cats improved, house survives

thanks to everyone who has been pulling for Mr. Head and Elise. it has been a stressful time here - what with all the vomiting, unformed poop, and general 'anything could happen' atmosphere. in exciting news, i can report that the cats Elise has started annoying the bejimminies out of me - knocking [expensive] things off end tables to prod me into feeding her sooner, trying to steal my lattes, insisting on camping on my arms while i try and type. in addition, Mr Head has stopped leaving bodily fluids scattered about like flower petals by a fairy. he still has a ways to go to get to 'fighting trim', but he will probably be normal enough to have his nasal CT this week. after a weekend of spot treatments and overall cleaning, i can report the house has suffered no irreversible damage.

today is an official university holiday so i have decided to alternate reading papers for my research with working on Mystic Waters since it has lain stagnant for close to a month.

but first i thought i would share something positive from my working life. when i am on clinics, i require the students to write one multiple choice question about every case they see. i edit them for accuracy and psychometric balance and then add them to a freely accessible self-study file for the students' boards preparation. the students gain a better understanding of the challenges in question writing, greater ownership of their cases, and increased knowledge about the diseases they 'met' while on rotation. in addition, i often catch misunderstandings this way and can thus make sure they leave with the right take-home messages.

benefits to me are few. it is a time-consuming process for which i get no 'credit', the web form likes to change answers in weird ways, leaving me baffled and challenged in determining what the student might have typed, and the questions can require a LOT of work to be useable in the file.

however, it is fascinating to see what the student, coming from a very different place in his/her career, felt was important enough to score a question. sometimes, i actually get to learn something new in some way. most awesomely, some of the students write questions that reinforce all the effort spent on the floor, make me laugh, and are eminently usable.

this particular question caught me off guard and i almost choked on my coffee from the laughter and wisdom. the great thing is that it can be enjoyed without extensive medical knowledge. just ignore words that are unfamiliar - i blocked out a few to get you started...

Your favorite client brings their 1 year old dog, Brutus, in with a history of acute onset lethargy and weakness. On physical exam, the only notable abnormality is a chronically elevated temperature of 104.5. After performing many diagnostics - including thoracic radiographs, abdominal radiographs and ultrasound, CBC, chemistry, lytes and urinalysis – you still have no clue what the heck is causing Brutus’ fever. You decide the best thing you can do is refer Brutus to the local veterinary college.

Prior to sending Brutus to the referral institution, what is your best course of action?

A) Give Brutus a shot of dexamethasone - it’s got to make him feel better.

B) Start Brutus on doxycycline - you heard somewhere that tick borne diseases were common in the area.

C) Give nothing - even though it kills you to watch Brutus suffer like this.

D) Give Brutus dexamethasone and doxycycline - you may not know what is going on but this should be a good start.

Answer: C

this was a challenging case where we actually had to stop medications and let the dog get much sicker before we could get a diagnosis and thus a cure.

the typical student would have written, "What test should you perform next?" this student, however, took away something more valuable. he read about the disease in humans and learned that the time to diagnosis was nine days if the primary care doctor started treatments before a diagnosis was made but only five if the doctor referred without starting treatment. in his question, he validated the pressure the doctor feels to 'fix it' - this is big because it is easy to do nothing on paper when one is talking concepts but hard to do nothing when you have an emotional investment, have to meet someone's eyes, and still say no. finally, he made it funny, so any student reading this question will remember it and the lesson it contains.

this student is why i do these damned questions.