The New Vet in The New Job

I'm settling in to the new job. I've had to make some mental adjustments--I still feel a twinge of anxiety when I leave at 5pm, after everyone else already left at 4:30pm. Vet school leaves deep scars, that's for sure.

I have had a string of very interesting cases these past few weeks and have really been knocking out some cool diagnoses based only on what I see in the animal remains--which are later confirmed with ancillary tests or by looking at microscopic slides of tissue. I think it's a combination of beginner's luck and a fairly decent vet med foundation.

There is a rule of thumb in vet med that goes like this: "don't go looking for zebras." I've also heard it expressed as "common diseases present uncommonly." In other words, if you see strange things, you shouldn't be thinking strange problems, although those are always possible. You should be thinking about common, garden-variety problems first.

Here are two good examples of this.

Case 1: intact female pit bull mix, 5 years old, history of vomiting, died suddenly. Before I even touched her, I took one look at the dog on the table and told my tech, "it's pyometra." Sure enough, there was more than 400 mL of brown, cloudy fluid in her left uterine horn. She died of sepsis as the bacteria and their toxins started leaking out into the rest of her body. It was not a good death. But it is a very common one for intact female dogs with this signalment and history. Her breed was one red flag. Her age was another. Five years old and still intact? Either a stray or a backyard breeder. A rescue org or a shelter would have spayed her. Sure, a foreign body or gastric volvulus (twisting) would have caused untreatable vomiting and death. And both were certainly on my list. But vets are trained to make a ranked list of differentials. And pyometra was at the very top of the list for this dog.

Case 2: neutered male Boxer, 5 years old, progressive neurological signs over period of 18 months that were not responding to anti-seizure meds. I told my colleague, "it's a brain tumor, probably a glioma." Sure enough, I found a huge gelatinous tumor in the left cerebral hemisphere, confirmed by a board-certified pathologist to be a malignant oligodendroglioma. Boxers are poster-children for gliomas. I also found changes in the valves and right side of this dog's heart that I carefully described in my report. The pathologist confirmed a right-sided cardiomyopathy of a kind that is very specific to Boxers. While in school, I learned about diseases that are more common in certain breeds of animal, and I went looking for those particular lesions. And found them, to my great satisfaction. This was a good case because it gave a lot of closure to both the referring veterinarian and the owners--there was nothing they could have done differently to change the course of disease or the outcome.

Cases 3 and 4: backyard laying hens, history of losing weight, died suddenly. Both submitted today from different owners. I told my tech, "it's either ovarian/oviductal carcinoma or it's yolk peritonitis. Equally likely." It was aggressive ovi carcinoma in both cases. In a surprise zebra finding, one of the birds had right-sided dilational cardiomyopathy and ascites. Didn't expect that, it's more common in broilers and even then you rarely see it in the U.S. But this hen had what I think is a metastatic tumor in her left ventricle, which appears to have caused upstream problems in the right side of her heart and so on and so forth. Histopathology on the heart nodule will confirm whether I'm just making shit up or whether I'm right.

Don't misinterpret these tales. This is not some game of pool where I'm calling 8-ball in the corner pocket. It is appropriate to think of differentials for any case before you begin the necropsy. You want to be prepared.

For example, whenever I am presented with an exotic animal (for example, I've worked on a snake, a bobcat, and a kangaroo), I research possible zoonoses before I even walk onto the necropsy floor. Zoonoses are diseases (or parasites) that humans can get from animals. We can get zoonoses from pet dogs and cats but there are some increased risks when you work with exotic animals. I want me and my support staff to be prepared with appropriate protective gear. I want to be able to specially identify samples if there could be a risk to other lab personnel.

As a newly minted veterinarian, it's validating to do a necropsy, find lesions, describe them, suggest some possible diagnoses, and have other tests confirm my analysis so definitively. Sure, I make mistakes. Sometimes I miss important lesions. Sometimes I don't collect the right samples. But I'm learning, and I'm gaining confidence in my ability to recognize when something is not normal. I may not always identify the disease process in detail, and I may not always properly rank what I see (abnormal doesn't mean important). But I'm getting exposed to a wide array of disease processes in lots of different species.

And I am slowly learning that I can leave work at 4:30pm and everything is just fine.

Archie, The Delicate Flower

For weeks, the outside temperature has been only a couple of degrees cooler than the surface temperature of the Sun. Nonetheless, Archie is convinced that he is not able to get even a moment of proper sleep at night unless his entire body is in contact with mine and he is covered with a blanket. As soon as Archie is ready to sleep (there's always play time first!), he will begin pawing at my arm, which means he wants me to lift up the edge of a blanket so he can slide under it, preferably right next to me. A complicated dance ensues as I try to cover him without having the blanket cover any part of me. Why would I need a blanket? I’ve got a 12-kg, fur- and blanket-covered heat factory attached to me all night long. 

I'm quite excited that Archie starts agility class this week. The local club holds its agility classes outside, so I hope that it cools off as predicted in the next couple of days. I am not sure my delicate flower from the PNW is ready for the heat and humidity. I bought him a cooling vest, and plan to have plenty of cold water and a fan for him. For us both!

I introduced Archie and myself to the club via email. They asked me to do a brief skills test with Archie and one of their instructors. I thought that was reasonable and readily agreed. The instructor had come up with a rather difficult Jumpers-style course that was 17 obstacles in length but that only used 9 obstacles so most were repeated in various tricky ways. Archie of course crushed it. She then said, what about his contacts? I ran him up and down the Aframe a couple of times. He nailed that too. Weaves?, she asked. To show off a bit, I rear-crossed him as he flew through a set of 12 poles. No surprise, then--we are in the Advanced Class. It will be interesting to see how this goes for us.

I'd like to find a private instructor but that is going to take more time. We are going to need to start going to trials, get known by the AKC agility community out here, let word get out that I'm looking for that.

I Smell Funny

So it's really hot and humid here in Little Rock. The necropsy floor opens onto a loading dock and temperature in there is only tolerable at best.

I wear business casual clothing to work, but change into scrubs for necropsies in the afternoon. I add a swaddling, impermeable, disposable lab coat and long-cuff, heavy-duty gloves. And I sweat like a beast of burden.

Humidity, sweat, and dead animals create a potent odor combo. I wash my hands and face. I change back into normal clothes.

And I still smell funny when I get home.

Thankfully I live with dogs and a cat. They don't seem to notice. They probably think that I smell better.

I Discover A Superpower

Convo, regular version:
"Happy Pets Animal Hospital. Can I help you?"
"Hi, yes, is Dr. X available?"
"She is in a room with a client/not here/gone home/not available. Can I take a message?"

Convo, superpower version:
"Happy Pets Animal Hospital. Can I help you?"
"Hi, this is Dr. A at the Veterinary Diagnostic Lab in Little Rock. Is Dr. X available?"
"Oh yes, just a minute, she really wants to talk to you!"

When I interviewed for this job, I got the impression that communication is one aspect that previous occupants of this particular job have not performed well. This has been confirmed more than once in my discussions with the director. Our clients are better served when they get information sooner. The reputation of the lab is bolstered when we add an invested, concerned name and voice to our necropsy cases. So I've been trying to call every referring veterinarian (or commercial producer) as soon as I complete their necropsies to chat about my preliminary findings.

This is how I discovered that I now have a superpower. It turns out that they quite value having a peer give them a ring to chat about their difficult cases. And I don't even have to wear a cape.