Class of 2016....how ya doing?

Veterinary Science Graduate Certificate from UofI
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Officially licensed to practice in Rhode Island. I still need to apply for my DEA license but I was told I could wait until I'm up there to do that, especially if I want the hospital to pay for it.
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dyachei said:
I checked AVMA then GA specifically. Maybe you can talk to your medical director?
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FYI, the Georgia VPO told me during my USDA certification class that it was state law we wouldn't couldn't give Rabies until we were certified.
 
Jamr0ckin said:
FYI, the Georgia VPO told me during my USDA certification class that it was state law we wouldn't couldn't give Rabies until we were certified.
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OK but then they need to make it known. Because they don't have it listed anywhere and it's not the norm anywhere else.
 
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dyachei said:
OK but then they need to make it known. Because they don't have it listed anywhere and it's not the norm anywhere else.
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I know, and I told them that. One of the people at the accreditation thing had been giving Rabies because it's such an obscure rule.
 
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I've been treating a veiled chameleon for severe metabolic bone disease. When I first saw him, I didn't expect him to live much longer. Saw him on Friday and he looked awesome! Owners are doing everything right to help him, which makes me super happy.
 
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psilovethomas said:
I've been treating a veiled chameleon for severe metabolic bone disease. When I first saw him, I didn't expect him to live much longer. Saw him on Friday and he looked awesome! Owners are doing everything right to help him, which makes me super happy.
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Go you! They're fragile little buggers.
 
I'm a little in love with a clinic, they like me, and pending anything crazy I'm pretty sure I found my job. It isn't perfect, but the two vets who own the place have a real drive for constant improvement and it's the "nice" clinic in a lower-income, smaller town a bit less than an hour away. Commute is the only big big downside. They see a lot of second opinion cases for people who don't want to go for a legit referral and are aiming for AAHA accreditation. There are definitely some things that made me cringe a little, but the vibe is fantastic and it's the type of jack-of-all-trades clinic I really want. Excited. Had neurogenic kcs, enamel hypoplasia and cutaneous lymphoma cases in today. (how crazy)!
 
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Feeling like I did something completely wrong in regards to this case, even though I know that there wasn't anything I could have done to prevent the complication, **** just happens. Still makes you feel like crap.
 
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orca2011 said:
Same here. Struggling with a few things and trying to get better but messing up still. After my overnight last night, would just love to do some GP work.
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I've just had a lot of crappy cases with crappy prognoses all on top of each other. Like I'm dying for some vaccine appointments actually. At least I'm seeing things during "business hours" but my shifts have been 7:30-8:30/9 lately. After multiple days in a row of that, it wears you down. At least today I'm feeling like we've caught up on all of the paperwork, calling clients, etc.
 
I got my first paycheck! But it only had like three days on it due to my weird start date, so I'm holding off on the excitement until next week.

Fixed a cloacal prolapse in a parakeet this morning. Between her and the hospice chicken, all of the techs are just super amused by the crazy exotics new grad.
 
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DVMDream said:
I've just had a lot of crappy cases with crappy prognoses all on top of each other. Like I'm dying for some vaccine appointments actually. At least I'm seeing things during "business hours" but my shifts have been 7:30-8:30/9 lately. After multiple days in a row of that, it wears you down. At least today I'm feeling like we've caught up on all of the paperwork, calling clients, etc.
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I ended my overnight with that. And I feel crappy cause I had hoped maybe he'd have bounced back with some fluids/a bolus and then he tanks, so I like super undershot the estimate. He ended up getting possibly encephalopathic, so he ended up getting PTS by the criticalist who took over. I just felt bad for the cat, for putting her in a position to be potentially reamed at by the owner and just that I wasn't as clear with the owner as I should have been.

Followed that up with getting blown up at by one of the other staff doctors in front of everyone for something pretty stupid. It wasn't a medical mistake. but I put something on her transfer list with intent of transferring but my notes made it sound like a guaranteed them the transfer, which I guess sort of happened since I forget that that's not how it works outside of academia and she was under the immediate impression that they wouldn't be up for all the diagnostics (o totally were...the bf even was willing to do a emergency MRI on the cat even though it wasn't currently seizing and could wait until Monday). Just brushed it off, but I don't need that kind of stuff after an overnight.
 
orca2011 said:
Followed that up with getting blown up at by one of the other staff doctors in front of everyone for something pretty stupid. It wasn't a medical mistake. but I put something on her transfer list with intent of transferring but my notes made it sound like a guaranteed them the transfer, which I guess sort of happened since I forget that that's not how it works outside of academia and she was under the immediate impression that they wouldn't be up for all the diagnostics (o totally were...the bf even was willing to do a emergency MRI on the cat even though it wasn't currently seizing and could wait until Monday). Just brushed it off, but I don't need that kind of stuff after an overnight.
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I am fully convinced that there is nothing that causes more drama in a specialty practice than case transfers. Absolutely nothing. No matter what service, what day, anything.
 
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nyanko said:
I am fully convinced that there is nothing that causes more drama in a specialty practice than case transfers. Absolutely nothing. No matter what service, what day, anything.
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It's not limited to specialty. We're a four doctor practice and we still have wailing and gnashing of teeth over transfers. Seems like no matter how thorough your notes are before you leave, the other doc will ALWAYS find something you missed.
 
Coquette22 said:
It's not limited to specialty. We're a four doctor practice and we still have wailing and gnashing of teeth over transfers. Seems like no matter how thorough your notes are before you leave, the other doc will ALWAYS find something you missed.
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Yeah there's that then the fact that as an intern you are the person who gets the brunt of all the pissed off specialists, both on the transferring end and receiving end. Who thinks this possible HE case should go to medicine or neuro first, blah blah blah. Even if you aren't the one who took the case in and it was your ER senior, if you're the overnight intern you're the one gonna get yelled at in the morning.
 
nyanko said:
Yeah there's that then the fact that as an intern you are the person who gets the brunt of all the pissed off specialists, both on the transferring end and receiving end. Who thinks this possible HE case should go to medicine or neuro first, blah blah blah. Even if you aren't the one who took the case in and it was your ER senior, if you're the overnight intern you're the one gonna get yelled at in the morning.
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100% my life right now. Then if I don't transfer it, I get yelled at for not doing so. You can't win. And I'm fine with dealing with it and not letting it destroy my day but doesn't stop it from being frustrating.
 
I hear you, as a neuro intern even I knew the morning was going to need some sorting out and discussion if there was a young pug or yorkie in the hospital with neuro signs, lol.
 
To residency or not to residency, that is the question...
 
I'm quite happy with my clinic so far. There are definitely a couple spots I'm nudging change in, but both of my bosses are as hands on or hands off as I ask them to be, the clientele has a good portion of people just trying to do what they can for their pets, and my interests fit in really well with what the other doctors don't particularly like - I have seen so many cats and exotics, ha. They're busy but have enough time scheduled to pretty much always have an hour+ for lunch, so I get to spend lots of time futzing around looking things up, playing with equipment, etc. Same with the end of day, appointments are only scheduled until an hour before close so I usually have some time to decompress and investigate things after afternoon appts. It's really nice to have time and a support system.

In retrospect, I really regret not taking our ultrasound rotation. I hedged my bets that wherever I was hired probably wouldn't have a machine, and feel like I could be using the machine much more effectively if I knew what I was doing with it more...
 
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to residency! (but first, to specialty internship)
 
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Trilt said:
In retrospect, I really regret not taking our ultrasound rotation. I hedged my bets that wherever I was hired probably wouldn't have a machine, and feel like I could be using the machine much more effectively if I knew what I was doing with it more...
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What I remember from my ultrasound rotation is that if they point at the screen and ask you what it is, and you have no idea, it's probably the pancreas.
 
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kcoughli said:
What I remember from my ultrasound rotation is that if they point at the screen and ask you what it is, and you have no idea, it's probably the pancreas.
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Or an adrenal gland. Don't forget that.

Shortly after getting out into practice (like, within a month or so) I had a non-specific gastoenteritis dog - 3 months old - that the doc before me admitted and I took over on my shift. It was one of those that just felt a bit odd - smacked of parvo, but not quite (and negative test) - so I did a quick scan - something between an aFAST and a "real" abdominal ultrasound. Found this weird big cyst-like thing in the cranial abdomen. Maybe 8-9cm?

Stared and stared. Tried to decide what the heck that could be. Couldn't decide. Maybe pancreatic cyst, but that's not really documented in a 3-month-old. Some other cyst? Do I poke it? Don't poke it? Decided that dog was improving, leave well enough alone. Dog did great, but I sent it off to IntMed for a real ultrasound - very committed owners, and I told them "this is weird" - just to see if this was something 'real'.

IntMed did their scan and said "yup, this is weird. Dunno. Maybe pancreatic cyst. Recheck in a month since the dog is doing great."

Moral: Trust yourself. What you see on ultrasound probably is what you think it is.
 
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LetItSnow said:
Or an adrenal gland. Don't forget that.

Shortly after getting out into practice I had a non-specific gastoenteritis dog - 3 months old - that the doc before me admitted and I took on rounding during my shift. It was one of those that just felt a bit odd, so I did a quick scan - something between an aFAST and a "real" abdominal ultrasound. Found this weird big cyst-like thing in the cranial abdomen. Maybe 8-9cm?

Stared and stared. Tried to decide what the heck that could be. Couldn't decide. Maybe pancreatic cyst, but in a 3 month old? Dog did great, but I sent it off to IntMed for a real ultrasound - very committed owners, and I told them "this is weird".

IntMed did their scan and said "yup, this is weird. Dunno. Maybe pancreatic cyst. Recheck in a month since the dog is doing great."

Morale: Trust yourself. What you see on ultrasound probably is what you think it is.
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What did you see on recheck?
 
PrincessButterCup said:
What did you see on recheck?
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Ha. Fair question.

It was gone a month later. The IntMed doc that I txfr'd to (a boarded internalist) stuck with "No idea." They talked to the owners about surgical explore (when we first saw the cyst), but even at that point the dog was essentially back to normal (bouncing off the walls puppy), so they decided not to explore and do the recheck in a month instead. By then it was gone.

Most likely a pancreatic pseudocyst (differentials would be mass or abscess). You see them with pancreatitis sometimes, and if the patient recovers normally the pseudocyst goes away within a few months. What is weird is the age - that doesn't fit well with pancreatitis.

I dunno. Maybe the dog had some viral gastroenteritis and the inflammation was enough to piss off the pancreas and it developed a pseudocyst. Could speculate all day, but in the end - dunno. :)
 
LetItSnow said:
Ha. Fair question.

It was gone a month later. The IntMed doc that I txfr'd to (a boarded internalist) stuck with "No idea." They talked to the owners about surgical explore (when we first saw the cyst), but even at that point the dog was essentially back to normal (bouncing off the walls puppy), so they decided not to explore and do the recheck in a month instead. By then it was gone.

Most likely a pancreatic pseudocyst (differentials would be mass or abscess). You see them with pancreatitis sometimes, and if the patient recovers normally the pseudocyst goes away within a few months. What is weird is the age - that doesn't fit well with pancreatitis.

I dunno. Maybe the dog had some viral gastroenteritis and the inflammation was enough to piss off the pancreas and it developed a pseudocyst. Could speculate all day, but in the end - dunno. :)
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I see you left your crystal ball at home today. ;)
 
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Did my first solo foreign body removal on a dog yesterday. Rock and a nail mid jejenum. One enterotomy site that I closed with simple interrupted and an omental patch. Dog is already eating and feeling great. I'm still in denial that I did it correctly and am waiting for it to return with peritonitis or something a few days after discharge.
 
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Jilary said:
Derm is pretty cool and in general you don't have to deal with heart wrenching cases.
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It's been like the only thing that has truly stuck for me throughout school. And I've done a FAD and food trial with my own dog prior to diagnosing him with atopy so I can relate with owners. Lifestyle associated with it doesn't hurt. Only down side is that I think I'd want to do it at Penn and I'm not sure if they're taking anyone one this year as they're not listed in the Match. So I might take a year or two off before deciding I really want to do it.
 
orca2011 said:
It's been like the only thing that has truly stuck for me throughout school. And I've done a FAD and food trial with my own dog prior to diagnosing him with atopy so I can relate with owners. Lifestyle associated with it doesn't hurt. Only down side is that I think I'd want to do it at Penn and I'm not sure if they're taking anyone one this year as they're not listed in the Match. So I might take a year or two off before deciding I really want to do it.
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I know a super awesome dermatologist that used to teach at Penn. I'm sure he'd be happy to talk to you if you are interested.
 
orca2011 said:
Intern mate has me all of a sudden looking through derm residencies...
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Derm has been growing on me a lot. However, I see a huge number of derm cases (many of which will let me do an involved work-up) in GP as it is and I don't know that it's worth it to pursue specialty when I can see a ton of cases as-is.
 
that redhead said:
Derm has been growing on me a lot. However, I see a huge number of derm cases (many of which will let me do an involved work-up) in GP as it is and I don't know that it's worth it to pursue specialty when I can see a ton of cases as-is.
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That's what's kind of holding my back too. I'll probably talk to some people and see if they think it's really worth it in the end. the only downside is that I'd probably like to be able to do IDAT but not sure if that is a realistic expectation and not sure if I would be able to build up the clientele to be able to afford to do it.
 
I have my first "O requests Dr. Trilt" in our schedule this afternoon and my day was totally just made.

:D

Also, we finally got new business cards in with my name on them yesterday so I'm just feeling ridiculously official.
 
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Trilt said:
I have my first "O requests Dr. Trilt" in our schedule this afternoon and my day was totally just made.

:D

Also, we finally got new business cards in with my name on them yesterday so I'm just feeling ridiculously official.
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I still smile every time I see someone requesting me specifically for an appointment. Makes up for the times I see an animal for some ridiculous "emergency" and the first thing the client says to me is, "Well we usually see Dr. BossMan" :yeahright:
 
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orca2011 said:
That's what's kind of holding my back too. I'll probably talk to some people and see if they think it's really worth it in the end. the only downside is that I'd probably like to be able to do IDAT but not sure if that is a realistic expectation and not sure if I would be able to build up the clientele to be able to afford to do it.
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I can ask our favorite skin referral guy how frequently they do IDAT or if it's a realistic expectation if you're looking for data.

I think if I were right out of internship and had nothing tying me anywhere, I would consider derm more strongly. As it is, there are a few different specialties I've considered (from derm to poultry back to lab animal) but taking a massive pay cut would be tough and moving really isn't an option (or something I'd want to do!) I would enjoy derm cases all day every day but I've also found that the other cornerstones of GP (like surgery...where did the real TRH go?!) are very enjoyable too. You might consider a year or two in private practice before deciding!
 
that redhead said:
I can ask our favorite skin referral guy how frequently they do IDAT or if it's a realistic expectation if you're looking for data.

I think if I were right out of internship and had nothing tying me anywhere, I would consider derm more strongly. As it is, there are a few different specialties I've considered (from derm to poultry back to lab animal) but taking a massive pay cut would be tough and moving really isn't an option (or something I'd want to do!) I would enjoy derm cases all day every day but I've also found that the other cornerstones of GP (like surgery...where did the real TRH go?!) are very enjoyable too. You might consider a year or two in private practice before deciding!
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I have about 1 client every 1-2 months that goes to AADC for IDAT. Which is great, but when you are recommending it multiple times a week, probably not great statistics.
 
cowgirla said:
Nothing you need to concern yourself with, Mr. ER VET.
Leave the skin disease to us lowly mortals.
And leave derm referral options to us Mid-Atlantic rDVMs.
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Hey now, it was a serious question. I looked at those acronyms and was like "what the heck?"

You have it backwards. ER vets are lowly mortals. People who deal with skin and ears and long-term management of metabolic diseases are the rock stars. Anyone can give a DKA fluids and get it eating again. I mean, seriously. I had a HBC Monday and the owners are gushing about all the 'skill' and great care we've been giving it. You know what I did? Took rads (boring - broken hips, non surgical), did an aFAST/tFAST (easy, and negative on both), did baseline bloodwork (yawn), fixed its laceration (yawn again), put it on fluids and fentanyl. Literally anyone could do that. ER work is easy compared to GP. (At least, from what I hear from my GP friends.)
 
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