Journal Entry #1
October 12, 2005
I have now completed my first equine rotation and half of the soft tissue rotation. This year is going to fly by! I really enjoyed my equine rotation. It was a slow start with the first week seeing hardly any patients at all. I think I had one case that week (each student got their own cases). It was a Thoroughbred cross for a recheck - history of inflammatory airway disease. I took a history, did a physical exam, and watched as the clinicians used an endoscope to get an aspirate of tracheal fluid (they did a wash). I took the sample to clinical pathology for cytology. That week, we did a lot of studying and talking as a group. There were 8 students total in my equine rotation group. We got along well all 4 weeks. We had tutorials and practicals spread over the entire rotation, and I found these to be excellent. That first week we had: orientation, radiography, clinical anatomy, colic, and radiology.
The second week was also really slow. My only patient came on Thursday (we had patients for other students that I watched/helped with too). It was a 4 year old Thoroughbred mare who was very very lame (4-5/5) on her left rear leg. There was a large swelling over the dorsal proximal metatarsal region, especially medially. We took radiographs and saw osteolysis and bone remodelling. This was not a good sign, as it meant either osteomyelitis or some sort of bone tumour (extremely rare in horses). We ended up euthanising her, which was probably best as chances of her long-term survival were 10% or less. This is the first time I've ever seen a horse shot (I think they did it so we could see it). That second week we had tutorials/practicals on clinical pathology and bandaging.
The third week I had a patient in for nuclear scintigraphy. He was a Thoroughbred gelding and very well behaved and handsome. His previous workup had included trotting up & down, lunging, joint and nerve blocks, and radiography. They had seen evidence of bone spavin (osteoarthritis of the hock joint) in both rear hocks. He was lame on his right rear leg (2/5). I helped with the scintigraphy on Tuesday afternoon, and he was radioactive until Thursday. On Thursday I helped with re-evaluation of his lameness and nerve blocks. We agreed that the problem was likely the bone spavin (vs. the pastern joints, in which we had seen increased radio-pharmaceutical uptake). He went home on Friday I think. Thursday, I got in an Irish Draft Horse patient for a recheck. He had a wound on his belly previously, and we looked at it on ultrasound on Friday. It had healed just fine. That third week we had a practical on rectal examination (using a dummy horse w/real guts!) and a tutorial on pharmacology/therapeutics.
The last week I was on call from Monday until Sunday, and Kirsten was also on call with me. Of course it had to be busy! Monday was a holiday (as was the Friday before). Tuesday night, a 37 year old donkey jenny came in and this became my case. She presented for colic, but didn't really have colic signs. Wanted to lay down a lot and had nasty halitosis. She came with her daughter (inseparable). On Wednesday we took radiographs of her teeth and they pulled part of a molar that had broken off. She was started on phenylbutazone and penicillin (IM). But she still wasn't eating well enough, and her appetite only decreased. Saturday we put an IV catheter in her, and swtiched from bute to flunixin (Finadyne) IV for pain - also from IM penicillin to IV (Crystapen). The clinician also placed a naso-oesophageal tube and I had to feed her through it every 4 hours, 5 times per day (luckily not between midnight and 8am!). That was quite time-consuming. We had drawn blood for triglycerides and found her to be hyperlipidaemic (not uncommon with donkeys). I hear that after my rotation ended, they started her on total parental nutrition (food via IV).
Wednesday late afternoon, a colicky Clydesdale filly came in. She became Kirsten's case. She didn't have many signs of colic - no nasogastric reflux, not much on ultrasound, and the peritoneal fluid wasn't so bad. Her main problem seemed to be osteochondrosis dissecans of the hock and extensor tendon laxity. Wednesday at 1am, another colic came in - and it was a 4 month old Thoroughbred colt. We were up all night with that one. Our major finding was 12+ litres of nasogastric reflux. After we refluxed him, he did very well for the next several days and as far as I know was going home yesterday. He and his mother were a lot of work, with frequent checks the first few days. Very cute though! Fluffy coat and he liked to nibble on you. Thursday was amazing to me - I functioned somehow with 1.5 hours of sleep on me and even made it through an ophthalmology tutorial. Other tutorials that week were on intensive care and cardiology. Friday we had our "spot exam" in the afternoon and then received our evaluations. I did just fine or maybe even more than fine, but wished to have done better (as usual). Saturday around noon I was called in for an emergency. It arrived around 2pm - an Arabian cross who had "choke" (oesophageal obstruction). I helped the resident flush out the oesophagus via a nasogastric tube and keep the horse sedated. Finally we flushed out the blockage. We used an endoscope to check things out - there was a linear laceration of the oesophagus (not full-thickness) and food was found in the airways and even into the carina. The horse was put on three antibiotics and an anti-inflammatory drug for pain (flunixin). Sunday was our last day on call and we were there until 1am feeding the donkey. :)
Now I'm on soft tissue surgery, beginning at 9am Monday morning. We had 3 cases that day, none too exciting (no surgery). One was hospitalised - a dog with pyometra and a permanent tracheostomy. The others included a cat with megacolon and a cat with a non-healing wound on its dorsal hind leg. Tuesday there were no cases (one was due in but it never showed up) - so we worked on case problems that we were given for a tutorial on Friday. We also went through some cases with the surgeon and one of the students on my rotation helped with the pyometra surgery (spay). Today (Wednesday) my rotation group (me and two other students) went to the cat & dog home. I got to do half of a bitch spay, and one of us did one whole bitch spay (except closing). It was a pleasant experience because the vet was a very good teacher and we managed to get each one done in less than an hour. I had the afternoon off.
Tomorrow we get to help with the suturing practical that fourth year students get, and then on Friday we have grand rounds (with one of us presenting a case) and pathology demonstrations - plus a tutorial in soft tissue surgery. Next week we're on to anaesthesia, which I look forward to as hopefully one of my favourite rotations.
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