomiting (plus fecal and can send home on Metronidazole and dewormer). See lots of animals in respiratory distress…once again some owner go for full work-up and others choose to watch and wait. I am learning fast that you can’t save them all, can’t do everything you would like to do for every animal, but that is when it gets interesting and you have to use your brain to come up with a good plan for that animal that fits with the owners budget…what is going to kill them first…treat that and then go from there… I enjoy what I am doing….I just don’t like the hours but they don’t call it an internship for nothing…Gotta head out to rounds now…then probably back home to study.