Small Animal Internal Medicine
Here at A&M, the third year of vet school is where we get
our first "official" view of the small and large animal
hospitals. We're on 4-week rotational blocks, four blocks per
semester, and in one of those blocks per semester we'll spend one
day of the week on the clinical floor. So, for this current
block I've been spending my Wednesdays in the hospitals -
observing, helping, trying to learn as much as possible, and having
a lot of fun in the process.
Last week, I was on Small Animal Internal Medicine. The
service had very few patients in the hospital this morning, so
after the fourth year students were done with their morning
treatments we met back in the rounds room with our lead
clinician. It was quiz time. Dr. Zoran put up two
imaginary cases on the whiteboard - two cats, one who had suddenly
presented for panting, one with a two-week history of coughing, and
gave us 20 minutes to come up with our next steps, possible
diagnoses, and treatment options.
By the time Dr. Zoran came back to review us, the entire
whiteboard was covered. We'd done a pretty good job of coming
up with a comprehensive list of differentials (airway obstruction,
respiratory infection, congestive heart failure, the ever-present
possibility of neoplasia, etc.) and treatment options, so Dr. Zoran
spent the majority of her review on what we should do next in our
patient assessment. While the two cases involve the same body
system (respiratory), they have very different action plans in the
clinic. Unlike dogs, panting is not a normal occurrence in
cats and requires immediate medical attention and triage.
Coughing cats can be handled in a more routine exam. Dr.
Zoran also discussed the most important information we should get
from the owners, best treatment options, and helped us narrow down
our laundry list of possible diagnoses to the top five most likely
and special considerations that we should always be aware of.
Talk about a great review!
That afternoon, I worked primarily with one of the fourth year
students on his case, a middle-aged dachshund mix who very clearly
wasn't feeling well. With a history of severe diarrhea and
vomiting, we were worried about his electrolyte levels and quickly
took him into our prep room to get a blood sample and start running
fluids. Once our patient was stabilized and resting
comfortably, the fourth year student and internal medicine resident
discussed the case and came up with some treatment options.
They suspected Cushing's disease with the possibility of concurrent
diabetes, so we took the dog to ultrasound for a complete workup
while we waited for the blood tests to come back. As we
suspected, the dog's electrolytes were severely out of order, so
after we consulted with the owners we admitted the dog into our ICU
for overnight observation and reassessment. While our patient
will require constant monitoring and a lot of TLC for the next few
days, we left confident that we can have him on the road to
recovery and back home with his family soon.
That's a great way to end the day.