Despite long, 8 am – 5 pm days, everyone enjoys Thursday mornings. We start off with two hours of Clinical Reasoning, a fancy name for a discussion-based course that helps us practice figuring out a medical problem using the pet’s history, physical exam, and lab work. While we have most of the skills now to glean information from our history, exam, and lab work, it’s easy to forget about some of the little things…which often turn out to have a big influence on the case.
For example, I was able to account for many of the labwork abnormalities from a gelding with jaundice (yellow skin and conjunctiva) who hadn’t eaten for a few days. The gelding had signs of infection and dehydration, and I suspected he might have some liver disease too. But during our discussion, I realized I had forgotten that anorexic horses normally become jaundiced when they begin mobilizing their fat stores. It’s one of those quirky, breed-specific things that often pop up in veterinary medicine—horses have a liver transporter that doesn’t work very well when the liver is also breaking down fat, causing a compound called bilirubin to accumulate, tinging serum, conjunctiva, and skin yellow. Because I forgot that my patient was a horse (and not a dog or a goat) I would have been misled into investigating a problem that didn’t exist instead of focusing on the gelding’s real problems.
It’s reassuring to know that I really am getting better at asking targeted history questions and interpreting bloodwork. Sometimes it’s hard not to feel stupid or beat myself up for forgetting some basic concepts, but I’m hoping with time that it will get easier and easier to put all the pieces together, whether the puzzle pieces are large or small.