Monday, September 24, 2007


His name was E.J. I never asked what it stood for... only now does it occur to me to wonder. He was a middle aged cat. A gray tabby with longer fur. He started off beautiful, but days of hospitalization, eventually with an e-collar, caused his coat to become grungy and gross.

He had bladder stones that he couldn't pass. And when he tried, they got stuck in his urethra, and he became blocked. A week ago, he presented to the emergency clinic for this problem. It was the first time it had happened to him. His owners weren't properly educated on what this meant in terms of lifestyle changes, diet changes, and survival time. Bladder stones are managable, they can be influenced by diet and water intake. They can be removed with surgery. They can be an incidental finding that will never affect the health of the animal.

But E.J. had problems from his. And each time the stones reentered his urethra, he had to be anesthetized again. He blocked 4 times in the last week. Yesterday, we did a cystotomy. That's the surgery where we go into the bladder through the abdomen and scoop out all the stones. It was like picking grains of sand out of a beach blanket. The stones were tiny, most of them. Many he could likely pass on his own. But two were larger, round stones that were small enough to enter his urethra from the bladder, and large enough to not be able to pass all the way through. We took out 30+ stones. Carefully flushing and flushing and flushing until we were convinced that the larger stones were all gone, and anything too small for us to remove would probably be able to be passed on his own.

We closed the abdomen. We took a radiograph that showed a nice bubble of air in his bladder, but no remaining stones big enough to be spotted. We placed an indwelling urinary catheter, because his urethra has been traumatized so many times in the last week that we wanted to relax it while the inflammation died down. Amy went to make some phone calls. The technicians were placing a new IV catheter, because his current one (though working well throughout surgery) had been in for 4 days and was at increased risk for infection.

They walked away for 10 seconds. Both new catheters were in, he was still on the table on anesthesia. The pulse-ox slipped off his tongue and the alarm went off. Gail went to replace it, and noticed he was very pale. Then she noticed he wasn't breathing. We located doctors, three of them.

We did CPR for almost 10 minutes. We used epi, atropine. We ventilated him at 40 times per minute, we pumped his heart as fast as we could (you try making a heart beat 150 times/minute). We watched the ekg each time we paused. He didn't make it.

A week ago, before first going to the emergency clinic because he couldn't pee, he was a healthy cat. Whatever stones may have been present were not affecting his life at all. Yesterday, he died. The owners elected a group cremation, with no ashes returned.

Ethical Dilemma

S is a 11 month old Doberman Pinscher. She is not spayed. She is purebred with papers. She has a class III malocclusion, an anterior crossbite (example in picture below), and "rostral flare" of her lower incisors.

A class I malocclusion is just when the front teeth (between the canines) don't quite meet the way they're supposed to. It is presumed to be some combination of factors including environment, congenital, genetic, and dumb luck.

A class III malocclusion is when the mandible is just a little bit too long, and rather than the top teeth fitting nicely and prettily over the bottom, instead they either meet straight on (try it, you can see how it would hurt after a while) or have the "bulldog look". Class III's are considered to be a genetic skeletal deformity, where the pre-molars and molars are involved to some degree as well as the more obvious incisors.

(For reference, a class II is when the maxilla is waaay to long, and a class IV is severe skeletal deformities like where the teeth don't even meet in the front, or one side of the mandible is longer than the other.)

Dogs that are shown are typically in the highest demand for breeding and continuing the lines of the breed. As a result, they need to be the best genetics available, and breeding dogs with cranial skeletal deformities is not in anyone's best interest.

S's owner came to the dentistry clinic when she was about 6 months old. In hand, he had an article written by the AKC for judges about how to spot (and disqualify) dogs who have had orthodontic work to correct malocclusions. The article had a picture of a dog with an expansion device, which many people I know had as children in conjunction with their braces. The expansion devices angle the teeth outward appropriately so that the skeletal abnormalities are disguised and the dog has a normal bite.

He pointed to the device in the picture and said "I want that for my dog."

After many hours of ethical discussions amongst themselves and with the owners, my clinicians ultimately decided to use the expansion device to correct S's malocclusion and crossbite. The owner desires to show this dog, and insists that "no other dogs in the line have any teeth problems".

I have several major ethical issues with treating this dog and working with this owner, which I will briefly highlight, along with some pertinent facts.

1) The dog is in no pain and has no quality of life issues with her current bite.
2) The dog is an intact female that may be bred in the future, potentially to relatives.
3) The dog is intended as a show dog, and judges are clearly *taught* to look for these changes.
4) There is no real way for us to "report" this owner to the AKC.
5) In order to become board certified in veterinary dentistry, a resident must perform and document two orthodontic device fitting and placements.

Personally, I have decided to not treat an animal when placed in this situation. While I would be happy to place the device, I would do it on contingency of spaying the dog. As a student, I abide by the choices of my attending clinicians.

Wednesday, April 18, 2007

Lazy me


The first case I had in the morning was a dog with progressive vision loss and cloudy eyes for the last month. She's a 5 year old Papillon (the most ADORABLE dogs ever, I love them). Her history is actually of stomach problems, which is more unusual in smaller breed dogs - so that threw us for a loop. She'd never really had any issues before with her eyes. When I looked in here eyes, mostly what I noticed was that she had complete cataracts in both eyes. This means that we can't see in and she can't see out. She can probably tell where shadows are, but not much else. What surprised me was that the owner hadn't reported any changes in the dog's drinking or peeing habits, and what I was seeing was incredibly consistent with diabetic cataracts. I asked the owner twice, Dr P asked again when we got in the room. Apparently any acute onset cataracts can cause separation of the Y-sutures, but the top 5 differentials in dogs are Diabetes. We talked to the owner about surgery, but warned them that because of the dogs ongoing digestive issues that we were a little hesitant about taking her to surgery. We did run bloodwork to check for diabetes and to see if she would even be a tiny bit of a candidate for surgery. She doesn't have diabetes (good), but she does appear to be in kidney failure (bad). This, of course, is my non-clinical-pathologist diagnosis based on anemia, low serum albumin, azotemia and no urine sample.... We called to let the owners know that the dog isn't a candidate for surgery, but that it's pretty important that she get a medical work-up by either her regular DVM or by the internal medicine service here. Also, she had fleas. Ew.

The next case I saw was a 7 year old basset hound that had primary glaucoma. This is an acute onset painful condition in dogs,unlike in humans where the eye pressures rise slowly over time and is generally first noticed when vision begins to be lost. They'd been treating the dog for about 6 weeks, and they had brought the eye pressures down to a nice low good level. It was a pretty straightforward case with good owners :) Unfortunately, eventually this type of glaucoma will become refractory to treatment and the eye will become blind and painful, and probably have to be removed. Double-badness is that this is a developmental eye issue, and the other eye is incredibly likely to also develop primary glaucoma, and eventually the poor dog will probably be blind in both eyes.

The last case that I saw for the day was a recheck from a dog that I'd had the opportunity to see last week! It was the dog with blood in her eye, glaucoma, an ulcer and KCS. We were only treating for the glaucoma and the ulcer over the last week, and while the glaucoma is now under control, the ulcer is still tiny but present. As soon as the ulcer resolves, we can start the dog on topical steroids in addition to the oral steroids to help drop the inflammation and resolve the blood inside the eye and start the dog on optimmune (cyclosporin A) ointment to help to decrease the corneal pigmentation and thickening from the poor tear production. I wish I was on this service longer so that I could continue to follow her treatment - but you do what you can do.


Yesterday we had just three cases. We started off the morning with a Jack Russell who had excessive tearing in one of his eyes. He was in to have his teeth cleaned, and as long as he was anesthetized we went ahead and evaluated the drainage through his nasolacrimal duct. (Un?)Fortunately, it was normal. So, we have no idea what's up with him. Oh well.

Next we played with J's cat Velvet, a hypothyroid Rex cat (go ahead and google Rex, I'll wait). She was incredibly patient with us and we got to play with both the super duper expensive slit lamp and the headset with the light on it. WOW do those things have a learning curve. I'm glad that I mostly use the handset that I've had years of practice with, as well as that's what most practices that I'm going to be working in have - and it's nice to become comfortable diagnosing with less sophisticated equipment if that's all that will later be available to you.

Then we went to 2 lectures, one on proptosis (don't google this one ~.o) which is when the eye pops out of the socket, and one on exotics. Both were lectures that I went to last year, and not too much had changed. I spent most of the lectures texting Sam and drinking Diet Coke (read: crack).

In the afternoon we had a horse come in who had a history of cloudy eyes. I ended up taking the case. In horses, their eyelids are so strong that you actually have to do a local anesthetic block in order for them to let you completely examine their eye. Dr P did most of the exam, I did most of the writing up and talking to the (young) owner afterwards. First of all, the owner was a senior in high school, and I'm pretty sure not old enough to legally enter into a binding contract.... The woman who drove her and the trailer in was a friend's mom, and had no say. So this teenager was making costly decisions for the horse and spending her mom's money... talk about a weird conversation to have. Anyways, we diagnosed the horse with equine recurring uveitis (moon blindness), but really what the horse had was a secondary uncontrolled glaucoma. We upped the anti-glaucoma drug that the horse was on and added in another drug. The horse had asteroid hylosis (it looks like the starry night screen saver only in the back of the eye), baby cataracts, a pale optic nerve head, and something called Haab's Striae (I'm going to recheck spelling on this). The Striae is when Decemet's membrane (the basement membrane on the inside of the cornea) cracks and it gets all cloudy with edema. It's related to increase pressure inside the eye at some point in time. The other eye was fine, but will probably ultimately also be affected. They don't know how/why it happens, except that it seems to happen to Appaloosa's more often, which this horse was.

Then we had the opportunity to see a cria, a baby alpaca, with lots of developmental defects. I missed most of the explanation, but I do know that the membrane between the nose and the throat never dissolved during development, so she can't eat and breathe at the same time. As a result, she never got colostrum after birth (2d old now) and has a blood infection. Also, she's completely blind, has an eye full of blood, and this kinda neat spiderweb of vessels in the back of the eye. Also, she's kinda neurologic, isn't walking well and has a head tilt. I'm pretty sure they put her down this morning, which is the right thing to do in an animal with so many congenital defects.

We spent the remaining time in the afternoon harassing R's dogs, Samoyeds, that she brought in for our amusement. It was kinda entertaining :) We got to use the toys again, and he had some cool tapetums, very grainy. He probably has early progressive retinal atrophy, because when we set up a maze in the room for him in the very very dim light he ran into a trash can. R's choice about the workup for him, he's a 10ish year old dog :)

Saturday, April 14, 2007


I gave my self a break last night from posting, because the week just completely drained me. It's rough to go from a 20 hour a week "desk job" to a 50 hour a week running around like craziness!

Yesterday was kinda fun, though absolutely insane. I was about 3 minutes late due to an important trip to pick up bagels and cream cheese before school. I remain convinced that the bagels maintained everyone's blood sugar at a reasonable level throughout the day and prevent the uber cranky that we've been seeing around noon when no one has gotten to eat since 6 or 7 am.

I had agreed on Thursday night to take the 8am diagnostic appointment, just so that we didn't have to choose first thing in the morning. Fortunately, my owner was a little late, so I had some time to settle in. This poor owner was absolutely hysterical on the phone on Thursday night, including kinda verbally abusing our (amazing) technician. We knew that she was pretty stressed, so I had really prepared myself for coping with the morning.

Her poor puppy had detached retinas due to high blood pressure and uncontrolled hyperadrenocorticism back in February. With blood pressure medicine her referring vet managed to get the left retina to reattach on it's own, but seemed to have limited success in the right eye. Based on the lab results that came with the record from her vet, her cushings has NEVER been controlled, and they haven't really changed the dose either (weird). It also looks like her hypertension is back in full form. Her right eye is completely filled with blood, and we presume that the retina is detached behind it. She is completely blind in that eye (if we can't see in, she can't see out), but the eye is not painful at all. So we prescribed some topical steroids to help resolve the blood, and referred her to the internal medicine service to get her cushings and hypertension under control. At last check she had an abdominal ultrasound that did not reveal anything diagnostic (big liver, spleen, lymph nodes, cystic pancreas, sludgy gallbladder, tubular mineralization in the kidneys... no tumors). I hope they can get her under control, because if they can do it by next week, there's a chance that we can actually resolve what's going on in her right eye and get her partly visual again.

I missed the 9am trip to the raptor center because of that first appointment, but R and J went with all the doctors, and got to see a snake. Apparently there were no birds, and one of the raptor center people had a snake with a retained spectacle (for whatever reason when the snake shed, the "lens" of skin over the eye didn't shed with it). They were unsuccessful in helping it to shed, so they prescribed some warm compresses and misting it with water to keep it moist and bringing the snake back next week.

The rest of the morning was just a series of rechecks that seemed to go on forever. I know that I rechecked a dog with dry-eye (KCS) who was slightly improved. We didn't have the records from the previous visit (grrrr), so I told Dr P that I thought I saw "slight flare" in the affected eye, and she agreed with me! I didn't know it was going to be there weee go me! I saw a dog with bilateral uveitis (inflammation in the front of the eye), that was also doing amazingly better. I helped hold for a couple of appointments that other students had, but I can't really think of what their cases were - I mostly just know the ones that I wrote up.

I finally grabbed a brief lunch break around 1:15 and got to eat my pizza, yummy! Because of the upcoming AVMA accreditation visit (starting today, actually), a group of gullible sophomores were under the Larry's supervision cleaning out refrigerators and microwaves that were REALLY NASTY. I've taken to eating my food at room temperature because if you put them in the fridge they pick up this really ... rancid kinda taste. SO gross. Oddly, reminds me of Boy's dorm room fridge in college at one point :) I totally ruined our leftovers one day.

The students after lunch kinda took the opportunity to regroup and talk amongst ourselves about cases and questions that we had. By the time the doctors found us (we were hiding in an exam room), we had the eye model, a laptop, an ophtho textbook, a set of Ross notes and a set of class notes out, trying to figure out the answers to our questions. Dr K stole R and J to hold the super insane lab that was getting a CERF exam (like OFA for eyes), so P and I just hung out for a little bit. Then Dr P came in and we held rounds for about 2 1/2 hours on eye emergencies. We got through glaucoma and the acutely blind eye. I have soo many pages of notes in my little notebook! It was really interesting, and while pretty similar to the lectures given in class 2 years ago - this time around it made sense! While Dr P was giving a powerpoint presentation, because there were only 5 of us in a very small room, it really played out like more of a discussion.

Thursday, April 12, 2007

Paper towel tube doo doo doo

Today was relatively low key, which was much welcomed after a first week that gave me a ton of blisters! I got in at 8 this morning, we talked about what was going on today, and went to watch Dr P give Grand Rounds. Her talk was about aldose reductase inhibitors for the prevention of diabetic cataracts in dogs. It looks cool, but because results for peripheral neuropathies in humans have been disappointing (side effects for the lose), there isn't anything available on the market. 90% of dogs have cataracts 18 months after being diagnosed with diabetes. Scary numbers.

(There's odd thumping from the other room, I hope Oberon doesn't get squished!)

Then I took the 9am recheck appointment, a cat who had massively severe uveitis in one eye two weeks ago and was here today for a recheck. The eye is about 95% better! Woooot. I kinda blew my exam though... I forgot to use the slit lamp to actually EVALUATE the uveitis - though I did a pretty reasonable exam other than that. We put the cat on antibiotics for another couple of weeks just in case it was toxoplasmosis and the antibiotics were the reason that it got better (could have been the steroids...). I managed to correctly diagnose a pupil that did not respond to light as an eye that had atropine put in it daily for the last two weeks, go me! (We gave it atropine to keep it's pupil as wide open as possible so all the inflammation wouldn't make the iris stick to the lens of the eye.)

(Update, it was a wrapping paper tube that he was wrestling to it's death)

Then I went and watched the eye be removed from the cat that I saw yesterday. He was doing well this morning, and did great in surgery. Next Dr D and R removed the eye of a little mini poodle. She was a GIANT sweetheart, and we cuddled for about an hour tonight while waiting for her mom and brother (a little black mini poodle) to come pick her up. R actually got to do some of the cutting of the conjunctiva during the surgery! It was awesome!!

I grabbed myself a quick lunch of leftover pizza from last night (did I mention that I was so exhausted last night that I ordered pizza and drank wine and put myself to bed early?), and relaxed for a couple of minutes. We had lab with the sophomores from 1-5, and I think I did a much better job this week. We had about a half hour break between labs, during which I grabbed a Coke Zero and chatted with A who had a concurrent break from her surgery rotation. It was nice to get to see her.

I hung out until we managed to do a quick rounds, and then waited with R to do the discharge of the poodle so that she could give me a ride home afterwards.

Wednesday, April 11, 2007

Eyes out!

This morning was fun, but actually went fairly slow.

We started off the morning at 8am with a case that J took. I went in to restrain the golden retriever while she did her exam. [Note: how many golden retrievers named Bailey do you know?] All we found was some scleral injection (the white of her eye was red), and very slight aqueous flare (inflammation between her cornea and her pupil). Since she's had no changes in vision, no pain, no squinting, no - well - anything, we were kinda confused. We went out, presented the case to Dr K, and she groaned and said "I HATE Golden Retriever Uveitis", to which J and I kinda tilted our heads and humored her. Fortunately, Dr D offered to take the case (she was supposed to be prepping for a horse surgery). We went in, Dr D re-examined the dog, and diagnosed her with, ta da, Golden Retriever Uveitis! It's essentially an idiopathic (we don't know why it happens) disease only of Golden's, that will probably eventually cause the eye to get glaucoma, which is very painful and often results in blindness. Under the microscope, Dr D said she could see lots of pigmented cells floating around in the anterior chamber of the eye - but we didn't see those because we're not supposed to touch the scope.

Next, I saw my own appointment, with a little sneezy Pekingese. Ugly old little dog - but very sweet and adorable. It was the fourth or fifth visit that he'd had with the ophtho service, and it was a three week recheck of a deep corneal ulcer. The danger with deep corneal ulcers is that they can go full thickness and then the eye pops and that's bad. I stained the eye with fluorescein (orange strip, the dye is green/yellow), and nothing showed up! I was actually incredibly happy to tell the owner that the eye was completely healed, that all medications could be discontinued and the e-collar didn't have to be worn anymore, and that he didn't have to come back unless something new and different happened. Even though he had to wait a little bit to get a Dr in to double check my findings, he was a happy happy man. It was fun to be able to have such a positive experience with a client!

Next I went into R's appointment, a little mini poodle with cataracts in both eyes. The cataracts were almost complete, so the dog was pretty much seeing the world through frosted glass. The owners were VERY interested in cataract surgery, which meant that we had to make sure that the dog would be able to see if the cataracts were removed. This was a slight problem, because when we shined a very bright light into the dog's eyes, nothing happened. In either eye. Even if he was seeing a very hazy view from the world, having a spotlight shined in your eye in a dark room should make your pupil's constrict a little bit. So we actually go to do an ocular ultrasound, which showed some vitreous degeneration but no retinal detachment (age related changes with little to no effect on vision). Next we got to do an ERG (the EKG for the eye to measure electrical activity). I was busy doing other stuff while they did that, but unfortunately the dog failed the test. The eyes didn't respond at all to the light during the test, and produced only baseline electrical activity. This means that the dog would not have been able to see even without the cataracts, which makes him not a candidate for cataract surgery. Best quote from that appointment, spanish wife elbowing white geek husband, "SEE! I told you it wasn't the tortillas that were making him blind!"

Then I hung around to wait for a noon appointment that was just supposed to be a fake-lens (cataract surgery) recheck, the surgery was done at Cornell and the owners have since moved. When the owners still hadn't checked in by 12:30, I was sent to go up to the waiting area and call to see if the dog was in the waiting room at all. He wasn't. When I got back, I made the technician check the messages, and the owner had called at 8:30am to say that he couldn't make it because of the weather. Because of the craziness of the morning, and the fact that they removed a horse's eye this morning (I wasn't in on that one), no one had gotten around to checking the voicemail.

In the afternoon I grabbed the first appointment (at 1:30), because J was still finishing up an 11am appointment (that dog ended up being there until 5pm doing various stuff). Since we went into the appointment fairly sure that we would end up taking the cat to surgery, J was supposed to take the appointment. Instead we compromised, and I did today's workup and paperwork, and she'll get to scrub in on the surgery tomorrow and do all the paperwork that goes with that. The cat was a beautiful 16 pound gray Maine Coon Cat who was just the mellowest cat ever. I was totally in love with him. Unfortunately, instead of a right eye, he had a mass the size of a golf ball completely filling his eye socket. We did a short workup, including chest radiographs to check for mets (cancer likes to hang out in the lungs) and to evaluate his heart because he had a roaring murmur*. The owner finally elected surgery, and he'll have surgery at 9:30 tomorrow morning. This case is sweet, because the only reason the owner let the mass get that big was because he was under the impression that the cat would not live through surgery due to the murmur. Apparently on Friday he came in on emergency because the surface of the mass had become infected and the eye was smelly and rotten. It was completely clear of infection today, thank god. But the owner came in today with the knowledge that even though the cat might not live through surgery, the mass was bothering the cat enough to take the chance. I can't imagine coming to the vet with the fact that your cat is not going to live, despite obvious health other than the eye. What a sweet, well meaning, but uninformed man.

I grabbed one last case at the end of the day, a miniature poodle who had his eye removed two weeks ago and was coming in for suture removal and a last recheck. We did the recheck, took out the sutures, and once again got to tell the owner that he did well and that he doesn't have to come back unless a new problem develops. Also a very good feeling!

Tomorrow: grand rounds (Dr P's presenting one of them), 9am recheck appointment that's mine, J's cat eye enucleation at 9:15am, R's dog eye enucleation at 10:45am. Teaching student labs: 1-5pm. Then home for the night!

Tuesday, April 10, 2007

Surgery and eye exams

Today I did surgery on a "boxer" cross named Angel. She looks like a pitbull to us, but who are we to judge the parentage of our patients? She had entropion surgery on her right eye this morning. Her eyelids were so rolled in that the eyelashes were almost completely and totally rolled under and rubbing against her cornea. She's been like this for a year, and the owners just got around to surgery for it today (just got it check out last week!). I scrubbed in on the procedure, it took about 45 minutes, and we completely remade the outer corner of her eye (lateral canthus), and then did a little face lift on her lower lid (modified hotz-celsus) to pull the eyelid all the way down to a normal position. She recovered slowly but beautifully. She is seeing well, looks amazing, is in so much less pain, and is my little Frankenstein. Her mom is supposed to come get her tonight and take her home! Unfortunately, her suture removal is in two weeks - and I'll already be on a different rotation.

After waking Angel up and calling her mom to let her know how the surgery went, I headed back to ophtho where the doctors and other students had preceded me (I was instructed to stay until they extubated her). I stared at the two closed exam room doors for a moment, discovered from the tech that there was one student in each with an appointment, and went into the room closest to me. There I joined J looking at a little Shih tzu who quite possible redeemed the entire breed for me. His name was Elvis and I'm in love with him.

Elvis was completely blind, though he did have some light perception in his left eye. He had a cataract in his right eye, as well as a superficial infected corneal ulcer. His left eye has glaucoma. We opted to treat the ulcer with ciprofloxacin (!!) and cefazolin, both compounded for the eye, and treat the glaucoma with two anti-glaucoma meds (which come together as a drug called Cosopt). The owner is a really sweet paramedic who was just wringing his hands as he watched J and I, and then Dr P do the work-up on him. I did try to explain to him what was going on, and give him an opportunity to look over our shoulders at some of the more noticeable changes to make him feel like he was a part of it. I know how hard it is to know so much and yet be completely helpless in a situation with someone you love. When Dr P asked J to turn off the lights so she could do part of the exam, he reached over (longer arms) and flicked them off. He joked that he was "glad to help in any way he could", and I joked back that we liked to empower the owners :) He seemed to enjoy that, and I think he appreciated that I respected his knowledge. I, in turn, respected that he stood back and let us do our work. A good working relationship all along. Also, he worships his dog, which gives him major brownie points in my book.

After lunch (which was harried and very short), we headed to teach the sophomores how to do ophthalmic exams. This is a lab that was optional last year, but they've made mandatory this year. In teaching all of the components and trying to explain the various details and giving hints and tricks, I suspect that the four of us got more out of helping with the lab than the students who took it. Fortunately for them, a couple of days on rotation will really solidify what they know and make them super duper happy that they had the lab this year! I'm glad I went to the lab last year even though it was optional - it's really helped me out this year.

The lab disbanded at about 4:15, and I headed back to Ophtho to do a rDVM letter, where we write a letter to the animal's normal vet to thank them for the referral and let them know what the heck is going on with their patient, and write up Angel's discharge. It took me 'till about 5:45. Then I sat in the locker room and read all about eye enucleations (we're removing a horse's eye tomorrow and putting in an implant) and biked home.

Monday, April 09, 2007

And so it starts...

I was up at 6, partly because I actually got enough sleep over the weekend (yay naps) and partly because of first day of school jitters. I was showered and out of the house fed and coffee'd and everything by 7:15, and made it to school by 7:30 by bike.

I did my locker stuff, checked my mail and hung out and finished my coffee until about 7:50, then headed over to Ophtho for orientation. The other three people on my rotation showed up right at 8am, I felt weird standing around being early for 10 minutes. I'm NEVER the early one!

Orientation was actually fun. Dr P is really an amazing teacher, particularly when it was just her and 4 of us. We went over all of the intake and exam stuff, and actually got to do it all on a volunteer dog (J, one of the ophtho tech's dog). J hung out all day, which was neat except for the bits where he was dog aggressive to some of our patients... oops. After 2 hours of going through stuff, which I swear flew by, I kinda felt like maybe I had a grasp on what I was supposed to be doing and in what order. Then appointments started!

I sat in on part of a "blind dog" exam that was P's case. The dog has a number of neurological changes in the last month, including loss of vision. We did an electroretinograph (ERG) at lunchtime, and the retina was mostly processing light normally. That confirmed the neurologist's diagnosis of a brain tumor inducing cortical blindness, which kinda sucked.

I went in with J on a dog who was a recheck for a lens luxation. The lens was hanging out in the back of the eye, and the dog has been on drops for years that cause the irises to seriously be pinpricks. I've heard the memory tool of: parasympathomimetics produce pinpoint pupils - but I'd never actually had the opportunity to see just how SMALL it makes them. I'd say the pupil was less than a millimeter in diameter, when a normal dog - even in very bright light - can usually only get down to 3 or 4mm. The other lens on the dog was "loose" and was also be kept in check with the drops. The theory is that a lens that's not where it's supposed to be but in the posterior chamber of the eye does a lot less damage and causes a lot fewer side effects than a lens hanging out in the anterior chamber (against the cornea). The dog passed the recheck with flying colors.

My first "primary" case of the day was a dog who had "possible glaucoma" from the referring vet (rDVM). The little shih tzu was adorable, but her eyes were AWFUL. In her left eye she had blood vessels growing across the cornea and increased corneal thickness from chronic inflammation and irritation probably from dry eye (keratoconjunctavitis sicca, KCS). The dog also had both nuclear sclerosis and a small cataract in the eye. She had about 25% vision in the left eye, and was mostly likely only seeing shapes and shadows. Her right eye was worse.

The right eye was completely blind, had both neovascularization (the corneal blood vessels), pigmentation from chronic irritation, clinical dry eye (KCS) diagnosed by a tear production test, and a small ulcer. The parts of the cornea that we could see through showed that the eye itself was filled with blood, called hyphema. The intraocular pressure of the eye was also between 24 and 34, diagnostic for glaucoma (increased pressure inside the eye). We (okay, Dr K) suspected a mass inside the eye, retinal detachment from high blood pressure, or a clotting disorder. The owners declined an ultrasound (to look for a mass or a blood clot or retinal detachment) and bloodwork, and opted to only treat the ulcer and the glaucoma. The treatment for the dry eye is another set of drops given 2-3 times daily, and they were having trouble considering that many eyedrops per day. the treatment for the blood in the eye is steroids, and we can't give steroids into the eye while there's an ulcer present.

In the end, we still ended up sending the dog home on three separate eye drops, which have to be given 5 minutes apart 3 times a day, and kept the dog on oral steroids that the rDVM had prescribed. It was a very hard case to write up, just because there were so many findings that may or may not be related, dependent on the workup we were not allowed to do, and then the instructions for the medications were challenging as well.

And that was just before lunch!

After lunch I, um, oh crap. I forget already. I know that I did an emergency that came in with a fixed, dilated pupil. It was this cute little 5ish year old miniature poodle who weighed all of 5 pounds. She could see fine, wasn't painful, squinted a little - but mostly had been into the vet this morning and the rDVM had noticed the eye abnormality and referred her in. I did everything right, got good readings, and the dog ended up being diagnosed with profound iris atrophy. That essentially means that for some animals the iris just... goes away. It doesn't affect the dog's vision, but they can become sensitive to very bright lights... predictably. We noticed that the other eye had the beginnings of atrophy as well, and advised the owner to check out - but that was about as far as we had to go. It was a great learning experience as well as a fun time.

I appear to have lost a couple of hours in the afternoon - I wonder what I was doing during that time... But that was just the first day!

Tomorrow, entropion surgery and teaching sophomores eye exams!

Sunday, April 08, 2007

Type A personalities

Rotations start tomorrow. Orientation was overwhelming, but was an incredible amount of useful information. I NEARLY feel prepared to start tomorrow!!

I spent much of yesterday reviewing my ophtho notes - today holds much of the same for me. I'm REALLY excited though.

And, we (me, helen, carrie) found the perfect 6-holed tiny binders for rotations. Along with folders, calculators, refills of paper ....

Office supply stores are DANGEROUS for type A personalities!

Friday, March 23, 2007

No more teachers, no more books...

Today was the last day of classes!! It's been so long coming, yet it seems kind of surreal. We don't start clinics for another two weeks though. Next week is a course on law, ethics and practice management - technically still a class, but an 8-5 pass/fail kinda class. Trust me, it doesn't count. Same prof, same expectations, same classroom - it's not the same as having 2 hour blocks of class. Then is a week of orientation - which is "technically" our first rotation. Dr Novo is the rotation coordinator, so if he's in his usual hilarity, it's going to be kind of awesome.

This weekend is our White Coat Ceremony, where we are individually presented with white coats to signify leaving the classroom and entering clinics. My mom, dad and nana will land in about 10 minutes so that they can be here for the ceremony :) My boy is obviously coming too.

Tonight is the annual "spring pig roast". However, whoever arranged it this year did a crappy job. While the theme is Luau, and prizes will be awarded for best costume, they have failed to roast a pig. Which seems like a giant waste of a party dedicated to roasting a pig to me. Also, the powers that be have told us that it has to be alcohol free. I'm going to have to find another excuse to get drunk this weekend - think I can find one? Anyways, back to the food. They're ordering catered Italian food. Did I mention it was a little ridiculous. Italian food. At a Luau. ::sigh::


Sunday, March 11, 2007

Less than a month to go!

I had this great illusion in my head when I opened the blogger dashboard that I was going to be updating in less than a month from the last time! Then I saw that I last updated just three days short of a month ago, and realized it probably doesn't count.

We are getting so close to rotations it's ridiculous. I've really adored my classes this semester - I've been learning a lot and getting to feel a lot more like I'm ready for clinics. Last week in Critical Care we had a lab where we had 3 minutes to "deal" with each case. I got less than half of them right, but nothing (when explained) was foreign to me, or didn't make sense. Baby steps. I'm glad we have guiding clinicians with us on clinics! Also, my Emergency rotation isn't until the week that I graduate, so I have some time.

We finished Orthopedics, Nutrition, Ultrasound and Public Health. Other ones too, but I can't remember them. We're really down to just Cardiology, Critical Care (and International diseases and law/ethics/regulatory stuff).

Schedule: this week - SPRING BREAK (Pennsylvania here I come!). next week - last Cardiology and CC classes, also International Diseases only class meeting. March 25 - White Coat Ceremony! The week after that - law/ethics/regulatory stuff 8-5 every day ew. THEN ORIENTATION TO CLINICS!

Well, it feels to me like it's coming up ridiculously fast, but written out it looks a lot more reasonable and like a month away. Baby steps. We start clinics on April 9.

I'm actually kind of on top of my MPH thesis at the moment. My spring break goals are to mostly have a massive rough draft. I'm hoping to defend in May, which seems forever away right now, but will attack me sooner than I expect.

Yay for a predicted 50 degrees this morning. Boo for daylight saving time making my reasonable 745am wakeup time into a slightly slacker 845 wakeup time.

This post is degenerating, so I'm gonna call it good. And hope to update sooner rather than later.

Wednesday, February 14, 2007

Poke me with a stick

I've been poked. Apparently I don't post often enough. It's probably true, this blog really gives very little indication of what it's like to be in vet school. Unless you can surmise that my lack of updating means that I have a lot to do, and I don't spend my time on blogger. To be honest, I spend my time on livejournal ;-) my first and true love. :-)

This semester is kinda awesome. We have 3 week long classes that meet between 5 and 10 times. They're just long enough to get into and get a handle on, and then they end before I get bored or frustrated or overwhelmed. Most of our classes have been incredibly focused on cases, which has been amazing for sorting the masses of information in my brain. The file cabinets in my brain are getting better labeled and better organized. Information and the answers to questions is coming to the tip of my tongue faster and more easily.

I'm getting more and more excited about the fact that rotations start in April. January flew by, and it's already Valentine's Day! We're 5 weeks into a semester that's only 11 weeks long. I start rotations with Ophthalmology and Necropsy - I think they'll be good for solidifying my understanding of the hospital procedures and computer systems, and then pounding some good old pathophys into my skull. I don't expect either to be a walk in the park, but I'd rather ease in with fewer all-nighters and not have to hit the ground running.

Maybe I'll try to post again soon. Maybe I should give up on this fruitless endeavor. What will happen? Only time can tell!