small animal surgery

starting March 17 I have been on small animal surgery, which is the rotation with the rep for being the toughest hour wise, and I would have to agree...
On Monday I showed up at 7am, and holy crap we had 4 transfers to three students (which is a lot, normally you get 1-2 transfers a day total). And so began my life in clinics...the SOAP! what do I mean when I say I am going in to school to SOAP a patient? no I am not giving a dog a sponge bath...SOAP stands for Subjective, Objective, Assessment, and Plan, and it is a systematic way that I have to write up my patients in their charts. So every morning I get to school a couple hours before we round with the clinicians, and I perform a physical exam on my patients, write up their orders for the day, and write up my SOAP. The process takes about 20-30 minutes per patient.

Then sometime between 7:30-8am we meet with the clinicians and go from cage to cage of our patients and tell the story, for example, totally made up, but it would involve me standing in front of a cage saying something like this :
"Mollie is a 5 year old spayed female doberman with a 1 month history of lameness in her right front leg that worsened after rest. She presented to her RDVM and an orthopedic exam was normal but radiographs revealed that she was suffering from DJD of her right elbow joint. She was referred to Tufts for elbow arthroscopy. Her bloodwork and physical exam were within normal limits today except for a mildly elevated cholesterol and some discahrge in her right ear. She is scheduled for surgery this afternoon and after the procedure we will keep her comfortable on buprenex as pain management. I do not think there is a need for antibiotics at this time. She should go home tomorrow if all goes well on rimadyl and tramadol." or something like that, and the doctors then most of the time agree, sometimes make suggestions on how to better manage my patient, and sometimes they grill me on my knowledge about the case, which in this make believe case would probably be something like "what are the four main radiographic findings in elbow dysplasia? how do you anticipate Mollie doing after the procedure? what is her prognosis? what is the percent chance that her left elbow is also affected?" etc. etc.

Once rounding on all our patients are done we either go in to surgery or see appointments. I handle all the requests, like submitting prescriptions on my patients, rad or anesthesia requests, etc. I love seeing appointments, in which I go in get a history from the client, do a physical exam on the pet, write it all up and report it to the doctor, and then we both go back in and he/she repeats a lot of questions and discusses options with the owner, and then we go from there.
In surgery I scrub in for all my surgery patients, and then the rest I either stand off to the side and watch or scrub in as well if they need extra hands. I write all the surgery reports and discharge paperwork to the referring vet and client, and the doctor double checks them when I am done. Thank goodness in two weeks I have NOT passed out in surgery...I have gotten quite comfortable with the whole surgery thing actually.

ok, back to my actual experience. My first day was BUSY!!! Then day 2 I was on call, and ended up being stuck in an emergency thoractomy (cutting open the chest, this time cause the dog was bleeding out in to its chest and we did not know why) until 2am. Of course after the surgery I was back at school at 6am, so I had to live on 3hours of sleep, yuck. I have learned so much, and while I tend to be a little slower on remembering all the facts from class I am quite quick at getting all the paperwork done and keeping things going quickly and efficiently.
Things are slower now then they were at first (thank god). Some memorable moments from my first three weeks:

Bailey a yellow lab with an ossifying epulis, a tumor on the jaw, we removed the first 2 inches of his mandible and he did GREAT! He was a sweetheart. I had my first panic attack over him, I woke up in the middle of the night and started panicking that I had not written to only give him soft food in his orders, but in the morning I was relieved to see I had written it all right.

Buddy was a min pin diagnosed by two vets (including ours) with a perineal hernia but he was so painful no one actually got a full rectal on him (whhich is the only way to properly diagnose a perineal hernia). Well, after knocking him down we found that he had a weird outpouching in his rectum and a rectal perforation in to his thigh muscles (we had to cut them open to drain all the shit out). His prognosis was poor, and I gave him so much TLC, everyone thought he was a abd dog but it really was just cause he was SO painful before the surgery. And despite his poor prognosis he went home last Friday doing well!

Ivy was an older lab with a sarcoma (cancer) on her lower right hind leg that could not be resected, so we amputated her whole leg. Pain management in a leg amputation is a lot of work, but I was proud to work so losely with the anesthesia doctors to get it right with Ivy. I talked to her owners twice a day with updates. And I happened to be there when they picked her up three days later...they were so happy to meet me, I got so many hugs, and met the whole family as they loaded Ivy up in to the SUV with the kids, it was really sentimental and hit me hard.

I have seen a lot more then that, but those three cases stick out in my mind a lot. Important ones that I will always remember.

Well, off to bed while I wait for the phone to ring since I am on call tonight.