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!!