Tuesday, August 31, 2010

Things I've done to a horse so far this week

This week's rotation is Large Animal Procedures lab, which is basically structured to teach us serious small animal people how to not be total fools around horses, cattle, etc. (Unfortunately for the equine-experienced students among us, everybody has to take the lab whether they want to or not.)

Yesterday we focused on basic "horsemanship" - nothing to do with medicine, just how not to get kicked in the head (well, not as often or not as hard, I gather). We worked on two of the VTH's teaching horses, who live on site and are pretty hilarious. They are quite cooperative for most of the things we need to practice on them, but they are also pretty experienced with manipulating students who don't know what they're doing or aren't comfortable with horses. They know when you're about to do something they aren't going to like, and they know how to keep you from being able to do said unpleasant procedure.

Yesterday's student-equine interactions included: picking up their feet (not as easy as it looks or sounds), taking rectal temperatures (heckuva lot easier than with a cat), lifting up lips to look at gums, and reaching your hand into the horse's mouth(!), grabbing its tongue(!), and wrestling the tongue out of the mouth so you can do a thorough dental exam and the horse won't bite you (since obviously it would then be biting down on its own tongue.

Well, that was about enough for me. Yesterday, however, was only Day 1!

Today, Day 2, we focused on general physical exam skills, again using three teaching horses. Since a lot of what we were learning involved using a stethoscope to listen to heart, lung, and GI sounds, we worked with the horses indoors, in standing stocks. (It was really windy out, which adds plenty of extra background noise to your ears as you listen through your stethoscope, and isn't terribly conducive to hearing sounds that are difficult to hear anyway in a horse in a quiet environment.)

I felt a lot more comfortable with the horses situated in the stocks. Yes, you can still get kicked or stepped on or bitten (and apparently people who are accustomed to working around horses sometimes forget that stocks aren't totally "safe"), but it was a lot easier for me to learn how to do things just knowing that the horse couldn't walk away.

We started with TPR -- temperature, pulse, and respiration -- gauging the respiratory rate by watching the horse's breathing from a distance, palpating the pulse using 3 different arteries (one under the jaw, one near the eye, and the digital pulses on the back of the feet), and taking rectal temperatures.

(Side note: Horses seem to tolerate rectal temperatures really, really well. Now, granted, these are teaching horses, so they are used to being poked and prodded and having all manner of rude things done to them. But it sure is nice to have that [if you'll excuse me] relatively huge opening to aim for rather than a cat or toy poodle anus.)

I was excited that I actually found the facial artery pulses on both sides on my first try, while some of the horse "pros" in the class had trouble.

We assessed circulatory status and hydration by doing capillary refill times on the gums. We palpated distal limbs to feel for effusion, heat, or pain. We held the horse's mouth open and percussed the frontal and maxillary sinuses. We palpated the trachea, larynx, thyroid, and lymph nodes. We listened to lung sounds, with and without rebreathing bags. We ausculted the heart and pretended to actually hear the 3 valve sounds on the left side and 1 on the right. We listened to GI sounds (rumbly!). As the horses kept pooping all over the place, we assessed the quality of their feces (all very normal).

At the end we watched the instructor pass a nasogastric tube on one of the horses. Yikes! Horse no like!

(Side note: Horses have a unique anatomical configuration in their stomach that makes them physically unable to vomit. As the stomach gets fuller and fuller, the sphincter between the esophagus and stomach basically begins to act like a one-way valve. If the horse continues to eat and drink, the material can pass from the esophagus into the stomach, but the pressure of the stomach contents stretches the stomach wall and pushes it so that the opening back into the esophagus is kept closed so no contents can reflux back into the esophagus. This can be life-threatening, because if the horse has an obstruction in its intestines that is preventing stomach contents from leaving the stomach, the stomach can rupture [i.e. burst open] if it gets too full. So if a horse presents with colic, you usually want to pass a tube into the stomach to see if the horse needs "help" emptying out its stomach contents before the stomach bursts and the horse dies.)

Here's something else sort of off topic: When there were a few minutes of downtime (since 22 students were trying to work on 3 horses), I overheard one of my (sort of annoying) classmates complaining to the instructor about how the junior students don't get to actually do anything on orientation (i.e. how we just got to watch the stomach tube being passed instead of doing it ourselves). He was going on and on about his friends in other vet schools and how they have been in the clinics since their first or second year, get to do all sorts of hands-on stuff, etc. I really just wanted to go up and point out that it's not like my vet school is all secretive and deceptive about how the program works -- he knew coming into vet school (or at least, he should have known, or should have asked questions if anything was unclear) that our program is structured this way. And hey, some vet schools don't even have any clinics until senior year -- imagine having 3 years of sitting on your butt in a classroom and only 1 instead of 1.5 years of clinics! Okay, mini-rant over. :-)

13 things to bring to LAP

Here are the things I have to be wearing, have in my pockets, or carry with me to Large Animal Procedures lab:

1. Clinic smock
2. Nametag
3. VTH ID badge
4. Pen
5. Sunglasses
6. Junior task booklet
7. Scrub top
8. Overboots
9. Coveralls
10. Clipboard
11. Notebook
12. Rotation handouts
13. Stethoscope

I hear it only gets better, as on future rotations I will also need additional items including but not limited to: thermometer, #40 clipper blade, bandage scissors, suture scissors, plexor, mayo scissors, scalpel handle, needle holders, hemostats, pen light, leash.

Good thing I have plenty of pockets between my clinic smock, scrubs, and coveralls.

Thursday, August 26, 2010

Swine Medicine? Really?

Yes, I admit it: I signed up for the Swine Medicine elective.

WHY, you're probably asking right about now. Why on earth would you want to learn about pigs? Do you want to work with pigs? Have you ever even touched a (live) pig?

Here are my reasons:

1. Much of what you hear about boards (the NAVLE exam) from senior students and new grad DVMs is how many questions were asked about pigs and poultry. Realistically, about 10-12% of the questions (far exaggerated by some students) relate to swine and poultry medicine, but that's still a pretty big chunk of the test. So I figure it can't hurt to learn the basics.

2. There isn't any other place in the curriculum for us to learn about pigs. We don't even have any swine medicine elective rotations available to us, due to a serious lack of pigs in the area.

3. This will be the easiest course I've ever taken, anywhere. This is the easiest course I've ever even heard of. It's all online (i.e. NO lectures), all self-taught, all self-paced. There are 5 "modules" to go through, with a "quiz" at the end of each module. The 5 quizzes together are worth 25% of the grade. They are open-note, open-book, and open-classmate, i.e. it is perfectly allowed for the entire class to get together one afternoon and do the quiz together. The remaining 75% of the grade is a cumulative final exam (online, multiple choice), again, all open-note, open-book, and open-classmate. Allegedly nobody has ever failed the course.

So I'm game. You say, "Why pigs?" I say, "Why not? Sure are tasty!"

"Why don't you laugh any more?"

Our first day of class on Tuesday included a 50-minute lecture by our much-beloved freshman anatomy teacher, who appears at this point in the curriculum to give us a brief review of the anatomy of the equine limbs. Actually, this is the only time she lectures in the curriculum outside the freshman year, so it was much fun to see her again. She is a fantastic instructor and really the main person who "breaks in" new freshmen vet students, since we see her 15-20 hours a week during our first semester anatomy course.

Anyway, we had not had a lecture from her for about a year and a half. She professed excitement on getting to see us "almost all grown up," but as she progressed through her lecture, and we failed to respond to several of her small jokes intended to add some levity to the not-entirely-fascinating task of mapping out the arteries and nerves on the equine distal limb, she finally stopped lecturing, turned to us, and said, only about half-joking:

"You used to laugh. Why don't you laugh any more? What have they done to you?"

I think that pretty much sums up how most of my class seems to be feeling so far this yaer. The very beginning of our freshman year was full of terror, intimidation, and the lurking voice in your head telling you the admissions committee made a big mistake. We lightened up quite a bit for the middle and end of freshman year, and at least the beginning of sophomore year, before the constant lectures, endless exams, and serious lack of animals beat us down.

This year, the whole "I want to be a veterinarian someday" thing feels a lot more real. We've already been told repeatedly by different instructors that the goal of junior year is to turn us from students into doctors. And it feels that way.

For one thing, we're a lot more separated. Previously in the curriculum, there have been some electives, but for the most part we've all moved through the same 4-6 courses every semester as a cohesive unit -- not many options in which classes you take. Now we start our mornings with rotations, ranging from only 3 or 4 students only some rotations, up to half the class in my surgial principles lab this week. Even our courses are more divided. We are all together for 2 hours of Clinical Sciences every afternoon, but there are swine medicine, food animal medicine, exotics medicine, and alternative medicine courses to choose from, and almost everyone is enrolled in at least some of those.

For another thing, we are no longer anonymous. Gone are the days of sitting hidden amongst a group of 133 other students all day, knowing that the likelihood of being called on or of the instructor even knowing your name was pretty slim. We are asked to wear our nametags at all times during our morning rotations so that the clinicians can get to know us. We are also told to take our assignments seriously, even things like playing pick-up sticks in surgical principles lab, because as the instructor said at the beginning of the week, "You will have an exam on Friday. Only 3 people failed last year. We remember exactly who they were. Two people failed the year before that. We remember exactly who they were too."

The expectations overall are much higher. Yesterday we learned hand ties (different techniques for tying knots in your suture using your hands instead of surgical instruments). We had an hour to learn the various methods, ask the instructor for clarification, make sure we felt comfortable, and get as much practice as possible. Now, it is expected that we know how to do hand ties. If you forget, that's your problem. If you're confused, you better take the initiative to find an instructor. If you need more practice, well, that's what all those pesky hours previously reserved for sleeping are for.

Some of my classmates were unlucky enough to start the semester with a two-week anesthesia rotation. Anesthesia is probably the most intense rotation we have as juniors, as evidenced by the fact that it is really the only rotation in our junior practicum that is longer than 1 week. On their second day of anesthesia rotation, these students were writing anesthetic protocols and executing them on REAL LIVE PATIENTS, often with the junior student solely responsible for running the anesthesia, including premeds, induction, monitoring, and taking care of any complications that come up, like high or low blood pressure, heart arrhythmias, hypoventilation, etc. Yikes!

While we have still had a few moments of fun and amusement during this week's lecture classes, it's really amazing to see -- well, not see so much as feel -- how much the atmosphere among my class has changed. Maybe we'll slip back toward our old ways once we've become more comfortable working in the hospital, but I doubt it. Don't get me wrong: I don't mean for this year to sound depressing. We still laugh and we still have fun, but everything we do and everything we learn now has a much greater sense of importance.

Stay tuned for continuing updates on Vet School: Junior Year!

Monday, August 23, 2010

On to different things

Capstone is over (well, the scary, closed-book, in-class part of capstone that I'm actually talking about when I say "capstone" is over). 191 multiple choice questions, plus some short answer/essay questions. All in all it wasn't too bad.

I feel that as I've gone through the last 2 years of vet school, I get better at taking exams. Well, maybe "better" isn't the right word. Maybe "efficient" is more accurate. I can pretty much know with my first skim of a question if it's something I have any chance of knowing, or if I'm honestly going to be stuck guessing randomly among the 5 possible answers no matter how much time I spend trying to pick my brain for tiny bits of information from the last 24 months.

So I guess that doesn't probably help me answer a greater number of questions correctly, but it sure cuts down on the stress and strain of staring at a question that you just don't know the answer to, and stressing yourself out about what answer you're going to pick, and going back and re-reading it, and changing your mind, then re-changing your mind, and on and on. I've learned to just let those questions go.

That's not to say that the majority of the questions on today's exam were like that - although there were a distinct few. More often, I knew the answer or had a reasonble suspicion, enough to narrow it down to a couple of choices.

At this point I have a lot more of the online portion of capstone done than I expected to; honestly, I wasn't even planning on working on it until this week or next (I intended to get the big scary part out of the way first). But one of the nice things about online capstone is that most classes have an in-class part and an online part, and by completing or at least looking at the online part, you can get an idea of how difficult that professor's questions will be, how in-depth they will go in the in-class questions, and what material has already been emphasized on the online portion, and thus (hopefully) you won't need to know as well for the in-class exam.

Really it's a just bunch of "strategizing" that my classmates and I do to take our minds off the looming exam and make ourselves feel better about how little studying we've done, or how unprepared we feel. I actually felt pretty good about my studying this year (thank you, box office), although I will admit to having some moments of panic during the last 2 or 3 days. (Especially when I realized on Saturday afternoon that I hadn't even opened my therio binder, my most hated and boring class from last semester. Thank the good Lord that those instructors had a TA who posted "take home messages" from every single lecture, or I never would have gotten through it.)

What's coming up next? An early morning tomorrow - getting up around 6 am, leaving the house at 6:45 to arrive at the VTH in time to get myself organized and change into scrubs and clinic smock and start my "Surgical Principles Laboratory" rotation. Tomorrow morning promises 4 hours of SPL fun: 2 hours of aseptic technique, 1 hour of pack prep, and 1 hour patient preparation.

Then I will actually have an hour-long break for lunch! And I will (at least theoretically) have said break for lunch every single day! I never realized (okay, maybe I did) how annoying some of those lunch-hour business classes were until I finally got to this semester, when I have no business class. But don't worry, I'm sure rotations will end up going past the scheduled end time of 12 pm and will cut into my lunch time so that I feel back to normal again.

The afternoon is just 2 hours of Clinical Sciences III tomorrow. Actually, Clinical Sciences ("ClinSci") is just about our only course this fall - we have ClinSci III through mid-October, and ClinSci IV after that till December. For the life of me, I cannot figure out why they divide it into 2 separate courses like that. It made a little more sense last semester, when ClinSci I was all GI disease (well, plus endocrine disease) and ClinSci II was all respiratory and cardiac disease. ClinSci III, however, contains such diverse topics as (on the small animal side of things) osteoarthritis, reproduction, seizures, vestibular disease, and incontinence, and (on the large animal side of things) equine hoof care, mare breeding management, bovine infertility, large animal neurology, and urinary disease. We have 1 hour of large animal and 1 hour of small animal every day.

I only have 2 other classes: Principles of Imaging Interpretation II (a continuation of last spring's xray interpretation course), and an elective called Alternative & Complementary Therapeutics. That second one meets from 5-6 pm on Mondays (yeesh) but should cover some cool stuff like acupuncture that I'm at least mildly interested in, especially since I didn't get the alternative medicine rotation as one of my electives this year. Imaging Interpretation meets on Mon & Wed afternoons.

I guess that's all I can say about tomorrow... Happy First Day of School!

Saturday, August 21, 2010

Capstone comments continue

(also alliterations)

Here are some more of my favorite Capstone-related comments from Facebook:

"Done with online capstone!! Really squeaked by on that last one. Actually I didn't technically pass until the ungraded portion gets fixed. Striving for excellence was so last year"

"must... finish... online... capstone..."

"Home cooked meal, bottle of red, movie, and my wonderful boyfriend...suck it, capstone exam!!!"

"Two and a half days till Capstone and already I don't want to study anymore....must continue because I need to still open some courses."

Where am I along this meandering yet stressful Capstone path? I'm finished with 5 of the 8 online/open-book sections, and am just about ready to give up studying for Monday's in-class portion. Really I need to finish studying respiratory disease (I'm about halfway through) and study all of Therio (yikes), then do some last-minute review of anesthesia, cardiac drugs, pharmacology, etc. tomorrow afternoon. At this point I'm mostly just looking forward to being done with it. As my classmate so aptly posted, "Striving for excellence is so last year." :-)

Thursday, August 19, 2010

Capstone looms

The online/open-book portion of this year's Capstone opened 3 days ago, and is due by Labor Day. The in-class/closed-book portion is in 4 days. Gaaaahhhh!

But seriously, it'll all be ok.

In lieu of studying at the moment, I thought I'd share some of my classmates' Capstone-related comments on Facebook:

"Want to go to bed but there are two dogs and lots of three-ring binders in the way. Guess I should take back the bed."

"Capstone was a much more enjoyable experience whist drinking a delicious glass of moscato! Only one left, and I've at least started it. Then on to studying the many things I don't remember... two days should be sufficient, right?"

"Sigh, you know it's the week before capstone when you wake up at 4:00AM and your brain will NOT fall back to sleep... why, oh why, do you torment me. Guess I'm up for the day."

"Trying to end this court dispute over my bathroom remodel... capstone will have to wait..."

"my cortisol levels are elevating, two more online exams..."

"Company left this morning and the radiator on the Suburban exploded. Studying's overrated anyway, right?"

And those were all in the last 24 hours. Think we're obsessed with Capstone much?

Tuesday, August 17, 2010

What I learned at "Junior Orientation"

Yesterday we had our much-anticipated day-long "Junior Orientation." I use quotation marks because, unfortunately, upon our arrival at 8 am we rapidly ascertained that the day's schedule had very little to do what we actually need to know to be juniors.

Sigh.

Here's what we DID get to experience:

1. 3.5 hours of radiation safety training, including such helpful tidbits as "we will kick you out of vet school if you take an xray of yourself"; "don't eat or drink the radioactive isotopes"; and in regards to reporting problems, "if it seems weird, there's probably something bad going on." Blah blah blah, wear your dosimetry badge, tell us if you're pregnant, make your classmates help you when you take xrays. Got it.

2. 30 minutes (haha) of VTH Biosecurity discussion - which ended up being about 6 minutes of the assistant to the biosecurity director (since the director himself suddenly couldn't be there) killing time and finally recommending that we just go read the 135-page biosecurity manual for ourselves.

3. 20 minutes of senior practicum discussion. That's right, we're still a week away from starting our 9-month JUNIOR practicum but one of the most relevant things they can include for us in junior orientation is a discussion of senior year. And most of what they told us was that, finally, starting with my graduating class, we don't have to do "wards duty" (which sounded really horrible: the Internal Medicine or Radiology students got multiple weeks of the year when they were assigned to after-hours duty, meaning they worked in IM or Radiology from 8-5 and then took care of after-hours patients from 5-11 pm, then got to go home at 11 IF there was nothing else left to do, but were on call from 11 pm to 8 am, when they started their next day of Internal Med or Radiology; my lucky class just gets to have 2 weeks of the year where the only thing we do is after-hours duty (assigned 5-11pm, on call till 8am, but free from 8am-5pm); sounds much better).

4. 10 minutes of "Rationale for completion of the Animal Welfare Act Training Module" which apparently is something that we have to do on RamCT that everyone always complains about doing so they decided during orientation they should tell us why we have to do it, but they never really told us that after all.

5. 2 hours (TWO HOURS) of a "Tolerance and Diversity" seminar taught by somebody from the university's human resources dept (who, to her credit, made the seminar just about as "fun" as I think anybody could). We learned that you can't discriminate against people, that you should probably go tell someone if you're being sexually harassed, and that we should all learn how to manage conflict. Boy howdy. Probably would have been a more interesting talk if I hadn't JUST covered all that stuff last spring between my mandatory VTH employee (tour guide) sexual harassment awareness training, and my semester-long Business Law & Ethics course.

6. 20 minutes of an "explanation" on how to use the various computer systems at the VTH to access digital xrays. Yes, that's all they taught us about the computer programms, the electronic records, etc: how to find the xrays. Which was totally useless, since we don't even know the name of the software, how to access it, how to login, how to look up a client, how to look up a patient, etc. But at least once we figure that out, we'll be able to find the patient's xrays. Unless we've forgotten what we learned at "Junior Orientation."

Here are a few of the things they DIDN'T talk about at Junior Orientation:

1. VTH dress code (which was mentioned during our FRESHMAN orientation) but we could all use a little refresher on, since everybody in my class seems to have a different opinion on it

2. What time to show up and where to go for our first set of junior rotations, starting a week from today. (Side note: I think I managed to figure mine out based on some intensive sleuthing on the vet school website: Junior Lecture Hall at SEVEN THIRTY IN THE MORNING.)

3. Facilities available for use in the VTH (which I mostly found on my own by wandering around: mail boxes, locker rooms, student lounge, bagel shop/cafeteria, computer labs, etc.).

It really seems like either (a) they sent out an email detailing all of this vital information a month ago, but nobody in my class actually got the email; (b) they are simply totally clueless about how confused we all are; or (c) the administration is being intentionally ambiguous in an attempt to "break us in" to the reality of being junior and senior students.

Who knows!