Friday, October 8, 2010

Soft Tissue Depression Week 1

My first week on soft tissue surgery has been one of the hardest weeks of my life. I have not exercised all week, I haven't eaten a true dinner all week, and I have seen a lot of poor prognoses and death.

My first day of the block we diagnosed a dog with splenic neoplasia and the owner elected euthanasia. My next case was the cutest Pomeranian ever. He had Adrenal Cushing's disease and came for an adrenalectomy. The mass was very large and intimately associated with the vena cava and the renal vein...out came the kidney too. His recovery was a disaster. I was with him in ICU all day until 1AM. The next morning I walked in at 6:15 to find out he had just passed. The owners were so sad but grateful. He was a legend in our hospital because he had his own human wheelchair to be pushed around. He had a ton of personality, and was loved like a child. He apparently was also included in TJ MAXX employee newsletters as their mascott.

My most promising case was a 13 year yorkie who had a liver mass removed and was doing better. 30 minutes before the owners arrived he had a seizure. We did a further workup on him the next day to find he has multiorgan failure, DIC, and half his spleen needs to be removed and he is a horrible candidate. He also likely has central vestibular (brain) disease. For lack of a better outcome he is going home to be with his owners for the time he has left.

My last case of the week is a super cool cat, with never seen before biliary cystic disease that could not be removed surgically and may not resolve medically. I got to do a lot during the surgery and place a feeding tube, but the owners are distraught over his unknown prognosis and what we don't know.
Note: All 3 cases written with owner's permission.

Between stress, lack of sleep, and poor outcomes I am depressed. Seeing Spokane last night was such a breath of fresh air. To see an healthy happy lively dog made me so grateful. I hope the coming weeks have slightly more optimistic cases. I gave me a lot to consider in terms of career choices, and dealing with death and disease on an emotional level.

My own little ophtho case

The reason there have been no new posts in over 3 weeks is simple, many other issues have come in between me and my blog. The most important was my first hand experience with an ophtho emergency.

I traveled to Chicago for a Pfizer career workshop and hired a cat-sitter to watch my 3 buds. When I returned home Saturday at 12 am, I found Garfield with his eye shut and filled with pus. When I attempted to open his eye he screamed and tried to bite me. I have never seen an animal in such pain. My second attempt to help him was the same. I debated whether it was an emergency, and wished I had my DVM to get him pain meds ASAP. I decided not to call the clinicians grading me at 12 AM Sat night, but did call first thing that morning. Upon exam, he had perforated his cornea due to corneal degeneration and lipid keratopathy. His other eye had extremely thin corneas as well, and is at a high risk of perforating. He went to surgery right away and did very well. An a-cell implant was placed (pig bladder tissue) and a conjunctival graft was sewn to his cornea. He has been a trooper. In order to treat him 4 times a day he came to school with me every day. He purred from his cage and let ophtho examine him without a fuss. He will likely need a second procedure to prevent the other eye from perforating, but we would like this eye to heal.

In an ode to Garfield, this poor cat has a heart murmur with a possibility of developing hypertrophic cardiomyopathy, FLUTD with a history of blocking, herpes, and now this serious ocular condition. He is quite the trooper and special guy though. I am so proud of him and how well he is done. He doesn't even mind his e-collar.

Ophtho went well. I do not want to be an ophthalmologist, but I really enjoyed learning about eyes and seeing some successful cases.