Me, taking a history: does your dog have any medical conditions we should know about?
Me: okay, how have your dogs activity levels been as of late?
Client: well, he’s found it quite hard to move around since he went blind from his cataracts
Yesterday I had an oh shit/oh cool moment. I am currently finishing up my 4 week ICU rotation and have learned a ton. But yesterday, I learned one more thing… something that is going to stick with me for a long time.
Yesterday, a cat came in referred from another hospital for a suspect foreign body. It had been seen 2 separate times by another vet and had a full vomiting work up: 2 sets of abdominal radiographs 24 hours apart, an abdominal ultrasound and Cerenia administration. Cat was still vomiting. There was a suspect obstructive pattern on the radiographs and potentially intestinal plication. It was referred to us since we are a large university with on call surgery residents.
Cat gets to us, is dull and lethargic. Not moving much in the carrier and overall looks dumpy. Took a thorough history from her worried owners and took a quick peek in her mouth. Everyone always says: vomiting cat? Check the base of the tongue for a linear foreign body. Did not see anything on her tongue. Grabbed the cat from the owners and went back to chat with my clinician.
My clinician, one of the ICU interns, takes a tongue depressor and after some prodding and some angry cat growling, lifts her tongue. He immediately exclaims: “I see a string! Lets call in surgery.” To which I responded to: “WHAAAAAAAT!” He shows me his trick and I, too, see the string wrapped around the base of her tongue.
Blew my mind that even though I looked in her mouth and thought I didn’t see a string, THERE WAS STILL A STRING! And from this moment on, I will forever use a tongue depressor to check under cats’ tongues for linear foreign bodies. Lesson learned.
My oh shit moment: I missed this very obvious/very ser ious physical exam finding. My oh cool moment: I now know the best trick for never missing that again. Clinics can be so awesome sometimes!
Ferret → Hyperadrenocorticism, Insulinoma, Persistent Oestrus, Diabetes mellitus, Hypothyroidism, Phaeochromocytoma
Guinea Pig → Cystic Ovaries, Alopecia of pregnancy and lactation, Diabetes mellitus, Hyperthyroidism, Hyperadrenocorticism
Rat → Pituitary Gland Adenoma
Syrian Hamster → Hyperadrenocorticism
Chinese Hamster → Diabetes mellitus
Degu → Diabetes mellitus
Chinchilla → Diabetes mellitus
Gerbil → Cystic ovaries, Diabetes mellitus, HAC
Rabbit → Diabetes mellitus, Adrenal gland tumours
I really like this blog! Hope it keeps things going!
Acronyms are an easy and effective way (most of the time) for doctors to take quick and efficient notes, write prescriptions, and fill in histories. He re is a list of some of the more commonly and frequently used veterinary acronyms:
- WNL: Within Normal limits
- NSF: No significant findings
- ADR: Ain’t doing right
- NDR: Not doing right
- SID: Once daily- every 24 hours
- BID: Twice daily- every 12 hours
- TID: Three times daily- every 8 hours
- QID: Four times daily- every 6 hours
- PRN: As needed
- QOD: Every other day
- D/C: discontinue
- q: every (q2hrs= every two hours)
- prn: as needed
- gt: drop
- qs: quantity sufficient
- AD: Right ear
- AS: Left ear
- AU: Both ears
- OD: Right eye
- OS: Left eye
- OU: Both eyes
- IM: Intramuscular
- SQ: Subcutaneous
- IV: Intravenous
- IO: Intraosseous
- IN: Intranasal
- IP: Intraperitoneal
- PO: By mouth
- NPO: Nothing by mouth
- PE: Physical exam
- SOAP: subjective, objective, assessment, plan
- BAR: Bright, alert and responsive
- QAR: Quite, alert, and responsive
- BCS: Body condition score
- TPR: Temperature, pulse, respiration
- HR: Heart rate
- RR: Respiration rate
- BP: Blood pressure
- PLR: Pupillary light reflex
- IOP: Intraocular pressure
- CRT: Capillary refill time
- MM: Mucous membranes
- GS: Gut sounds
- BM: Bowel movement
- ICP: Intracranial pressure
- CPP: Cerebral perfusion pressure
- F/S: Spayed female
- M/N: Neutered male
- Hx: History
- Tx: Treatment
- Dx: Diagnosis
- Rx: Prescription
- Sx: Surgery
- CBC: Complete blood count
- HCT: Hematocrit
- PCV: Packed cell volume
- TP/TS: Total protein/ Total solids
- CRI: Constant rate infusion
- UA: Urinalysis
- USG: Urine specific gravity
- UTI: Urinary tract infection li>
- URI: Upper respiratory infection
- STT: Schirmer tear test
- DIC: Disseminated intravascular coagulation, aka dead in cage
- PU/PD: Polyuria/Polydipsia
- CHF: Congestive heart failure/ Chronic heart failure
- HBC: Hit by car
BPM = Beats per minute / Breaths per Minute
MC = Male castrated
DOA = dead on arrival
-> Even though this is a teaching hospital, some doctors/interns/techs are not interested in teaching you. Find those that are.
-> Attitude and communication skills can be more important than knowing everything.
-> Call your family/friends/loved ones every once and awhile. You can get away from clinics for bit, plus it is nice for them to know you didn’t fall off the the face of the earth.
-> Coming to the realization that you are PAYING to be worked to the bone and scolded constantly is hard to swallow.
-> Stress dreams about failing in clinics are the worst.
-> Lear ning a new software/paperwork system is STRESSFUL.
-> It is still okay to dislike parts of clinics, just like it is okay to hate class. This is still not the real world and clinics are still just transportation to the other side.
-> Help your rotation mates any way that you can. You are all in this together.
-> There is some exhaustion that sleep can’t fix.
-> You will be yelled at for things you didn’t know existed. Apologize and move on the best you can.
-> Clinics are not “easier” than class. In fact it can be more difficult in certain instances.
-> Food makes everything better. Keeping an emergency stash of chocolate/food/candy is a must.
-> You will not be able to do everything correctly, especially on the first go. Do not beat yourself up, but take faith that tomorrow is another day, and you will strive to do better next time.
The last one is important. Even as a vet you get things wrong. It’s okay to be wrong especially at vet school so you can learn to be right.
One thing that helped me through vet school is that although you are worked hard you are not responsible for your cases. If anything does stress you tell someone about it.
Throw yourself into it and you will learn so much more too. I have a particular dislike of all things equine (sorry but I do!!) but it was the rotation I worked hardest in because I knew I had the most to learn. In the end I got the nicest review about it.
You will get shouted at at times but it’s because the bets are stressed too. They’re teaching you with living cases and they have to be a referral level hospital. They’re responsible for you and the patient so don’t take it personally they’re probably just stressing too.