My last two days

Ok, I thought that the 8a-8p shift would be great because I was going to finally get off at a decent time...laugh...I should know better than that. Sunday was absolutely horrible...it was so busy and there were three of us on the floor!!! I did not get out of there until 2:30a, got 2 hours of sleep and headed back in there Monday. Not as bad but still did not get out until 2am. Damn this job and it's long hours!!! But, have to say, saw some very interesting cases. A diabetic cat with diabetic ketoacidosis (DKA)...very sick, flat out, glucose >500, glucose and ketones in urine, ketones in serum, not to mention that electrolytes and acid base was majorly messed up!!...bad, bad, bad...owners euthanized b/c cat never came out of lateral recumbancy and we are talking $2-3000 in treatment, days of hospitalization, and twice daily insulin injections for the rest of this cats life....a lot to handle...sad though because I really wanted to try to work the case...pure internal med case and I was so intrigued...god I love internal medicine!!!!!! But alas, I did not get to do that. Next comes my most favoHad a cat, flat out, hardly able to lift head, febrile...history of stone blockages in bladder and urethra, cystotomy to remove the stones, referred here from rDVM because of possible leaking of bladder from the surgery site in the bladder. Bloodwork...renal values through the roof...honestly I did not even know they could be that high!!!! (BUN>255, Creat 8.9, Phos>16.1, K6.3 -- for those of you who values mean something....for those who don't, this is a sick cat), crazy painful abdomen, of course messed up acid base and electrolytes. Started cat on fluids at high rate (75ml/hr!!!!!) and fentanyl CRI (pain med). Abdominal ultrasound later in the day showed dilated kidneys (actually dilated renal pelvices --obstruction?? or high fluid rate??), huge mass in bladder (likely blood clot) and free abdominal fluid--uh oh, tapped the abdomen and analyzed fluid for creatinine and potassium - results? Creat=14.1, K=7.0 --yup, it's urine. Phone call to owner goes: large clot in bladder that is likely causing partial if not full obstruction of urine flow from kidneys into bladder, fluid in abdomen means bladder is leaking - likely from surgery site, clot in bladder will have to be evacuated with another surgery, elevated renal values are poor prognostic indicator, cat is still laterally recumbent, explain possibilities of cardiac arrest, cost will definitely exceed $2000...owner already took out care credit to pay for this visit....final decision...euthanasia to my dismay...probably right choice but kidney are my most favoritest things!!!! I am so into renal disease especially in cats....that is what my intern paper is going to be on...lucky for me!!! I don't know why I so interested in it, but I am for some reason. So, love those kidney cases. On a side note, was talking with my resident and he was asking if I wanted to do a residency, I said I did originally and now not so sure, he asked in what and I said internal medicine....he goes you should do it, it is worth it....hmmmm, I would love to be able to do an internal med residency...I don't know why I am so interested in all the physiology of the different diseases and treatments, but I am....especially the kidneys!!! We will see. I digress...my other cases was a little Puggle with respiratory disease...likely pneumonia or really bad kennel cough (he is a pet store pup!!)...got to do an endotracheal wash last night at 1am...helped by our extern who is visiting from UW--and actually she was in my class and then entered the master's prgram so now is just finishing 4th year...cool to have her around to talk with...started talking about some of the residents at UW...Dr. Foy....we all loved him!!!! I digress again, sorry...so my little Puggle "bear"--tough guy name!! So cute, worked up whole case on my own because so busy....rounded it and got kudos from my senior on the complete work-up!! Felt good...maybe I am learning things...anyhow he doing great with my treatment so I feel good about that one!!! Also have gotten props on my records because they are so complete...my stupid, anal-retentive, obsessive-compulsive personality won't let me do anything half-a.. so that is why, but hey....whatever, at least the next doctor coming on knows exactly what I did and what I want to continue to be done....Other cases -- an IMHA (immune-mediated hemolytic anemia), IMTP (immune mediated thrombocytopenia)...blood transfusions and steroids for both; many vomiting animals, diarrhea cases (same treatment--rads, bloodwork, fluids, nasogastric tube, antibiotics and dewormers, abdominal ultrasound if not getting better, endoscopy or colonscopy if really not getting better), an intact male dog with blood dripping from penis (differentials?,,,prostatitis, prostatic hyperplasia, prostatic adenocarcinoma, urinary tract, urethral prolapse)...not urethral prolapse, rectal-feel nothing but that means prostate could be so big it is over brim of pelvis. Recommend to owner radiographs and then ultrasound of urinary tract and prostate, bloodwork, urinalysis and culture...owner doesn't want to do anything because we are too expensive - wants to take to rDVM... dog was febrile 104) so convinced him to let me hospitalize with fluids, antibiotics, and urinalysis...he ok'd and transferred to rDVM next day -- disappointed because that is a different case and I wanted to work it up but oh well. Had many other cases as well, I am definitely learning a lot...definitely stressed out. I can now drink caffeine at any time of the night...and then go straight to bed....nervous, panic attack ang is gone!!!! Awesome....!!! I am so happy about that. I am watching some TV now...it is nice because I have cable...so basically I now have a bunch of channels with nothing good on!!!! I apparently have DVR--but Dad,,,I still can not figure it out!!! I knew I wouldn't be easy...I can save things but have me figure out technology and I am like a chicken with its head cut off. Well, I am going to get going and study some on the intersting cases I had. If any of you are off and around tonight...give a call...I should be around...