Sam and I had another patient the other day. It was our first SOAP, as he stayed at the hospital. He was a warmblood, presenting for colic. I was able to place his jugular catheter as well as the nasogastric tube - but he was so tall that I was on my tippy toes for part of it!! Sam was so sweet in letting me pass the tube. She's one of the nicest equine people I know - she's always letting me do things so I can learn since she's done a lot of it before, and I definitely appreciate that.
We ended up getting sent home early Friday night because there were 4 or 5 Columbus State tech students and not a lot of in-house patients so they were able to take care of all of the treatments themselves.
The hardest part of this rotation has been adjusting to this time schedule. I'm working 8am-8pm today and then am on midnight to 8am the rest of the week... I'm sleep already!
Sunday, April 18, 2010
Friday, April 16, 2010
I had my first patient... and she went home alive :)
It's been a long few days, and I can barely keep track of my days anymore.
Tuesday, about an hour after coming home, I got called in and was at school till 1am doing midnight treatments. I enjoyed working with Amy and Sam - it was Amy's first day, and so I'm glad I went in since Sam was still scrubbed in to the colic surgery.
We did the routine treatments on all of the in-house critical care cases. We milked some mares (done either to keep them to continue producing milk for when the babies can nurse or to feed that milk to the babies through a nasogastric tube.
Wednesday, I had my first patient! It was an older mare presenting with respiratory distress. She had a few month history of coughing and a heart murmur. While not good for the horse, it was very easy to hear (and feel) the murmur and the lung sounds. I was able to ultrasound her heart and lungs, which was pretty neat to do! We took some radiographs, looked at the lung pattern, and decided the treatment. We sent her home on steroids, antibiotics, and recommended meds for the murmur. I got to sign (and write) her discharge papers! She went home, and though she doesn't have a good prognosis, she's only being used as a pasture pet and will hopefully enjoy the rest of her life comfortably!
These 16 hour days are wearing on me. I'm nearly finished helping at the Franklin Co Emergency Management office, though... YAY!
Tuesday, about an hour after coming home, I got called in and was at school till 1am doing midnight treatments. I enjoyed working with Amy and Sam - it was Amy's first day, and so I'm glad I went in since Sam was still scrubbed in to the colic surgery.
We did the routine treatments on all of the in-house critical care cases. We milked some mares (done either to keep them to continue producing milk for when the babies can nurse or to feed that milk to the babies through a nasogastric tube.
Wednesday, I had my first patient! It was an older mare presenting with respiratory distress. She had a few month history of coughing and a heart murmur. While not good for the horse, it was very easy to hear (and feel) the murmur and the lung sounds. I was able to ultrasound her heart and lungs, which was pretty neat to do! We took some radiographs, looked at the lung pattern, and decided the treatment. We sent her home on steroids, antibiotics, and recommended meds for the murmur. I got to sign (and write) her discharge papers! She went home, and though she doesn't have a good prognosis, she's only being used as a pasture pet and will hopefully enjoy the rest of her life comfortably!
These 16 hour days are wearing on me. I'm nearly finished helping at the Franklin Co Emergency Management office, though... YAY!
Tuesday, April 13, 2010
Equine ICU is definitely different than ambulatory...
I am now 2 days in to my Equine Emergency/ICU rotation.
Yesterday, we had orientation from 4-6, which is the normal time for rounding everyday. After that, Melissa and I were assigned to work, with Sam on back-up. For learning's sake, Sam stayed with us for the evening - I'm really enjoying working with Sam so I was glad she stayed!
We spent the first few hours trying to figure out everything needed for treatments of the horses. There are currently a decent number of horses in the hospital. There are 2 sets of mares and foals in our NICU and then 2 more sets of mares and foals in Isolation (one set went home today - yay for them!!). Needless to say, it was a bit stressful figuring out where everything was (meds, syringes, needles, hay, grain, hoses, etc) but once we got the swing of things it was ok!
Because everyone covers all of the cases collectively, none of the cases are "mine" and also, none of the cases really belong to Emergency - they all belong to either Medicine or Surgery. It's kind of confusing to figure out everything, and even more confusing to keep track of it all!
Today in rounds, however, we each had to present a case. I picked a 16yo Thoroughbred gelding who presented on 4/5 with colic. He went to surgery and had a jejunocecostomy. Two days later, he was colicky again and went back to surgery. This time he had torsed just orad (towards the head) to the previous anastomosis. He has recently been put back on feed, but wears a muzzle when not eating to prevent him from eating the straw in his stall. Last night he began flank watching (looking at his side), so today some additional work-ups were done. On ultrasound there was normal distension of his small intestines and normal peristalsis. On rectal, he was found to have soft, passable feces with no abnormalities noted. He is currently on metaclopramide (to keep things moving) and banamine (for pain). He pooped just before I left the hospital today at 6pm!
I'm on back-up tonight... so I'll keep my phone handy. I wouldn't mind going in and working with Amy & Sam, but I'm also pretty exhausted! I'm spending my days this week and next at the Franklin County Emergency Management and Homeland Security office writing and working on the Animal Emergency Response Plan for the county (it can't leave the office, and office hours are 8-5... this is the only time I can do it!)...
Yesterday, we had orientation from 4-6, which is the normal time for rounding everyday. After that, Melissa and I were assigned to work, with Sam on back-up. For learning's sake, Sam stayed with us for the evening - I'm really enjoying working with Sam so I was glad she stayed!
We spent the first few hours trying to figure out everything needed for treatments of the horses. There are currently a decent number of horses in the hospital. There are 2 sets of mares and foals in our NICU and then 2 more sets of mares and foals in Isolation (one set went home today - yay for them!!). Needless to say, it was a bit stressful figuring out where everything was (meds, syringes, needles, hay, grain, hoses, etc) but once we got the swing of things it was ok!
Because everyone covers all of the cases collectively, none of the cases are "mine" and also, none of the cases really belong to Emergency - they all belong to either Medicine or Surgery. It's kind of confusing to figure out everything, and even more confusing to keep track of it all!
Today in rounds, however, we each had to present a case. I picked a 16yo Thoroughbred gelding who presented on 4/5 with colic. He went to surgery and had a jejunocecostomy. Two days later, he was colicky again and went back to surgery. This time he had torsed just orad (towards the head) to the previous anastomosis. He has recently been put back on feed, but wears a muzzle when not eating to prevent him from eating the straw in his stall. Last night he began flank watching (looking at his side), so today some additional work-ups were done. On ultrasound there was normal distension of his small intestines and normal peristalsis. On rectal, he was found to have soft, passable feces with no abnormalities noted. He is currently on metaclopramide (to keep things moving) and banamine (for pain). He pooped just before I left the hospital today at 6pm!
I'm on back-up tonight... so I'll keep my phone handy. I wouldn't mind going in and working with Amy & Sam, but I'm also pretty exhausted! I'm spending my days this week and next at the Franklin County Emergency Management and Homeland Security office writing and working on the Animal Emergency Response Plan for the county (it can't leave the office, and office hours are 8-5... this is the only time I can do it!)...
Friday, April 9, 2010
Emphasis on the fact that Dr. Burns is amazing!
Typically, the second Friday of the Equine Ambulatory rotation is when you get your grades. You're called in, one at a time, and the clinicians and interns give you your evaluation. That didn't happen today. Drs. Gallatin and Schmall decided not to come in today, so our grades will be posted on "one45" (a complex system the university pays for us to use) on Monday. I'm a little bummed that we didn't get the feedback, but will check my grade Monday to see how I fared.
Two of the students on my rotation went home after we played Jeopardy (which, by the way, my team won - yay!) because there were no calls. Dr. Burns squeezed four of us into her truck to go visit an acute lameness in a 17 year old Standardbred mare. We were able to locate the abscess, and begin the draining process to make her feel better. We applied MagnaPaste and wrapped the foot, with instructions to keep her inside with stall rest for 48 hours. She should be feeling better soon!
It's now noon, and I'm done for the day - and for the weekend! I am heading to the lake with Erin and the dogs! :) :) :)
Rotation #1: COMPLETE!
Two of the students on my rotation went home after we played Jeopardy (which, by the way, my team won - yay!) because there were no calls. Dr. Burns squeezed four of us into her truck to go visit an acute lameness in a 17 year old Standardbred mare. We were able to locate the abscess, and begin the draining process to make her feel better. We applied MagnaPaste and wrapped the foot, with instructions to keep her inside with stall rest for 48 hours. She should be feeling better soon!
It's now noon, and I'm done for the day - and for the weekend! I am heading to the lake with Erin and the dogs! :) :) :)
Rotation #1: COMPLETE!
Lameness...
We had a great morning meeting with Dr. Burns yesterday. After that, we went to our respective trucks. Dr. Burns was forced to take 4 students and Dr. Jury had room for 2. Amy and I went with Dr. Jury and signed up for Dr. Burns the following day.
We ended up meeting up with Dr. Schmall to do lameness exams. We examined 5 or 6 horses, each with a decently severe problem that needed treatment. We (and by we I mean Drs. Jury and Schmall [Amy and I were lucky enough to do betadine scrubs to prep the spot for 10 min]) injected joints (both hocks and stifles) and injected the back of a horse that seems to have issues in her "hip" area. Because Dr. Schmall does a poor job of explaining things and answers the question of "what are you injecting?" with "what do you think I'm injecting?", I have no clear answer as to what was injected into the muscles of the back. I have included a picture below.
After our really long appointment at that barn, we stopped to check on a horse with insulin resistance. He was very sweet and we were only there a brief time.
We ended up meeting up with Dr. Schmall to do lameness exams. We examined 5 or 6 horses, each with a decently severe problem that needed treatment. We (and by we I mean Drs. Jury and Schmall [Amy and I were lucky enough to do betadine scrubs to prep the spot for 10 min]) injected joints (both hocks and stifles) and injected the back of a horse that seems to have issues in her "hip" area. Because Dr. Schmall does a poor job of explaining things and answers the question of "what are you injecting?" with "what do you think I'm injecting?", I have no clear answer as to what was injected into the muscles of the back. I have included a picture below.
After our really long appointment at that barn, we stopped to check on a horse with insulin resistance. He was very sweet and we were only there a brief time.
Wednesday, April 7, 2010
Dr. Burns is AMAZING!!!
If I learned one thing today it is that Dr. Burns has more knowledge than anyone I've ever met before. My favorite thing about her is that she LOVES to share this wealth of knowledge with others for the betterment of everyone. SHE IS AMAZING! Dr. Burns is probably one of the best clinical teachers I could imagine existing.
Today we examined a 32 yr old mare (with PPID ["Cushings" <-- but not really) with non-weight bearing lameness in her left front limb. She's been previously laminitic and had a series of other problems. She is essentially the poster child for "Cushings-like-syndrome" in horses. We ended up blocking her foot to isolate the lameness, but were only moderately successful in exact identification. Because there are likely other issues occurring concurrently, we gave her some pain meds, wrapped the legs, and headed to the next appointment. She will get digital rads tomorrow.
Next we vaccinated 2 horses that are incredibly lucky horses. As Sam said... if she were a horse, she would want to have this lady as the owner. I agree. The lady was reading with her mare when we arrived, and picked up that again as we were leaving. Her 20 year old gelding looked like he was about 10 at most. She fox hunts (which I found out today is not actually hunting foxes at all) with him, and he is quite fit and healthy. It was a routine stop, but the horses were beautiful and very well loved.
We saw a colic appointment in the afternoon - it was my first colic. As we were trying to identify the mare with complications, she laid down in the field and looked at her side. Perfect. There was our colic case. We brought her in, and I sedated her. We ran a nasogastic tube to check for reflux, which was absent in quantities outside of normal limits. I gave an IV injection of Banamine and we told the owner how to handle the feeding and to call if there were any problems.
One horse needing spring shots was left. We gave the vaccinations and headed back to the clinic, getting back around 5 or so. It was a really fun, educational day. I love Dr. Burns and am really happy I had the opportunity to pick her brain as long as I did today!
Today we examined a 32 yr old mare (with PPID ["Cushings" <-- but not really) with non-weight bearing lameness in her left front limb. She's been previously laminitic and had a series of other problems. She is essentially the poster child for "Cushings-like-syndrome" in horses. We ended up blocking her foot to isolate the lameness, but were only moderately successful in exact identification. Because there are likely other issues occurring concurrently, we gave her some pain meds, wrapped the legs, and headed to the next appointment. She will get digital rads tomorrow.
Next we vaccinated 2 horses that are incredibly lucky horses. As Sam said... if she were a horse, she would want to have this lady as the owner. I agree. The lady was reading with her mare when we arrived, and picked up that again as we were leaving. Her 20 year old gelding looked like he was about 10 at most. She fox hunts (which I found out today is not actually hunting foxes at all) with him, and he is quite fit and healthy. It was a routine stop, but the horses were beautiful and very well loved.
We saw a colic appointment in the afternoon - it was my first colic. As we were trying to identify the mare with complications, she laid down in the field and looked at her side. Perfect. There was our colic case. We brought her in, and I sedated her. We ran a nasogastic tube to check for reflux, which was absent in quantities outside of normal limits. I gave an IV injection of Banamine and we told the owner how to handle the feeding and to call if there were any problems.
One horse needing spring shots was left. We gave the vaccinations and headed back to the clinic, getting back around 5 or so. It was a really fun, educational day. I love Dr. Burns and am really happy I had the opportunity to pick her brain as long as I did today!
Tuesday, April 6, 2010
I almost died twice today.
I guess that's being slightly dramatic, but it's kind of true.
After a fun morning with Schmall, telling stories of a clinician he had in school who referred to the girls as "angels of mercy" (except one, who he called "angel of death") as well as many other stories that had us laughing, Amy and I decided to ride with Dr. Schmall for the day.
Our first stop was to radiograph 2 horses. The first was a 3 year old Thoroughbred (prior race horse) who was young and misbehaved. I was holding the horse when something must have spooked him. He was standing about 2 feet away from $85,000 of digital x-ray equipment when he began freaking out on me and backing up. "Get him up!" Dr. Schmall frantically yelled to me. I was trying, as best as I knew how, pulling as hard as I could to try to move the horse forward and away from the equipment. I got him a few steps when he jerked his head as high back as he could, snapping the lead rope. Suddenly we had a 1000+ lb unrestrained horse much too close to the equipment. What do you do when all you have in your hand is the torn off end of the lead rope? Dr. Schmall tapped the horse's rear end to get him to move forward, but he reared a bit in my direction. Trying not to panic, I looked to the owner of the horse who was now standing by the horse and had just yelled something along the lines of "she no longer has control of him". Nope! I sure didn't! The horse came forward towards me, I stood my ground, she grabbed a hold of him and he calmed down. I took hold of him again and we were able to get the right radiographs. Whew! My heart was racing.
Our next stop was uneventful and pretty routine. We did a few lameness exams on a variety of horses, dispensed some meds, and headed to our next stop!
Our last appointment of the day also proved to be quite interesting. We began with a pre-purchase exam (something quite common in the world of horses - a veterinarian evaluates a horse and makes note of anything they find that seems to be abnormal and reports this information to the buyer and seller). Starting with the neuro exam, Dr. Schmall drilled Amy and I on cranial nerves. Needless to say, we were a bit rusty in naming ALL of them and giving the exact tests for them. Dr. Schmall told us that it was valuable information that we should know - the first thing I did when I got home (after laying top soil and planting grass) was look up neurological exams in horses. You better believe I'm prepared to answer tomorrow if Dr. Schmall asks me again.
After that, we had to look at a few lame horses. Typically uneventful, you jog the horse down and back in order to check the gate. It was my turn to run with the horse. I was handed a "nice horse" who had been on stall rest for a few weeks. "He's really good. He'll go right with you" Dr. Schmall noted. I "clucked" (I believe that's what it's called in the horse world) and the horse did NOT come right with me. He freaked out, spun around, and moved backwards the other direction. Pulling down hard a few times, he finally stopped. Whew! "Ok, now just try it again" I was instructed. And so I did. The damn thing did it again! Of course, it never fails that there is a group of people (including the owner of the horse, the owner of the barn, riders, etc) watching you attempt to control the horse. Really? This happened to me twice in one day? Yes, really. Twice in one day. After that, I got the horse to behave, jogged him, and examined his suspensory ligament. It was quite sore.
From that horse, we moved on to another in need of joint injections. Amy and I scrubbed the heel bulbs after Dr. Schmall had given local anesthetic (which was after I had given IV sedation). He injected the joints and Amy and I wrapped the feet! To the left is a picture - I did the right foot and Amy did the left (that's her in the picture!). We injected some mares with progesterone and headed back to school for the day. It was a long enough day for me.
Whew! I survived. The $85,000 digital x-ray machine and computer survived. And, I'll do it all over again tomorrow...
After a fun morning with Schmall, telling stories of a clinician he had in school who referred to the girls as "angels of mercy" (except one, who he called "angel of death") as well as many other stories that had us laughing, Amy and I decided to ride with Dr. Schmall for the day.
Our first stop was to radiograph 2 horses. The first was a 3 year old Thoroughbred (prior race horse) who was young and misbehaved. I was holding the horse when something must have spooked him. He was standing about 2 feet away from $85,000 of digital x-ray equipment when he began freaking out on me and backing up. "Get him up!" Dr. Schmall frantically yelled to me. I was trying, as best as I knew how, pulling as hard as I could to try to move the horse forward and away from the equipment. I got him a few steps when he jerked his head as high back as he could, snapping the lead rope. Suddenly we had a 1000+ lb unrestrained horse much too close to the equipment. What do you do when all you have in your hand is the torn off end of the lead rope? Dr. Schmall tapped the horse's rear end to get him to move forward, but he reared a bit in my direction. Trying not to panic, I looked to the owner of the horse who was now standing by the horse and had just yelled something along the lines of "she no longer has control of him". Nope! I sure didn't! The horse came forward towards me, I stood my ground, she grabbed a hold of him and he calmed down. I took hold of him again and we were able to get the right radiographs. Whew! My heart was racing.
Our next stop was uneventful and pretty routine. We did a few lameness exams on a variety of horses, dispensed some meds, and headed to our next stop!
Our last appointment of the day also proved to be quite interesting. We began with a pre-purchase exam (something quite common in the world of horses - a veterinarian evaluates a horse and makes note of anything they find that seems to be abnormal and reports this information to the buyer and seller). Starting with the neuro exam, Dr. Schmall drilled Amy and I on cranial nerves. Needless to say, we were a bit rusty in naming ALL of them and giving the exact tests for them. Dr. Schmall told us that it was valuable information that we should know - the first thing I did when I got home (after laying top soil and planting grass) was look up neurological exams in horses. You better believe I'm prepared to answer tomorrow if Dr. Schmall asks me again.
After that, we had to look at a few lame horses. Typically uneventful, you jog the horse down and back in order to check the gate. It was my turn to run with the horse. I was handed a "nice horse" who had been on stall rest for a few weeks. "He's really good. He'll go right with you" Dr. Schmall noted. I "clucked" (I believe that's what it's called in the horse world) and the horse did NOT come right with me. He freaked out, spun around, and moved backwards the other direction. Pulling down hard a few times, he finally stopped. Whew! "Ok, now just try it again" I was instructed. And so I did. The damn thing did it again! Of course, it never fails that there is a group of people (including the owner of the horse, the owner of the barn, riders, etc) watching you attempt to control the horse. Really? This happened to me twice in one day? Yes, really. Twice in one day. After that, I got the horse to behave, jogged him, and examined his suspensory ligament. It was quite sore.
From that horse, we moved on to another in need of joint injections. Amy and I scrubbed the heel bulbs after Dr. Schmall had given local anesthetic (which was after I had given IV sedation). He injected the joints and Amy and I wrapped the feet! To the left is a picture - I did the right foot and Amy did the left (that's her in the picture!). We injected some mares with progesterone and headed back to school for the day. It was a long enough day for me.Whew! I survived. The $85,000 digital x-ray machine and computer survived. And, I'll do it all over again tomorrow...
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