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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.