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.
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