Internal Medicine is a delicate dance

So, internal medicine can be pretty intense.  It starts early, really early if you're on treatments (every other day) and have a patient to attend to.  The other days, we do appointments with the doctors (we take the history initially, do the first physical, report to the doctor, come up with differentials and ideas of how to proceed).  We also do the early morning treatments for our patients in the hospital (check fluids, basic systems, weight, blood pressure, blood draws, giving medications, and all such stuff) and the late day treatments.  We get new patients through the VHUP Emergency Service and transfers from other departments and appointments during the day.  So, you never know what may wander your way, needing a blood transfusion or constant fluids or lots of monitoring.  It's actually fun.

And you get to work with some wacky doctors.  The attendings are all wacky smart and seem to know pretty much everything...and thus-far I've avoided terribly heavy grilling - which makes me feel terribly dumb.  Apparently, I don't know much.

Two hours every day (at least) seem to involve rounds - conversations and grilling on topics in internal medicine.

There's also a lot of writing on your patient - what does the patient have?  What might be causing it?  What might be causing it?  What might be causing it?  What should we do?  Really?  We should do that?
Anyway, it can go pages and pages...

12 hour days are standard.  Most folks have to go in every day (yes, Saturday and Sunday) to take care of patients.  2 nights during the month I do treatments in the evenings, so I'm there until at least midnight.  Then you're back at 6am for treatments.  Sleep deprived fun.  Makes me an unhappy student the next day.

So, cross your fingers for 3 1/2 more weeks of middle-of-the-road case loads, so I can get some sleep and learn while I'm treating the beasties.

And yes, the catlings are not happy with the new tired, stressed Sandra.

But, I'm learning stuff.  Hopefully I'll learn lots more.

The Schedule - if you want to find me, here I am!

You might say, when is Sandra doing all these things?

I thought I would give you an overview of the schedule to come this year.

       Rotation #       Name                                   

• 1 & 2 -          S(mall)A(nimal) Medicine   5/12-6/6
• This is the biggest, baddest small animal rotation - 14 hour days are routine and then we're on call

• 3 -                  SA Pathology    6/7-20                  
• This is all about anatomic and histologic analysis of our departed beast friends.  Like a coroner for animals. 

• 4 -                   SA Cardiology     6/21-7/5                
• This is what is sounds like - hearts, ECGs, and more hearts.

• 5 -                   L(arge) A(nimal) Medicine   7/6-18
• This is 2 weeks of basic horse/cow/small ruminant medicine at New Bolton Center.

• 6 -                   Field Service     7/19-8/1
• This is vets in trucks who go out to treat local equines & cows within about half an hour or so of New Bolton Center.  It's like Dirty Jobs, but real.

• 7 -                   LA Surgery   8/2-15
• This is the sometimes-hellish surgery-on-horses (mostly) rotation.  It often involves being yelled at and doing a lot of standing in the OR.

• 8 -                   SA Pediatrics    8/16-29
• Back in Philadelphia after my 6 week sojourn in Kennett Square.  Pediatrics is just that - lots of shot, lots of genetic diseases, and - if you're lucky - squiggling puppies!

• At the end of this month, my other pediatrics project is due.  Squiggle Platt is due to be born August 22nd!

• 9 -                   SA Ophtho   8/30-9/12

• 10 -                1 Week Vacation    9/13-18

• 11 -                Camelid       9/19-10/10

• 12 -                SA Soft Tissue    10/11-24

• 13 -                Special Species      10/25-11/7

• 14 -                SA Dermatology     11/8-21

• 15 -                SA Emergency Service     11/22-12/5

• This is probably the week I will take the National Board Exam

• 16 -                SA Radiology      12/6-19

• Christmas Rotation - Emergency Service    12/20-26

• 17 -                Newark VCA       1/3-17

• This is also known as the start of job hunting

• 18 -                SA Oncology      1/18-30

• 19 -                SA Anesthesia       1/31-2/13

• 20 -                LA Emergency/Critical Care       2/14-27

• 21 -                SA ICU  (sorta funny to have small and large animal critical care back-to-back)

                                                                    2/28-3/13

• 22 -                Sheep Station      3/14-27

• 23 -                SA Emergency Service      3/28-4/10

• 24 -                Vacation        4/11-24

• 25 -                Shelter Medicine        4/25-5/8

•  GRADUATION        5/16

SA Internal Medicine (or IMED, as I call it)

Let's talk about this.  This rotation is the only 4 week rotation.  This is also traditionally a rotation which is light on the sleeping.  I'm not sure how often we'll be able to have these little chats. 

What we do in internal medicine - we take care of those sick dogs and cats who do not need surgery or have a diagnosed cancer or need care from our intensive care unit.  Everything from testing for diabetes and other endocrine problems and canine influenza (kept in isolation) to giving blood transfusions will be on the table.  This is a big hunk of small animal veterinary medicine.  In smaller practices, neurology is also encompassed in this area of practice, but being VHUP, we have a separate neurology department.  However, the practice is generally pretty broad and also includes scoping (what you human folks would consider a Gasteroenterology department), analysis of radiographs (what the rest of the world calls x-rays), ultrasounds, CT scans, and MRIs under the guidance of our radiologists, and lots and lots of blood and body fluid analysis.

On all rotations I will be responsible for writing up daily SOAPs for my patients.  The SOAP defines the Subjective, Objective, Assessment, and Plan for each patient each day.  These are extensive and define all the differential diagnoses (potential causes of each medical sign) for the patient.  They will change from day to day depending on how the patient is doing.  They're difficult to learn to write and - due to their extensive nature - tend to take a while.  I will have to have the SOAP for my patients done by 7am (and their AM treatments).  Each day I will have medical rounds, in which we discuss relevant medical topics and our patients.  I will also treat patients.  Some days I will be responsible for seeing appointments, and this depends which clinician I am working under.  These appointments often become inpatients who I will treat for the duration of their stay.  We also pick up patients from the Emergency Service each morning, and I may get new patients there as well.   

So that gives you a sense of what I'm doing. 

LlamaLland - The Twirling Dance

Welcome to the VetMouth

May 10, 2010 until May 16, 2011 I will be a 4th Year veterinary student.
It is a treacherous year.
I expect to experience panic, sleep deprivation, the joy of hunches, and massive unpreparedness as I get ready for professional practice.

I hope this blog lets you experience my last of veterinary school with me!

Academic Feats

• 19 different clinical rotations ranging from "Special Species" to "Large Animal Emergency and Critical Care"

                  4 at New Bolton Center in Kennett Square, PA  (I'll be "living" in Kennett         

                                                                                                        Square for 8 weeks)

                 15 at The Matthew J. Ryan Veterinary Hospital, in West Philadelphia

• 1 Clinical Externship at large practice in Newark, Delaware (there will be job searching)

• 1 Trip to Corvallis, Oregon to take a class in Camelid Medicine

• 1 Trip to Dubois, Idaho to work at the USDA Sheep Station facility

Extracurricular Feats

• Take the National Veterinary Board in November/December

                  *** hopefully, I'll also pass

• Welcome my first niece/nephew in late August

                   *** B'sha tova! In a good time!

• Get my first job as a veterinarian

                   *** hopefully a good job

• Find a brand new place to live, probably in a new city
  

                   *** hopefully near the new job

• And find a dog to come live with me

                   *** intended to live in the new home

See you at graduation - May 16, 2011!