And then the job gets interesting...

It is definitely slowing down at the AEC with the fall and (yikes) winter months approaching...at least during weekdays...weekends can still be crazy...expecially between midnight - 3am ... why are people up at that time staring at their pet??? Stop...go to bed!!!! So I have spent the last 4 days in ICU, but that means I still end up as the primary doctor on the floor from 1a-4a...and let me tell you that sometimes that is when the crazies of Milwaukee come out!!! Sheesh... Last night saw a cat that was in shock, not responsive, owner had not even any money for an exam but they dinked around for an hour and finally we euthanized the cat after they fought with me and thought that sending it home with SQ fluids and antibiotics would cure it....the cat was lasterally recumbant, not responsive, HR of 90bpm (normal is 180) , blood pressure so low it wouldn't read, temperature 93 (normal is 100), respiration about 5 breaths per minute....cat was dying and I actually had to be mean and say I would not administer SQ fluids and send home because the cat was going to die...so I might have a complaint brought against me for this one but the cat was dying before our eyes...they darn thing almost died before I euthanized it... Next up...Lynx named Oliver with a urinary blockage!!! Cool pics below...knocked out...took rads...stones..needs surgery...owners took home because we cant really keep one here....see below for pics....I also emailed them to some of ya... It has been nice to be in ICU for the past 4 days because I have been taking care of some patients for 4 days in a row...it is nice...you start to know them...they grow in your heart...and you really get to take a huge part in their care...you are their primary doctor...you make all the decisions about their treatment...and so when they start to circle the drain, or the owners can't go on...it is really hard...Let's see, if it weren't for my two kitties and the fact that I live in a small one bedroom apartment...and the fact that I have no money... I would probably be the proud owner of 6-7 very sick animals that were about to die...as it was, they were euthanized...some for the best, some because owners just couldn't go on anymore - financially or emotionally. But, I did have some really great cases that I sent home...one was a big black cat named Bob who came in dead, CPR was started and he was brought back to life, he had a urinary blockage and that is why he arrested, his bloodwork was horrible when he first came in - renal values through the roof - electrolytes at unreadable levels...well he got unblocked, placed indwelling catheter, started on fluids and other meds...I met him about day 2 or 3, he was blind at that time (from oxygen deprevation during his arrest phase)...throughout that first night on my shift I noticed him startig to gain his sight back-he was responding to shadows and lights-pupils were responding-dazzle intact...continued supportive care and bloodwork gradually normalized...he did spike a fever because he catheter cut-down sites becaome infected so I started antibiotics and daily wound care...had him all four days and finally sent him home last night as a perfectly normal cat....I loved bob...big beautiful long haired black cat...the only set back...once he gained back sight he had to be sedated to even touch him...guess he was pissed off that we saved his life!!!! Owners were very grateful...Bob definitely had an angel on his shoulder...and I think he used up about 8 lives.... Next was a big old Rottweiller...Bear...nice at first then became so mean couldn't touch him...he had immune mediated hemolytic anemia and thrombocytopenia...came in with a PCV of 19% (normal is >30%), white mucous membranes, icterus, and platelets of 50,000 (normalis > 200,000)...ouch!! So, started on prednisone and azathioprine (steroids for tx of immune disease), doxycycline (antibiotic because some infectious tick-borne diseases can cause this and so we treat pre-emptively for it), low dose aspirin (to decrease risk of clot formation), and a bunch of GI protectants (because for some reason rDVM had placed this sick not eating dog on non-steroidal anti-inflammatory drugs....and now we had him on steroids....huge risk for GI ulcers)...then it was just monitoring him in case he needed transfusion..a lot of times they do...he is lucky and never did, his PCV remained 19-20% the entire time despite being on fluids. I monitored his platelets daily though and they fell to 15,000 -- yikes and poor prognosis -- so I stopped aspirin for a couple days so he didn't bleed...gradually then platelets started to increase, probably as the steroids started to work..so he went back on aspirin and eventually went home...still very sick and poor prognosis but from here on out it is just supportive care and frequent monitoring of blood values...he will either continue to respond well to the steroids or he will not...only time will tell... My favorite patient...a large 17 pound orange cat named...Pumpkin!!! Inside/outside cat, owners found under a tree with blood running from nose/mouth/eyes, unable to walk...came in in respiratory distress, was treated as head trauma case, gave mannitol and he was a lot more alert and able to function, still not able to walk (manitol is an osmotic diuretic so it pulls water out of the brain (helps with cerebral edema) and also it scavenges for free-radicals so helps in inflammation as well)...I met cat and he was laying on side in o2 cage...his lungs and heart sounded good and he seemed to be breathing well, his mouth was open but I felt it was more from pain than respiratory distress so I had them check a pulse ox (checks how well he is oxygenating) it was 98% so I moved him out of oxygen cage. He was extremely painful over his lumbar spine and would not even allow palpation of the hips. He had a huge fat, black and blue chin, lips, tongue and fractured tooth but luckily no jaw fractures. He also had a huge bruise covering his entire caudal abdomen - I was worried he had been run over and was worried about both pelvic trauma and vertebral fractures...he was urinating which is good (less chance then that bladder was ruptured)...I called owners and discussed radiographs of spine/pelvis and abdominal ultrasound...they agreed...I took them and.....this cat has an angel as well because not a single fracture, not a single abnormality on ultrasound!!!! So, he had been a low dose fentanyl cri for pain, I increased the rate and this made him for comfortable. I started to have them hand feed him and he actually was eating well. He seemed a little mentally dull so I administered a dose of lasix and another dose of mannitol in case of cerebral edema...didn't really change anything so I think he was just painful...He still wasn't getting up. The next day, he was feeling a lot better and towards the end of the night had us all in the ICU cheering as he slowly got up and went into his litter box on his own to urinate!!!!! He was so painful but still doing it...and last night he continued this...was actually getting up and moving around, very very slowly and crying while doing it because it hurt so bad, but he was up...so I transitioned him from IV fentanyl to a fentanyl transdermal patch and he will go home tonight!!!! I am so happy for him,,,he is one lucky cat!!! I still think he got run over completely but someone his angel protected him...He may never walk normally because there still could be some nerve damage, but he will at least walk!! Yay pumpkin... Had a cat come in with a fever...another outside cat...had fight wounds all over it...and one really nasty puncture wound/infected by shoulder...placed on IV antibiotics, fluids, abdominal ultrasound and radiographs normal...did also have weakness in hindlimbs...set him up to get knocked out daily for wound care (because he was a pistol!!)...gradually improved and was set to go home today!! Had a little dog last night with very low proteins and bloody diarrhea and vomiting...abdominal ultrasound found come enlarged lymph nodes but nothing else...three causes of hypoproteinemia are renal loss, GI loss, and liver disease...sent out biles acids (to test liver function), did urinalysis and sent out a urine protein:creatinine ratio (to test for renal protein loss)...and otherwise supportive care, tests are still pending...likely he has GI losses and will need some intestinal biopsies, but time will tell... One of the residents last night saw an egg bound bird...he lubed up the egg and the bird laid it and then proceeded to immediately fall over dead!!! I hate working with birds...stress just always kills them....it sucks and is so not gratifying!!! Got my paper proposal turned in...renal failure in cats....can't wait....how lucky for me to get my most favorite topic!!!! We will see if it gets approved...Now I am on my days off...go on call here in a couple hours for the next 24 hrs....but it is still nice to have some days off... Funny thing happened that I want to share,,,me and my internmate Katie were working the other night..and most of our residents and the cheifs are at the IVECCS conference so our one senior clinician who just took the boards was on with us....well a bunch of the residents previous and some of those who had been here before must have hooked up at the conference and decided to call AEC and talk....me and Katie are sitting there and she says..."that is so pathetic, who drunk dials their work!!!" and we were cracking up with laughter....then all of a sudden I'm like..."oh no, maybe it is because after three years of this schedule at AEC...work is all they have!!"...that is so sad.... god I hope I never have to drunk dial my work...please let me have a life outside of it all......smiles ;)

Surgery

So I got called in for the first time on my on-call shift Saturday...at 5am for a surgery because a dog ate the carpet out of its kennel and now was obstructed. So, had to go in and do that surgery...pulled carpet from the stomach (gastrotomy) and then two sites in the intestines (enterotomy)...went well...I was a little disappointed about being woken up so early, but then the surgery was actually fun to do so I guess it ended up not to be so bad...and then I didn't get called in again which was nice. So I may indeed have a peeping Tom...we thought we saw someone on my porch the other night as we were going to bed...I hope we were just seeing things because I just do not want to have to deal with that...hopefully it was just shadows of the trees...guess I am going to have to leave my lights on when I am away from now on and the TV on. Stupid freaks in life....get a life!!! Finally out of the city of Milwaukee which is nice...not heading back until Tuesday or Wednesday. Then I just have a couple weeks and then I have my 13 days off of vacation the second week of October which will be a nice break...am definitely heading out of town then...going to Chicago for the conference and hopefully to hang for a little bit and then hopefully Minnesota for a while as well...really excited about that...! Fall is coming, it is nice...all the pumpkins out waiting to be carved...think I am going to start buying some just for the seeds....yummmm I love the roasted pumpkin seeds...those are the best....maybe I will do that here on my few days off... How 'bout those Packers...especially Favre...settin' records...the Vikes...well we won't talk about that right now...Had some beers and watched the games...it was fun... Ok, well it is getting late and I think we are going to head off to bed here...long day...we woke up early to leave Milwaukee...Brought the kitties too so they are all freaked out about being in a new place again!!! It is funny because they stick so close to me because we are all used to being so close in my little apartment...poor webster...slammed on the breaks on the drive and his carrier fell off the seat and he went head first into the floor boards....no wonder that cat hates to travel!!!...and it makes me feel so bad every time... this is the second time his carrier has fell....luckily for me he doesn't get hurt!! OK...Smiles.. ;o)

Journal Club....done

Finally...my last shift for 5 days unless I get called in on my on-call day Saturday. Journal club came and went today...actually went ok, think I got nervous for no reason...Elke seemed pleased with how I did so that is good...here was the title of my article "Cardiac Filling Pressure are not Appropriate to Predict Hemodynamic Response to Volume Challege"...yeah, exactly what I thought....????what???? Tonight was a slower night...did not admit any inpatients - saw only patients that I sent home. Had a laceration repair...the owner had been cutting mats out of the fur of her cat and then she accidently cut the cat's skin...ouch...so we fixed 'er up...it gets a little more complicated though...she bit one of our technicians...not current on rabies...so I had to contact police dept and they sent over two officers to file a report..cat now has to be quarantined at home for 10 days. Say another dog had beenbit by the neighbor dog...deep puncture wounds all over body...just cleaned them because she wanted to have them repaired at rDVM tomorrow. Saw a ear infection at 12:45am...why are you up at that time paying attention to your dog's ears? So they paid a large amount of money just for that...but whatever. Saw a little kitten that was flat out...smelled like she was rotting from the inside out...huge swelling in caudal abdomen that I think was a hernia but not sure...she was euthanized and owner did not want to do a necropsy so not really sure what that was...tried to aspirate it and just got air. Well, I am tired and so going to head to bed...it is late or early depending on how you look at it.

STRESS!!

So it is a little stressfull working on the floor and having no time and trying to prepare for my journal club...it is tomorrow...I will let you know how it goes. At least I then have 5 days off in a row that I am really looking forward to. Work has been slow up until about 7pm and then we been getting slammed...last night we were really busy...saw once again some vomiting animals, admitted just one little dog who had been vomiting and his electrolytes were very off so he may have something else going on...radiographs didn't show a huge abnormality, but he may get a contrast series done today to make sure GI is moving as it should or an abdominal ultrasound. I will see when I go in today. Saw a vomiting cat who was really mean!!! So had to knock her out to draw blood and take radiographs,,,didn't find much on rads or bloodwork so owners just took her home with some supportive care and monitoring...they may be back. Saw a female cat who was straining to urinate...bladder was not huge...can see this in female cats with urinary tract infections, but also cannot rule out a stone or tumor...owners didn't want to do ultrasound or rads to look for anything else so just ran some bloodwork to make sure her values were ok, a urinalysis - which indicated possible infection (lots of white blood cells in there which is not normal) - so they are going to try antibiotics and some pain meds and if she continues to strain I said we will have to prob. do the ultrasound to look for another cause. Saw a couple lame dogs, but no one really wanted to do anything,,,the one just wanted pain meds because she had an appointment with her vet today and felt dog just needed some comfort overnight...he had some shifting leg lameness, some joint effusion--most likely either infection in joints, lyme disease (characteristic is shifting leg lameness), or some immune-mediated polyarthropathy (joint disease - treated with steroids)...but I guess rDVM gets that one, oh well, would have been cool to tap some joints and see what it is...also to take rads of all joints as well to evaluate them...maybe next time. Well, I can't write much...have to work more on my articles. I will write more after my shift tomorrow and let ya know how my presentation went.

Ahh some days off...

Finally some days off, although they will not be nice and relaxing as usual because I have this stupid journal club artivle to work on and then my paper as well...stress...does it really ever end? Who are these happy non-stressful people? I would like to hurt them!!!! Hee hee - just kidding. Well, I was there at the clinic until 6am this morning...it was slow in the early day and then we got slammed later at night... I admitted a Goose!!! I know I think crazy as well,,,a pet 25yr old goose...and yes...the owner was very crazy...poor goose is "circling the drain" (close to death in ER terms!!!)...very lethargic, maggots in the hind end, increased respiratory effort with horrible sounding lungs and mucoid nasal discharge, history of elevated liver enzymes, not eating, random bleeding from the eye....ok can I tie all this together?...well, if has liver disease could be slowly dying and could explain the other illness, could have cancer of liver and spread to lungs, could have fungal infection (aspergillosis is common in birds and can cause a multitude of systemic signs all seen in this bird...hmmmm)...the bleeding in the eye? I have no clue and honestly that is not killing the bird so at 4am I really did not try to figure it out...started IV fluids, antibiotics (enrofloxacin/baytril), antifungal(itraconazole), and gavage feedings...also iced lines because temp was crazy high at 106.8f(normal high in birds is 105...i think). But, goose looks like it is trying to die...will it survive...most likely not, but we have been surprised in the past...and let me just say one thing...an owner kissing a goose should have been the first indication that this case was going to be crazy...she wasted 3 hours of my time because she couldn't make a decision... I then had a really cool orange cat that was fighting with his buddy cat and now was sitting with his tongue hanging out of mouth, not wanting to move jaw...I sedated to look but already had my suspicion which was confirmed...fracture of the mandibular symphysis (joint in your chin between the two side of lower jaw...ouchy!!! Needs to be fixed with a wire...very easy procedure, but owner young and not much money so I hospitalized overnight and he was going to call his vet this morning and see if they could fix for cheaper because cat also has teeth rotting out of head that need to be removed and since his is 11years old I recommended doing it all under one anesthesia if possible. Saw a little puppy that was stepped on...luckily no broken bones...sent home with rest and pain meds. Saw a blocked cat that owners had no money so me and the extern did an outpatient unblock and sent home...probably will re-block and warned owners of that but they were happy for the time being. What else...?? Euthanized a couple,....of course that happens nightly...old dogs...with cancer or neurological disease...ok..honestly I can't think of anything else I saw right now. I have to go to read through my articles because we are meeting today at 3pm to go through them...it is so hard because I have only had two hours of sleep today because of course being on shift all night doesn't allow me any chance to read my article so I had to wake up early today and read through stuff and study...not cool...smiling though....really really really trying hard to keep smiling through it all...

One more Day

One more day of shift...then it's off for 3 days...can't wait. Has been a little hectic this week...had some doozy cases. One was a very serious dog that was referred over from rDVM because of anemia and weakness, hadn't eaten in about 3 days, not drinking, very weak and lethargic. I did full bloodwork, thoracic radiographs, abdominal ultrasound, and prepped them for possible blood transfusion. Thoracic radiographs didn't show that much, small heart likely due to hypovolemia (shock condition); abdominal ultrasound showed weird changes in liver, spleen, pancreas that none of the docs could explain; bloodwork--disaster: anemia, severe metabolic acidosis (almost inconsistent with life), and liver enzymes so high they were unreadable. So when the dog first came in, because it was a cocker spaniel I assumed likely immune-mediated hemolytic anemia (IMHA) because the breed is poster child for it. However, the severe metabolic acidosis and liver enzymes just didn't fit. So, talked with owner again about any possible chance of liver toxins and they say no chance at all. Other abnormalities was the dog was severely hypoglycemic (this can happen with liver failure, sepsis)...so then is dog septic (meaning does he have infection through bloodstream, are we missing a huge nidus of infection somewhere?)??? In meantime, dog blew 2 catheters so had to place a central line in the jugular vein, started the blood transfusion, high fluids, glucose at constant rate infusion, antibiotics in case of infection, steroids for immune mediated disease...repeated bloodwork and values had improved...however dog still looking horrible...continued supportive care but owners decided to euthanize the next afternoon because dog not improving clinically and money had to have been through the roof with all we were doing. Unblocked an orange male kitty last night that had a urethral obstruction...then he was wigging out on his opiods so I had to reverse him from those.,...he was rolling around the cage and likely seeing pink elephants...but reversal worked well and kitty doing well. Had dog with ear infection last night, dog that ate burrs and was hacking (offered to scope the dog, but owner wanted to try medical support at first so placed on pain meds and some sucralfate to coat esophagus...burr could still be stuck, but if it gets into stomach dog should be fine); saw a rabbit (severely dehydrated, not eating, not defecating, hypothermic...admitted, gave pain meds and some sedation, went to take radiographs and rabbit began agonal breathing and died on the table....she was very sick and luckily I had warned owner that this may happen as bunny's like to circle the drain when they are in the hospital). So, we will see what cases I come up with tonight. I am all stressed out because I have this journal club to do next week...the articles my senior clinician came up with are way over my head so I have to study in order to study the articles!!!! Crazy...and then there is my paper...that needs to be written yet too...so I have a lot of work to get done this weekend. I am excited about the weekend though because Kevin is going to come up and visit...it's nice to see him as we hardly ever get to see each other much anymore. And he is going to stay all weekend I believe he is taking off work on Friday to visit...he has a lot of work to do with his class as well...for those who don't know he is in a Master of Biotechnology program--he absolutely loves it...but lots of work on top of his work at Covance...so we are going to hang out at some of the little cafe's around Milwaukee and do some studying this weekend... I am so lonely here that I am really looking forward to having a buddy... I really miss having someone to hang with, although I am becoming more independent which is a good thing. Kitties are doing well, they are zonked in the sunlight right now... they are waiting for me to have days off as well... it is so hard sleeping at night because they just fight over who gets to sleep with me... and now that it's getting chilly at night they want to snuggle down in the covers...becuase you know I don't turn my heat on...learned that from Dad!!...especially since I have to pay for it. Fall is coming, football season--yay!! Although it will come and go without me really noticing it--sorta like summer, I can't believe it is already almost over. And it is getting near that time when I have to start looking at where I want to do residency...right now...Minnesota, East Coast, California are in my mind....we will see though, life sometimes has a way of deciding for you...try to plan and you just end up disappointed...go with the flow, take the hits, get right back up, dust yourself off, and keep trekin' and you will find that it really isn't that bad and you will start to find smiles around you....the worst thing in life is not living it...the others are just bumps in the road meant to wake you up and alert you to things that need to be changed in your life....breath in life around you, open your eyes, watch the birds, catch a sunset or sunrise, listen to nature, dance in the rain.....and always always always go to bed smiling over what you have experienced in that day....THAT is what makes all the difference...

Gotta love the days off...

Ok, I am finally on my days off...I had 5 of the worst days on shift ever...bad in terms of sleep is what I basically mean. Labor day...so busy that I just about walked out of the clinic and quit...I can't believe working conditions such as what I am in exist!! For future interns...I hope this clinic ups their intern numbers and stocks more interns per shift or makes the shifts shorter because this is crazy!! The last two days actually were scarily not busy, but I was so tired from the beginning of the week that it didn't really matter! I got a call back from the officer of the poilce dog that I surgerized and fixed the open joints and torn tendons...he wanted to submit the cultures I had taken...which is a good choice because we want to know if there is infection in the joint and if there is...it needs to be treat quickly because otherwise it won't just be that the dog won't work again....he may not ever walk again. But, I was happy to hear that Bosco was doing well, the officer said it was hard to keep him quiet. I asked if he had had the bandages changed like I had asked and he said he took to his vet and they changed them and said things looked great, incisions intact and minimal swelling....so that made me happy...I did good job!!! Yay me... I had another really sick dog come in, a large 144 pound Rottweiler named 'Bear'...luckily a big loveable intact male rottweiler. Peeing pure blood, anemic and severely thrombocytopenic (low plateletes), so that explains the hematuria (bloody urine)...can't clot, losing blood, ecchymosis as well (bruising of skin) due to bleeding. So, did abdominal ultrasound and saw odd looking spleen but can't aspirate it because dog has no platelets and will surely bleed to death. Let me give you an idea of how low the platelets are...normally should be greater than 200,000...this dog had 3000!!!! Yeah that'l make you bleed. He was also very anemic (normal is 30-40%, he was 16%)...so I gave him a blood transfusion and brought it up to 24% which is actually quite good...the amount of blood I gave him should have brought it up to only 19% so that means he is making some red blood cells on his own. So, he stayed in hospital on doxycycline (because infectious causes like tick born diseases, erhlichia, lyme,,,all can cause this and they are treatable with that antibiotic). Also started on prednisone and azathioprine (steroids in case this is an immune-mediated cause)...last I checked he still had no platelets but was doing clinically very well. The dog was never down and out like he should have been with blood values such as his...so it may have been a more chronic condition and his body adapted. Got a very sick renal failure dog in just the other night...very weak, pale...renal values through the roof!! This dog was a 14.5yo golden retriever...woman not really into heroics in saving dog, but I convinced her to do ultrasound and bloodwork and fluids to at least see what happens with the renal values, I said if they don't budge after 24 hours that gives us a more prognostic indicator (poor) and we can make decisions then...this dog is her life and if it was just simple renal failure, sometimes all they need is fluids and they can then bounce back...IF that was all it was, his story gets more complicated. He was diagnosed with renal failure in may and has been slowly declining since then...never was startedeven on subcutaneous fluids at home...hmmm..anyhow, dog stopped eating a couple days ago, woman thought it was maybe his arthritis, called her veterinarian (who keep in mind made the diagnosis of renal failure) who went ahead and placed the dog on Rimadyl (a non-steroidal that causes renal toxicity and should not be prescribed if the dog had renal issues)...it gets worse...dog hasn't been eating and woman has been giving this med for 5 days...did I mention this drug can also cause GI ulcerations? Ok, so far dog has not had any GI signs according to the owner. So, I get him all set up with fluids, phosphate binders, GI protecants, and hetastarch fluids (because he has low albumin and is in a possible DIC risk)... I also place a nasogastric tube for feeding purposes...his ultrasound shows nastiness in spleen and possible pancreatitis, owner doesn't want to aspirate it because she wants to wait and see if he will respond to fluids first, I say no problem we can always aspirate another day...doing well, then around 2am dog begans to breath very hard and with increased effort, I listen to lungs and hear occasional crackles but really nothing worse then when I originially ausculted...but contact owner and suggest we run thoracic radiographs and re-run some of the electroyte bloodwork(because this can cause increase in respiration also)...at this same time, dog breaks with blow-out pure bloody diarrhea...my heart sinks at this point because I think I know what is happening but I wait...radiographs are fine...bloodwork...worsening of values despite fluids ...hypoglycemia ...severe left shift (high WBC count indicative of infection)...clotting time prolonged...my fears are confirmed...dog is septic (because of the low glucose and hig WBC) and possibly going into DIC (disseminated intravascular coagulation - where he will bleed from every suface of his body while at the same time throwing clots all over....grave prognosis...horrible to try to treat)..I call owner to say we either go all out and hunt for source of infection, start on dextrose, and start treating...we are looking at thousands of dollars.....or we euthanize...owner chooses euthanasia which is not a bad choice as I fear we would have spent a considerable amount of her money and still sent her home with ashes. IT was very sad though...this dog was her life...but a very interesting case to treat. Had another little dog in for ultrasound, we aspirated the spleen and probably has either lymphoma or histiocytic sarcoma (another bad cancer)...only way to determine which is to do a bone marrow biopsy....owners consent and I got to do my first bone marrow biopsy...that was really cool. My other patient was an olde little painful toy poodle with probably chronic pancreatitis but also back pain. Treated her por the pancreatitis...IV fluids, nasogastric tube with liquid feedings, pain medications, GI protectants...if she starts eating and is not vomiting then plan to feed her per os (via mouth)....then send her home...recommend work-up of the spine then because she had severe changes on radiographs suggestive of disk disease. Saw a cat with a huge cat fight bite wound and abcess...owners just chose antibiotics and planned to take to reg vet for further opening up of the wound and flushing....cat will probably slough all it's skin off the back...hopefully does ok though. So those were my cases. I saw a ton more but those are the ones I remember. I talked to my friend Sandy the other day from vet school...she is in an internship in Georgia...said she hates it too!!! However she has day hours and goes in at 6am and it done by 3pm...how nice would that be!! I have been thinking more about the residency program and I think I am going to apply, but for an internal medicine residency, not emergency and critical care...can't handle these hours for another 3 years...nor do I like surgery so I want to get as far away from that as possible. Ok, well I need to work on my paper these days off...additionally I am due to run journal club in a week or two so I need to look for articles to teach the group....can you believe that non-sense? What am I going to teach the residents? This is a crazy thing!! My paper though, excited about that because it is on renal disease and that is my favorite thing...plus now I know I need to write it and get published to get my certificate and get into residency. Hope all is well with you. Check out below I added some new pics. Went out with my internmate Rachel and Andrea the vet from Italy last weekend...also finally used my grill!!

I'm back

Sorry I have not written in a while, have been really busy with work...long shifts...home just to sleep and then back to work as soon as I wake up the next day. I am on a string of 5 days on this week and it has been really busy and I am really tired and I still have two days to go. And the holiday weekend when no other vets were open...we got killed with cases!!! It was so busy on Monday night!!! Oh my god...and then of course at around 11:30pm when I am almost off and suppposed to be off the floor by this time...in walks a stat...a big old police dog German Shepherd bleeding profusely from both front limbs...had been working in the field and ran thru barbed wire and opened up both his carpal joints (wrists)...so of course, didn't start that surgery until 1am (keep in mind my shift was over at 12a)...Finished at 3:30am...then still had 5 inpatient records to type up....got out at 8am home to sleep for 2 hours and then back in again at noon yesterday...I was tired!!! I hate the hours...hate how busy it is sometimes!! Can't wait for my next set of days off here...Fri, Sat, Sun...So the surgery was cool though-he had completely torn his common digital extensor tendon (the one main tendon needed for movement of the limb) so had to repair that, then had torn right through both joint capsules, flushed very well with sterile saline and then closed the joint capsule and then closed the wounds...Also had a laceration on the chest that was easy to close...then I splinted the one leg with the torn tendon because he can't walk on it...going to be some long recovery for this guy....may not ever work again because may always be lame on that leg! Poor dog. What other cases have I seen? So many that I can't remember...saw a hit by car dog last night....no real external wounds...seems to be ok but monitored overnight anyway... Ok well I lost track of the time..I need to get ready to head back in for another day. God I am so tired. I just want a day off.