Colorado, Week Three!

Hey everyone! After 3 weeks at Littleton, I’m starting to feel like I know my way around now. I’ve been helping with a lot of the regular treatments, which occur every three hours throughout the day. It’s been really nice to develop confidence in my ability to take vitals such as heart rates, assessing gut sounds and mucous membranes, and feeling for digital pulses. So many of these skills are easy to learn about in class, but the only way to get good at them is to practice doing it every day.

The majority of the cases we see in the ICU are emergency colics. One case that was particularly interesting to me last week was a horse that had been brought in right at the start of my shift on Tuesday because of moderate discomfort. He was worked up by an intern doctor, who determined by ultrasound that he had a nephrosplenic entrapment. The nephrosplenic ligament connects the spleen to the left kidney, and for reasons that are not well understood, the colon can displace from its normal position on the abdominal floor and become lodged over this ligament. This can become problematic because intestinal contents cannot move past this point, causing the colon to distend, which can be incredibly painful.

After his condition was diagnosed, our first goal was to treat him medically, which is both less expensive and less invasive than surgery. The common treatment for a nephrosplenic entrapment is to give phenylephrine, which causes the spleen to contract and shrink in size. The hope is that this combined with trotting will help the colon slip down from the nephrosplenic space. While initially this seemed to help, after a few hours on intravenous fluids he quickly became dramatically painful. At about 7 pm he was taken into surgery and I was able to sit in and watch. I love watching surgery because it really helps solidify my understanding of anatomic relationship of different structures. What I wasn’t expecting was to be quizzed on all of it by Dr. Toppin! Definitely a reminder that I need to hit the books! This particular horse came through the surgery very well and is still recovering in the ICU barn. I have really enjoyed following his case from the first moment.

In addition to all of the horses, I was able to take some free time this weekend to explore Boulder with a co-worker from the clinic. We went on a long, steep hike (seriously, the altitude here is pretty killer!) in the flatirons to one of Colorado’s few natural arches. Afterwards we explored downtown shopping and spent a few hours at a rooftop bar. Every new place I go in Colorado, I fall in love with the state a little bit more. I’ve only been here for three weeks and I’m already wishing I could stay.

‘Til next week!

Kiva