Weeks 25 and 26: Neurology and Neurosurgery Rotation!
Recently, I had the privilege of being on neurology and neurosurgery rotation. In all honesty, I headed into this rotation with a little apprehension and was preparing for the notoriously long hours, emergencies, and extensive inpatient care. Word spreads fast around the teaching hospital, and there are a handful of rotations that have earned their place under the “intensive” category, and neurology is one of them. While everyone’s experience is different, I can truly say that this rotation exceeded my expectations, and the support from the team made each day more than manageable and actually quite enjoyable.
This rotation was an amazing way to practice my neurologic exam and work on consolidating my findings to localize a lesion. This is something we have been taught multiple times in a lecture setting and practiced in a controlled laboratory environment, but none of that compares to being in the teaching hospital with real patients and with a variety of neurologic abnormalities. Unlike in lab, these patients are not “normal” volunteer dogs; they are patients coming to our service because of a suspected neurologic issue. To put things simply, neurology is fun but the patients don't just come to hang out and have a good time.
The schedule of this rotation is extremely variable and was comparable to my internal medicine rotation. We are in the clinic 6 days a week and have one 24-hour period off. The weekends involve in-patient care as well as any transfers that came through the ER service the night before. Even though the schedule was more busy than some other rotations, there was still plenty of time to be a human outside of the clinic. Churro and I still got our run in every morning and slept a reasonable amount of hours per night. With the proper planning and expectations that things may not always go as planned, every rotation is more than survivable!
Most weekdays start between 6:45 and 7:00 with inpatient treatment. At 7:00 we also get assigned transfer cases that came in through the ER service during the night. One of the keys to success is having all the inpatient care done before the transfer cases get distributed so that you can be fully present for the case. Once these cases are assigned, we work with the residents and faculty to develop a diagnostic plan. The ability to take on a transfer case is a great way to watch a full neurologic workup and follow through on an interesting case.
While working on localizing a lesion, we first need to consider if the animal actually falls under the neurologic category. Sometime other health issues such as orthopedic problems or metabolic disorders may closely mimic neurologic abnormalities. Once we have determined that the patient is at the right service (neurology), we then work on localizing the lesion to the best of our ability.
Through a variety of different tests, we assess the functionality of cranial nerves and reflexes which give us clues as to which part of the nervous system is affected and then try to determine what is happening by coming up with a list of differential diagnoses. Once we have a fairly good idea of what is going on, we can then proceed with targeted diagnostic imaging such as an MRI to get a better idea of what we are dealing with and assess if our initial localization was correct. If the owners are unable to pursue further diagnostics, we can also discuss treatment options based on our highest suspicion while still realizing that we may be incorrect with our initial diagnosis.
One thing that makes this rotation so manageable is the incredible technician support. This team is on top of everything; they manage all the diagnostic workup scheduling and are extremely willing to help with things as well as teach. Their assistance made my life so much easier on multiple occasions, and I also learned a lot from their guidance. They were always willing to help hold patients so that I could practice my neuro exam, and they also always gave me the choice of collecting my own samples to gain additional practice. During this rotation I had multiple opportunities to collect blood and urine from my patients which are always handy skills to practice. Their patience and guidance were remarkable, and I am so grateful for their support!
Monday through Thursday we had daily topic rounds which covered things such as trauma, inflammatory brain disease, seizures, seizure drugs, bladder control, and the typical “down dog” general practitioners often hear about from panicked clients. I personally felt these rounds were of high educational value and appreciated the faculty’s commitment to delivering this content in a digestible manner. In the clinic there are often times where things are so busy or happening at a rapid pace too fast for appropriate learning, so their topic rounds are always a nice way to reflect on things that happened during the day and work through them in a more controlled setting.
During this rotation, I also had the opportunity to learn how to tube-feed a kitten which was a skill I had never practiced. Dr. Vernau does a lot of work with the Orphan Kitten Project and when there was occasional down time during the day between appointments and consults, we had the opportunity to learn about neonatal kitten care. This was a bonus part of the rotation I was not expecting but greatly appreciated!
Reflecting on my two weeks on the neurology service, I was reminded of how important it is to go into every rotation with a clean slate and not let preconceived ideas or the opinions of others influence your perspective. Each rotation will be different for every student, and that is what makes veterinary medicine so much fun. We don’t all have to enjoy the same things, and we have the flexibility within our careers to find the parts of veterinary medicine that light our hearts on fire. This clinical year is a wonderful way to test different specialties and see what clicks as well as what doesn’t. As always, even if a rotation is not your cup of tea, there is still something that can be learned and brilliant minds willing to teach which is a gift that should not be taken for granted.
This rotation had some fun owners so instead of one quote of the rotation, here is a little list:
“They come in for their antibiotic club on Tuesdays and Wednesdays” – Dr. Dickinson
“We kept her in the psych ward” - client
“So, you’re paying a lot to hope you don’t find anything” - client
“This is not in medical terms, but it was a teeny weenie tablet” – client (we later found out they were referring to imodium which is indeed a teeny weenie tablet)
“You know how the vet was supposed to help me urinate… not me but Jaxxon” - client
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