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Get Me Into Vet School
– A final year vet student at the Royal Veterinary College. Getting through vet school one paw print at a time...
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Pyometra in a dog. Pyometra is a life-threatening uterine infection that can arise in intact females who have not been bred. While medical management may be attempted rarely (typically in females with a small uterus, open drainage of pus, few clinical signs and valuable breeding status), the gold standard is immediate surgical removal of the reproductive organs. Were the enormous pus-filled uterus to rupture, a septic abdomen would result. The old adage in vet school is “Never let the sun set on a pyometra!”
Me, taking a history: does your dog have any medical conditions we should know about?
Client: no
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
Me: …
Aggressive behavior in animals is sometimes caused by a painful condition. This cat was so aggressive that her owners had use a feral trap in their house just to get her to us! Any time they tried to even approach their pet, she’d attack viciously. Her behavior in the clinic was just as bad as at home.
During her spay our vet discovered this HUGE ovarian cyst – a condition that is known to be quite painful in humans – and removed it along with the rest of the reproductive organs. Her recovery was uneventful, but she returned in a few days for a recheck (dx: worrywart owner ^_~), and to our shock she was THE sweetest, mild-mannered little kitty you could imagine. Purred and head-butted us during the entire examination, even the tem
p check.
She had just been in such excruciating pain and as soon as that pain was relieved, her true temperament showed through. Needless to say, the owners were super grateful for the change! :)
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!
Last week, we had a chicken come in with severe periorbital swelling on her right side. The owners had been treating her with some antibiotics from the farm store, thinking she had some form if sinus infection. Unfortunately, she was just not getting better, so they brought her in.
Long story short, the swelling turned out to be a large, deeply involved tumor that we were only able to debulk. The owners declined biopsy, so we’ll likely never know what the tumor really was, but an impression smear suggested some form of lymphoid neoplasia, possibly due to one of the many viruses chickens can get.
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
URI: Upper respiratory infection
STT: Schirmer tear test
DIC: Disseminated intravascular coagulation, aka dead in cage
-> 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.
