Thursday, September 30, 2010

Not looking forward to YOUR Friday morning?

Well, I get to tour a crematorium at 8 am.

Beat that.

Music nerdiness is...

...watching a commercial for a video game and immediately realizing the background music is 'Thaxted.'

Tuesday, September 28, 2010

Breaking news: Vet school does something efficiently!

One of my favorite moments of this school year thus far occurred in my Week 3 Community Practice/Surgery rotation (and I can't remember if I already wrote about it here, so maybe you'll get to hear it twice).

My single CPS week happened to begin on the same day that a 4-week rotation for the senior students began, so we started Monday morning with a general orientation for everyone.

One of the first activities was to go around the (very small, crowded) room and have each of the 16 people tell their name, where they're from, their vet med interests, several goals for what they wanted to get out of CPS, and one thing about their junior or senior year so far that has surprised them.

One of my classmates' surprises went something like this:

"Now that we've been in the hospital for a couple weeks, and had a chance to see different departments and learn the procedures and paperwork and forms and charts and rules, my biggest surprise of the year is that anything ever gets done around here."

She wasn't joking, and I can understand her feelings. Because it's a teaching hospital, many things are more redundant than how you'd operate in private practice or elsewhere in the "real world" -- and I think that redundancy is probably to our benefit as students while we're learning, but it definitely slows things down and makes you want to bang your head against the wall sometimes.

Well, today I encountered an example of how the vet school does one thing better than anywhere else I've gone: giving flu shots to staff and students.

Since the student health service on main campus has very limited vaccine hours (M-F 9-12 and 1-4) that are completely incompatible with the schedules of most clinicians, technical staff, and 3rd & 4th year students, the VTH kindly brings over a couple of nurses once a year in the fall to spend a couple hours administering flu shots.

This year's flu shots were available from 1:30-3:30 this afternoon. Since I and all of my classmates had lectures until 2:50, I hurried over to the diagnostic lab for my vaccine as soon as I could once class got out. I was fully prepared to wait for awhile, anticipating a rush of other junior students eager to build up some herd immunity among ourselves.

Well, there was a bit of a rush, but it was literally no more than 2 minutes for me to sign in, pay my $20, fill out a consent form, discuss with the nurse my allergies and prior vaccinations, get the shot and get out of there. I was so impressed. The student health center on campus is pretty darned efficient -- I can usually be in and out for a vaccine within 15-20 minutes** -- but that's nowhere near today's awesome assembly line of flu prevention. Go VTH!

**And I've had lots of experience at the immunization dept at student health: As a freshman I got an MMR, tetanus, flu, and 3 rabies vaccines. As a sophomore I got a regular flu shot and the H1N1. I scoff at people who fear giving their pets too many vaccines! At least you aren't giving them 8 vaccines in less than 2 years! (Ok, you might be if you go to a shall-remain-nameless Giant Veterinary Corporation at which I have been employed, but let's not open that can of worms tonight.)

Client Communication Rotation = Fight Club?

The first rule of Client Communication rotation is: You don't talk about Client Communication rotation.**

The second rule of Client Communication rotation... well, you get the picture.

I am pleased to announce that I have thus far survived 40% of this semester's much-dreaded week-long Client Communication Skills (CCS) rotation!

(trumpets sound)

Now, let's be honest.

As much as I would like to be able to commiserate with my being-videotaped-impaired, communication-phobic, distressed and tearful classmates with the misfortune to experience this rotation before me, I would be lying if I told you that my rotation so far has been an absolutely fantastic experience.

The truth is out. Don't tell my friends, or I won't have any.

I think I approached CCS with the following attitude:

"I am going to go into this rotation being able to say that I came in trying to keep a positive attitude, but I am really not going to have a good time."

But.... the things we've done so far have been really beneficial.

(Really, I don't mean to sound so astonished. I'm truly excited that this hasn't turned out to be an absolute waste of 20 hours of my time.)

Yesterday we did some semi-hokey stuff, talking about feelings, what we did over the summer, how to ask open-ended questions and let your clients know that you're empathizing with them.

(Oh, and the instructor started off the week by saying "Good morning" to the class of 25 students repeatedly until she got a satisfactory chorus of "Good morning"s in return. Talk about a surefire way to come off as condescending and make your students feel like 8 year olds. Thankfully, things went uphill from there.)

Today was the first of two days of "simulated client interactions." The vet school hires actors to come in and portray clients bringing in their dog, cat, horse, or (if you're unlucky) hedgehog to see us students. The actors also work with the state's medical school, doing the same thing pretending to be actual medical patients so the med students can practice communication and history-taking.

Let me tell you, these actors are amazingly good. Invariably, in each of the 5 simulations it was a matter of moments before everybody forgot that the "client" wasn't really some person bringing in a sick pet.

We were divided into 5 groups of 5 students. Each small group had a "coach" (all were vets, two from the vet school and three from private practices). Some of the newer coaches got their own coaches who were coaching them on how to coach us.

Each student got 45 minutes for their simulated interaction:

-- In the first 5 minutes, the interviewing student got to find out what the case was about (owner's name, pet's name, breed, age, and the apparent reason for the visit [wellness exam, behavioral problem, medical problem, etc.]). Among the group of students, we discussed things that may come up during the interview, what the interviewing student's objectives were, how they were going to approach certain subjects, etc.

-- The next 15 minutes comprised the actual interview. The client was seated in the exam room (with 1 or 2 coaches in there too). The other 4 students were in the observation room next to the exam room, which has a one-way mirror looking in on the exam room. The student entered the room, introduced herself, and started the interview. You got to pause, take breaks, or rewind if you needed a minute to gather your thoughts, needed some advice from your coach, or realized that something didn't go well and you had something you wanted to try again.

-- The next 20 minutes were "debriefing" -- first the interviewing student discusses how she felt the interview went. Then the 4 observing students take turns critiquing different facets of the interview technique (initiation, gathering information, logical flow, etc.). Then the actor/client gives their feedback on how they felt as the one in the conversation, what they liked and didn't etc.

-- The last 5 mninutes are a discussion of what everybody learned from the case.

**The Fight Club rules (I named them that, not the rotation instructors) mean that we are bound by the honor code (and it's even extra-official, since they made us sign something) to not discuss the simulated case scenarios with anybody who hasn't taken the rotation yet. And that's with good reason -- as they point out, the learning experience is a lot less effective if you know ahead of time what sort of situation you're getting into, what hidden information is there for you to discover if you make your client feel comfortable enough to open up to you, etc.

I ended up going last among my group of 5 -- not really by choice, but the first 3 people kept volunteering to go next, then the last person and I flipped a coin to see who would go 4th and 5th.

It was a very surreal experience. During the past few weeks when I've been thinking ahead to upcoming rotations and remembering that I had CCS during week 6, I'd been getting progressively more nervous about it. During our initial Pet Hospice volunteer training during fall semester freshman year, we had a similar training session where we role-played with actor clients about how to talk about their ill pet, how to start conversations about quality of life and euthanasia, etc. -- and that experience was pretty awkward.

But I was surprised when I showed up this morning and really didn't feel that anxious about the whole thing. Sure, I didn't want to make a fool of myself, but everyone in my group was very supportive of each other and good at giving plenty of positive feedback along with a few suggestions for improvement. Yesterday as the instructors discussed today's exercise, they were very clear about the fact that none of our grade for this rotation comes from how well we perform in the simulated interactions -- our grade is all about a reflective paper we write, and how well we are able to analyze what we did well, what needs improvement, where our strengths are, phrasing that sounded good, moments that felt awkward and how they could be made more comfortable, etc. That really took the pressure off and made me feel like if I totally got tongue-tied or off-track or distracted during my simulated interview, it would all be ok.

CCS really has a terrible reputation among the upper-level vet students, and I don't think that's deserved. I know that some people really have a problem with the more "touchy-feely" style of communication, for whatever reason, but I think the next 3 days just might make a believer out of me... stay tuned!

P.S. If you have read this entire post, holy cow, I'm impressed! Way to be a dedicated reader! Here's hoping you find my rantings, ramblings, and reflections interesting and not just completely self-absorbed...

Saturday, September 25, 2010

Capstone: Success!

Well, 5 weeks into the semester, we finally have (I think) our final capstone grades.

On the in-class portion, I got 85.68%. The average was 78.3.

On the open-book portion, I got 91.57%. The average was 86.5

I'm satisfied though not ecstatic about my performance. I'd hoped to get a little higher than a 91 on the open-book part -- after all, it's open-book. (Actually, one person failed that part, and I'm not entirely sure how that's possible.)

However, I've found that the further I get into vet school, the lower my standards are, and I'm okay with that. Would I have been thrilled with another 94 or 95% like I got on last year's capstone? Of course. I'm actually pretty happy with my 85 on the in-class part -- I figure that if I need a 70% to pass the NAVLE next year, then if I can keep up my retention of approximately 85% of what I learn before then, I should be set to pass with an easy margin.

Academics just seem so much less important this year. We're spending more time on rotations every week than we are in classes, and we're treating actual patients, talking to actual clients, assisting in actual surgeries, and completing actual medical records. It feels like what we do in the morning is the reason we come to school every day, and the 2-4 hours of class each afternoon are just sort of an add-on. I must say with only 3 (non-elective) courses, it's a whole lot easier to keep track of exam dates and homework assignment due dates.

There's also more of a sense of accomplishment with having a different rotation every week -- rather than waiting an entire semester (or 8 weeks, for our short classes) to finish a course, you feel every Friday like you've completed another whole class (i.e. whatever rotation you finished). It's nice.

Small animal procedures

All in all, we got to do some really neat stuff on Small Animal Procedures lab this week (smelly dripping cadavers aside). Procedures we practiced included:

- jugular and saphenous vein cutdowns
- CSF tap from the cisterna magna
- bone marrow aspirate
- chest tube placement
- transtracheal wash
- tracheostomy
- esophagostomy tube placement
- arthrocentesis (carpus, tarsus, and stifle)
- abdominocentesis
- soft padded and Robert-Jones bandage placement
- splint placement
- cystocentesis
- urinary catheter placement
- digital rectal exams
- digital vaginal exams
- anal sac expression and infusion
- dental probing, charting, scaling, and polishing
- dental extractions (simple and complicated)

Now, there are a bunch of those things that I would be pretty reluctant to do as a private practice vet after graduation (namely, CSF taps, bone marrow aspiration, or a transtracheal wash). But it was still pretty cool to get to practice them, and not have to worry about messing up on the first try.

(Side note: The instructors demonstrated each technique first, then we all split up to practice on our various cadavers. The CCU resident who demo'd chest tube placements started out by saying "A lot of practitioners are leery about doing chest tubes, but I don't get it. They're not actually that hard." About 2 minutes later, as he was actually showing us how to place the chest tube [basically punching a hole through the side of the chest into the chest cavity, to let air or fluid out], he cautioned us "Don't push too hard, or you'll stab it through the heart and nail your patient to the table." Gee, I wonder why anybody would be reluctant to place a chest tube...)

Next week's rotation is Client Communication Skills, which I can safely say I have not been eagerly anticipating. Several of my friends were among the twenty or so students on CCS this past week, and I heard multiple reports of students experiencing extreme distress +/- tears at various points during the 20 hours in the rotation. I'm trying to keep a positive attitude about it, but I'm fearful that it will just be hokey and embarassing. But come on, who doesn't like to watch themselves getting yelled at by a pretend client on videotape with their peers watching? And then get to take the videotape home so you can watch it over and over and write a 4-6 page paper about what you need to improve??

Thursday, September 23, 2010

Bovine Repro Quote of the Day

"Any chance you get, palpate some testes."

"You may have a 10 minute break while we get the heads out"

My instructor's parting words as we were temporarily dismissed at the end of this morning's introduction to cadaver dentistry. Thursday promises to be at least as much fun as Wednesday!

Wednesday, September 22, 2010

A great start to my Wednesday

First task of the morning: shave a bunch of dead cats.

My day had better go uphill from here...

Monday, September 20, 2010

Alternative Medicine Tip of the Week

"You don't want a dog with diarrhea in your underwater treadmill."

Sunday, September 19, 2010

Mares don't get no privacy (PG-13)

For about a week in a half, we've been studying equine reproduction in the large animal section of ClinSci. We've focused mostly on the mares, although we did have a lecture or two about "collecting" stallions (seriously, "collecting" is one of my absolute favorite euphemisms in this field) and assessing semen quality.

But honestly, if after this week's exam I never ever have to see another picture of the inside of a horse's vagina, I'll be 100% okay with that.

After looking at photo after photo of labia and vulvas and vestibules and vaginas and cervixes, you really can't stop thinking about a bunch of med students sitting in a gynecology lecture looking at the human equivalent. Please pass the mind bleach!

Oh, and eewwwwww. Here's something semi-related from radiology rotation that I forgot to mention. On Friday they had a Boston Terrier come in for a vaginogram -- where they would knock her out (due to the forthcoming unpleasantness) and place liquid contrast material (shows up bright white on xrays) into her vagina, and see where it went. This rarely performed procedure was all due to a strong suspicion of a vaginal-rectal fistula, or in lay terms, a connection between her rectum and vagina basically causing her to periodically poop into her vagina. There were lots of jokes about just not having "that fresh feeling down there." Yes, board-certified vets may have spent years in college, vet school, internships, and residencies, but that doesn't mean that all of them qualify as grown-ups...

Prostatic massage, chest tube placement, and intraosseous catheters, oh my!

Those are only 3 of the 29 small animal medicine & critical care procedures I just learned about through some exciting online modules with associated quizzes, in preparation for tomorrow's start of Small Animal Procedures lab.

We'll have half a day of bandaging practice, 2 days of trying out the above procedures on cadavers (how exactly do you gauge the success of your attempted prostatic massage on a cadaver, I wonder?), and 2 days of dental procedures (extractions, nerve blocks, etc. -- also cadavers -- "Hey dead dog, can you feel anything, or did I numb up the correct nerve just now?").

I understand the value of models and cadavers as teaching tools before unleashing us vet students on real live pets, but come on. I REALLY don't want to do a digital rectal exam on a cadaver...

Saturday, September 18, 2010

4 weeks down

And I don't even want to count how many more to go... (how long is it until graduation???)

This week's radiology rotation ended much better than it started (thank goodness). After the first couple days, we had all figured out how to set and use the xray machines, how to position animals for chest and abdominal films, how to correct errors we made, and which techs were nicer than the others and more willing to help us hapless juniors.

Actually, other than a bunch of met checks (radiographs of dogs on their right and left sides and lying on their back, to look for metastatic cancer in the lungs), we mostly hung out in the ultrasound department and watched a variety of scans.

Yesterday, we headed over to CCU to pick up what ended up being the saddest little dog I've ever seen, and bring her to ultrasound. This little 6 year old terrier had come in a couple weeks ago because of a tumor growing on her right shoulder. They knocked her out to biopsy the mass, and found out it was a really nasty kind of cancer. The plan was to surgically remove the mass, so they did a CT scan to see exactly how invasive it was, how much tissue they would need to remove, etc. -- so they could be sure they got clean margins during surgery and didn't leave any pieces of tumor behind.

In the meantime, the little terrier was hospitalized for a few days for various procedures. They noticed that she was running a fever but didn't know why, so a couple days after the first CT scan, they did another, and found out she had a pyometra -- basically a really serious infection causing her uterus to fill up with pus. (Get your dog spayed, folks!)

Pyometra basically necessitates spaying the dog, so the terrier went back to surgery and had her uterus and ovaries removed. Now in addition to an ugly incision on her shoulder where the tumor biopsy was done, she had a huge abdominal incision too.

Fast forward a couple more days, and the poor little thing is now in CCU with a very serious infection that has developed in her shoulder biopsy site. Given the aggressive nature of her cancer, its location, and the current infection, the decision is made that this poor dog is going to have her entire right front leg removed instead of just the tumor.

As this point she comes down to ultrasound (complete with multiple IV lines, a urinary catheter, EKG monitoring, and a huge drain coming out of her infected biopsy site). Nobody knew exactly why the ultrasound had been ordered, but in the end they aspirated some lymph nodes and decided she should indeed go for the amputation surgery asap.

What a poor little dog!

Fortunately most of the cases we saw in ultrasound weren't quite that sad. A bunch of them had cancer of different varieties, so we were doing abdominal scans looking for lesions in the liver, spleen, or lymph nodes. There was one dog with a hemoabdomen (abdomen filling up with free blood from an unknown source) so we scanned the abdomen but didn't find the cause. We got to see a bunch of ultrasound-guided needle aspirates of liver, spleen, or lymph nodes. A golden retriever yesterday was being treated with chemo for lymphoma and all of a sudden just wasn't feeling well, so we checked his abdomen.

All in all, ultrasound is pretty darn cool. I've never really seen a live ultrasound before, and it's way different from the still pictures they show us in lecture as demonstrations of various abnormalities.

At the end of radiology, we all took an online exam that was basically identifying various artifacts on sample radiographs -- like a hair stuck on the film inside the cassette, static electricity, the patient moved as the xray was taken, the settings on the machine needed to be adjusted, etc. I breezed through that with a satisfactory 88%.

In other exam news, we had our first ClinSci exams this week. Small animal orthopedics & reproduction (what a great combination) opened on Monday and closed Wednesday. I was pretty worried about that one (we went through about 90-100 PowerPoint slides in each of 15 lectures that the exam covered), so studied a ton and got a 92. Equine orthopedics opened on Tuesday and closed Thursday. By the time I finished the small animal test, I was sort of studied out, so didn't put in quite as much effort on the large animal side as I'd hoped, and as a result squeaked by with a 77. (Okay, 70 is a passing grade, so it wasn't like I really almost failed, but I always feel way more comfortable if I get at least a solid 80. However, at no point in my future career do I anticipate the need to treat a foal with angular limb deformities or a mare with an olecranon fracture, so I'm okay with my 77.)

All of our exams are online this semester -- large & small animal ClinSci, and radiology -- which is sort of nice. With the online exams, you have a much more flexible time range in which you can take them (usually 48-72 hours). You can take them before class if you're better at exams in the morning, or in the afternoon after class, or later at night. You can take them at school or at home. They're all closed book, and it always feels nice to know that the faculty trust us enough to take an exam at home with nobody watching, and still believe we won't cheat.

Upcoming rotations are small animal procedures this week, then client communications the following week (dreading that one).

For this weekend, nothing to study except equine repro (and I am really bad at reading ultrasounds of mares' ovaries and uteri, so wish me luck). Equine repro exam opens Monday!


Rad rotation
Tests

1.5 years of VTH tours finally pay off

Don't get me wrong -- I've enjoyed giving tours of the VTH for the last year and a half. But I'd begun to doubt that one of my original goals when I trained as a tour guide -- to learn my way around the hospital -- would ever really help in my vet school career.

But during the last 2 weeks especially, I've had lots of opportunities where I was the one among my rotation-mates who knew where a department or rounds room was located, how to get to the ultrasound department, extra sets of stairs to run up to the locker rooms, hidden restrooms, or what the heck it means when the computer says a dog is in "OR17" or "3R2."

It may seem like a small thing, but I really don't need any extra stressors this year, such as feeling like I'm wandering around aimlessly hoping to stumble across my desired destination by sheer luck. And it's neat to know multiple ways in and out of various locations, so I don't have to drag a reluctant 150 lb dog through a busy treatment area but can instead take the long way around and not be in anyone's way.

There are lots of reasons why I started giving tours and why I still enjoy them (and let's just say the stellar hourly pay isn't one of them). With having done so many tours, it's just been interesting to realize this year how lost some of my classmates are. Go me!

Tuesday, September 14, 2010

I've decided what I like about radiology

I have determined that I like the idea of being good at radiology a lot better than I like actually learning radiology. Guess that in itself isn't going to do me a lot of good, though.

This week's junior practicum rotation is, as you may have guessed, radiology.

Monday started off with my 5 rotation-mates and me arriving to the radiology department promptly at 7:55 or so, for our anticipated 8 am start time. At 8:05 or so, a radiology tech came by and told us that she didn't have any idea who was supposed to be doing our orientation, but she would check around and we should just "sit tight." At 8:15, she was back to say she was the only radiology tech in the department at the moment, so she would give us "some kind of orientation or whatever."

Great. I have a great impression of radiology already.

The "orientation" consisted of haphazardly showing us around the department: the film cassettes, the computer showing currently radiograph requests, the 3 imaging suites, how to run the computerized radiography machine, and a few other things.

Then we sat around for awhile twiddling our thumbs while the seniors were in rounds and there was nothing else going on.

At 9:45 someone poked their head in and asked if a couple of us could go get a dog from CCU (critical care unit) and take him to ultrasound. There was a veritable stampede of eager vet students toward CCU, although we quickly realized it probably wouldn't take all 6 of us to move this yellow lab down a couple short hallways. I was one of the "lucky" 3 that got to help.

The yellow lab had had chemo on Friday, which was given in a vein in his left hind leg. On Sunday, he came back to the VTH for an acute onset of severe lameness -- as in he wasn't able to walk at all when we saw him on Monday. On Sunday, they stuck a needle into his swollen knee joint and got back bacteria and white blood cells, making them think he had an abscess or possibly a septic joint (bad news). So the ultrasound was intended to seek out that alleged abscess and see if it might be something they could drain.

All 6 of us regrouped in the ultrasound suite to watch the ultrasound of the dog's stifle. It wasn't real exciting. We didn't really know what we were watching, and the resident doing the US wasn't too eager to tell us what was going on. Midway through the US, 3 students got called off to the barn to help take some radiographs on a sick horse. A few minutes after that, I got to go over to nuclear medicine with one of the radiology techs to help her sedate a cat and give it an IV injection of technetium (a radioactive isotope that they were using to look at this hyperthyroid cat's thyroid tissue, prior to doing an iodine-131 injection the following day to "kill" the overactive thyroid tissue). I got to give the cat the 2 IM sedative injections, which was honestly the most exciting part of my morning. Oh, and I pushed "start" on the scanning machine once the kitty was becoming radioactive.

At 11, we had rounds and went through normal abdominal structures and 1 abnormal case (which was a linear foreign body caused by a clever dog eating the blanket out of his kennel -- natural selection, anyone??). We got out early, at 11:35 or so, because the clinician doing rounds with us had somewhere else to be.

Today was slightly more interesting. Having learned from our mistakes on Monday, we all arrived armed with notes and study materials for our two exams this week (small animal and large animal orthopedics).

And what good planning that was. After an hour of instruction on positioning dogs and cats for thorax, abdomen, and pelvis radiographs, we had almost 2 hours to ourselves for study time, minus about 30 minutes interspersed in which a few of us got to go help take met check rads (checking the lungs for pulmonary metastases from a primary cancer elsewhere in the body) on a Norwich terrier and a chocolate lab.

At 11, we had rounds again, this time with one of the brand-new residents. It was okay; we just went through abnormal abdominal films.

I think the rest of the week is basically the same sort of schedule: an hour of "class" for sure from 8-9, and rounds from 11-12, with the 9-11 period pretty much left open. Which is just as well, because although I'd like to get better at radiology, I'd also love not to fail this week's small and large animal orthopedics exams...

You'll never guess what senior track I picked

Just kidding. I'm tracking small animal. Hope I didn't surprise you there.

My class has to select our "tracks" (which actually apply for our next 1.5 years of school) by the end of this week.

The three options at my vet school are: small animal, large animal, or general (a combination of small and large).

Some other vet schools have additional choices, like exotics, wildlife, food animal specific, equine specific, or "build-your-own-track." Guess my school just likes to keep things simple.

Tracking starts to affect our curriculum this coming spring. It doesn't affect our rotations in junior practicum, but everybody takes different classes in the afternoon depending on your track: Small Animal Medicine & Surgery I and II, or Large Animal Medicine & Surgery plus Bovine Herd Medicine.

Senior year is where it makes a big difference. (To review, senior year = all rotations + no classes. Basically it's as though we're working in the hospital [except we have to pay $25-50K for the privilege, and we have to work about twice as hard with longer hours than anyone else; but I'm sure it "builds character"].)

My 48 weeks of small animal track breaks down as follows:

* 3 weeks of anesthesia (really intense)
* 2 weeks of cardiology (tough but good to know)
* 4 weeks of ER/critical care (I *think* only 1 of the 4 weeks is actually a scheduled overnight shift, and the other 3 are a mix of daytime and evening hours)
* 4 weeks of community practice (healthy pet appointments, primary workups of ill animals, dentistry, spay/neuter, and shelter medicine)
* 2 weeks of dermatology (skin! not stressful!)
* 3 weeks of diagnostic imaging (the seniors on this rotation this week describe it as "extra vacation time")
* 4 weeks of internal medicine (intense and difficult, but great clinicians to work with)
* 2 weeks of neurology (also difficult, but important to know)
* 2 weeks of oncology (no idea how this rotation is)
* 2 weeks of ophthalmology (good thing, since we haven't really had any in the curriculum so far)
* 2 weeks of "postmortem diagnosis" (aka necropsy) (not looking forward to this)
* 2 weeks of orthopedic surgery
* 2 weeks of soft tissue surgery
* 2 weeks of after hours urgent care (like 5-11 pm scheduled, then on call from 11 pm to 8 am)
* 4 weeks of elective (which is 2 different 2-week-long electives)
* 8 weeks of VACATION! (some combination of traveling to externships, doing local externships, studying for boards, and, oh yeah, actual vacationing)

On the one hand it's nice that I'm not required to do any large animal rotations as a small animal tracker (although I think maybe one of my electives has to be in equine or food animal). On the other hand, it might be nice to get a little more experience in those areas before taking boards. However, as the senior practicum coordinator pointed out, seniors take boards in November, and there's a very good chance that I would get any selected large animal rotations after I've already taken the boards, so that they wouldn't be beneficial for studying anyway. Or at least that's the rationalization I'm using to justify avoiding large animals at all costs...

The large animal track has some of the same core rotations: 3 weeks of anesthesia, 3 weeks of diagnostic imaging, 2 weeks of postmortem diagnosis, 2 weeks of after hours urgent care. Large animal trackers only take 2 weeks of small animal internal medicine, and the rest of their core is made up of equine field service, equine medicine, equine lameness/surgery, food animal field service, food animal medicine, large animal emergency medicine, and a large animal externship.

General track has the basics from small animal (except derm, cardio, ophtho, and neuro) and the basics from large animal (just fewer weeks of some of them).

A lot of people seem to be having trouble picking their tracks. There are a variety of sources you can go to for advice: other juniors, current seniors, recent graduates from our vet school or other schools, vets you know out in practice, prospective employers, and the senior practicum coordinator. Apparently people tend to get conflicting advice from just about everyone they ask, and it doesn't help at all.

I'm really interested to see what the breakdown of track selections ends up being in our class. Apparently prior to a couple years ago, they had had a pretty predictable ratio of small versus general versus large, but this year's seniors messed everything up: they had a huge number of people decide to track large or general, which I hear sort of messed up the curriculum and scheduling for their year. From an informal, unscientific poll of my classmates, I've heard very few people express a plan to track small animal -- even a lot of people that I expected to track small are telling me they've decided on general. Stay tuned since I hope they'll tell us the general breakdown of track selections at some point in the next few weeks.

Friday, September 10, 2010

Fashion sense? Not a prerequisite for vet school

It wasn't until the start of my afternoon classes today that I noticed I was wearing brown socks with my grey pants and black shoes. I guess that's what I get for getting dressed in the dark this morning, and assuming that the pair of socks I grabbed would be one of my 10 black pairs and not one of my 2 brown pairs...

But minor details.

This morning started off with attending Grand Rounds at 8:30. "Rounds" are something we do in vet med (and in human med) as a sort of learning experience. On Community Practice/Surgery, for example, we have "topic rounds" for an hour every morning, 3 or 4 days a week. Our topics this week included what to talk about at puppy and kitten visits, vaccine protocols, and heartworm testing and prevention. In the afternoons, the seniors get together with the clinicians for "case rounds" where they all talk about different cases they've had in the last day or two, or give updates on continuing cases.

Grand Rounds is a little different. It's a horrible torture apparently invented for the sole purpose of scaring poor senior students to death. Each Friday, two to four seniors present a case at Grand Rounds. You can't get out of it; every senior has to do it at least once during senior year.

The three cases presented today were: (1) An old French Bulldog with heart disease and ascites (fluid in her abdomen); (2) an old Thoroughbred with epistaxis (nose bleed); and (3) an old Shih Tzu with sudden blindness in one eye (the other eye had already been blind for a long time).

At the conclusion of each student's presentation, the audience (comprised of 100-150 juniors, seniors, interns, residents, clinicians, and, at least today, the director of the VTH) can ask questions to the hapless seniors, in front of everybody, so that we all get a chance to watch awkwardly as they hem and haw and try not to appear stupid.

Sounds like great fun.

After Grand Rounds, we Community Practice students headed down to pair up on cases with seniors or other juniors. I went with a senior to an appointment for a suture removal (a dog that "ran into a car" about 3 weeks ago, got a laceration on her hock, and had several days of bandaging and debridement before they sutured up the laceration), then went along with a different senior to help teach an owner how to clip her puppy's toenails (puppy no like!). I got an opportunity to practice filling out all of the paperwork, medical records, history form, physical exam form, reminder postcard, etc. that go with every single appointment.

It's funny how tired I can get every week by Friday. I start out feeling like I'm "tired" on Monday and Tuesday, but every week ends with me thinking that I must have been feeling comparatively great and really energized earlier in the week. Part of it is having to be at school by 8 am most days (7:15 some days, 8:30 a few times). A big part of it is that we spend all morning actually doing things -- thinking and planning and managing cases, if not actually up on our feet and hiking all over the VTH. No more sitting passively in lecture all morning. And part of it is probably nerves about not knowing exactly where I'm supposed to be, or when, or what I'm supposed to be doing much of the time. I'd guess that's going to get better (and soon, I hope).

You hear a lot of current vet students say, when talking to prospective students, "You think you know what vet school's like, but you have no idea." Or they'll say to each other, "Back when I was in college, I really didn't know what I was getting into."

I feel like junior year (and, I assume, senior year) is similar to that. I've given lots of VTH tours to prospective students, and tried to explain to them how the curriculum is set up and what each year is like, but even I didn't have a good idea of what junior year would be like. It's more grueling and stressful but also more rewarding and enjoyable than I expected.

Spay, Take 2

Yesterday's morning of Community Practice/Surgery rotation included scrubbing in on a second spay, this time with a different senior.

The patient was an adorable little tan shepherd(?) mix, maybe 30 pounds and 6 months old. I'll be checking the humane society website over the next few days to see if they put up a picture of her once she's recovered a bit and ready for adoption.

Today's spay was my senior partner's first spay in which she was the primary surgeon. Like me, she had scrubbed in on several spays during her junior year, but had never done one on her own before. Hence, she was a bit nervous and had to ask a few questions, but I imagine I'll do the same next year, and she ended up doing a great job. It did mean that I didn't get to do quite as much of the surgery as I did on Wednesday, though.

I pretty much just ligated one of the ovarian pedicles, tied one of the transfixing ligatures on the uterine body, and sutured up the SQ layer again. The body wall and skin are the two most important of the 3 layers to get sutured really well, so I was happy to let my senior do those. The intradermal suture pattern meant to close the skin ended up leaving a small gap in one part of the incision, so I got to place a single cruciate suture over that -- my first time suturing anything in live skin, and wow does it bleed!

Puppy woke up MUCH easier than poor Research Beagle. She woke quickly, even though she was under for about 3 hours including 2 hours of surgery time. We didn't even have time to get her to the anesthesia recovery area before she started to come to, so she got to wake up in the surgery suite. She looked SO confused about what was going on, but was very relaxed and seemed nonpainful.

I visited the puppy this morning -- routine elective surgeries stay overnight two nights in the hospital; they are dropped off in the afternoon on the day before surgery, stay overnight to make sure they are fasted and seem healthy, then have surgery in the morning on Day 2, get the rest of the day to recover and be monitored for pain or complications, then get checked on in the morning of Day 3 and sent home later in the day.

I hadn't had a chance to meet this sweet girl before the surgery (our first encounter was after she was anesthetized), so it was fun to get to see her the day after surgery. She was SO needy, wanted only to snuggle up to me and be rubbed and petted (belly rubs, please!). She seemed very comfortable and didn't mind me palpating around her incision site, which actually looked really good -- some minor swelling, but almost no bruising, which I was worried about after doing a hack job on my poor banana during suturing practice in my first week this year. Her green tattoo ink (placed in the incision after it's closed, to identify in the future that she has been spayed already) had sort of smeared all over her abdomen and thighs, but oh well.

Here's hoping puppy gets a great home, and soon. It was really rewarding to see her after surgery and to see how well she was doing. A lot of people are concerned about doing surgery on young dogs (well, mostly on the pediatrics, like 6-12 weeks old -- this girl was a bit older). But once you see how quickly they get right back to normal, and act as if nothing ever happened, I think it's almost easier than doing it on the 1 or 2 year olds, who can tend to be real babies about this type of thing (case in point: Wednesday's Research Beagle).

All of the other surgeries (5 more) on Wednesday were cats and kittens from the same humane society -- 2 or 3 adults and 2 or 3 itty bitty kittens, maybe 10 weeks old. They were SO adorable! Especially after they had had their dose of happy drugs (opioids) before getting anesthetized...

Wednesday, September 8, 2010

I spayed a dog today (sort of)

I say "sort of" because I wasn't really the one spaying the dog, although I watched very closely and helped a little bit!

My rotation this week is Community Practice-Surgery. On the first and last day of the week, we see medicine appointments (mostly healthy pets for vaccines, but some minor things like ear infections, lumps & bumps, etc.). On the middle days, we juniors scrub in for elective surgeries (mostly spays and neuters, rarely declaws) with the seniors.

My surgery today was supposed to be a 9 month old yellow lab mix, about 50 pounds. She came in yesterday afternoon and I got a chance to say hi to her while she was hanging out in a kennel. However, turns out she had an ear infection, urinary tract infection, AND was currently in heat, so no spay for her today!

My actual surgery today was a 2 year old Beagle who was used for one of the many research studies going on in the VTH but has now found a home. I didn't meet her while she was awake (not before anesthesia, at least) but she was a cute little thing.

I have never really scrubbed in for surgery before, so I was fairly nervous. Once while working in Arizona, I "scrubbed in" to help with the removal of a massive 6 lb lipoma (coincidentally, also on a Beagle), but that was pretty much "wash your hands really good and put on these sterile gloves" - no proper scrubbing, no gowning.

We did learn all about the proper ways to scrub, gown, and glove for sterile surgery during my first week this year (surgical principles lab), and thank goodness, or I would've had no idea what I was doing.

The scary part, though, is how much they talked to us during that first week about the stresses and strains of being scrubbed in for surgery - how you have to drink lots of water to stay hydrated yet make sure you won't have to go to the bathroom, eat something right before surgery so your blood sugar stays up, try to wear appropriate clothing so that you don't get overheated, don't lock your knees, ask for help if you feel like you're getting hot or dizzy, etc. I think I was not alone among my classmates in feeling fairly intimidated by all of these warnings.

However, I think my years of choir must have paid off, having seen enough people keel over on hot Sunday mornings in a crowded loft! I tried to stay very aware of my body position, shifting weight, etc. so that I wouldn't be "that junior" who passes out on their first day in surgery.

The scrubbing, gowning, and gloving all went smoothly, as I'd hoped. It helped that the senior student with whom I was working was very willing to give me little tips along the way and encourage me.

I helped towel and drape the Beagle, then watched as my senior made the skin incision (good thing, since what I thought was the umbilicus wasn't -- oops!). She found the linea alba and made a stab incision then extended it cranially and caudally, and lo and behold, intestines appeared!

(It's sort of funny, but I had nearly forgotten that all of that viscera is just sort of hanging out together in the abdomen; it's not like we were cutting into a special pouch that just held the uterus and ovaries.)

Apparently one of the most difficult parts of doing a spay is actually finding the uterus among all of those other organs, many of which look very similar. In fact, when my senior did fish out the first uterine horn (very efficiently), we both thought it was a loop of intestines -- they looked that similar.

My senior showed me how to palpate along the uterine horn until you get to the ovary (very firm, much different feeling than anything else I felt) (and by the way, it is really HOT inside that abdomen when you stick your fingers in!). She broke down the suspensory ligament that anchors the opposite side of the ovary inside the body, then I watched as she clamped below the ovary and tied off the vessels and tissue that would be cut and stay inside the dog.

I got to fish out the second uterine horn and ovary, although I failed to break down the suspensory ligament on my own. (In my defense, you are pulling on something that you're supposed to break just by sort of yanking on it, but without hurting anything else by pulling too hard... so I guess it's an acquired sensation.) I clamped below the second ovary and ligated it myself, and was very excited when we released the clamps and I had done a good enough job that it wasn't bleeding.

My senior ligated the uterine body above the cervix, then we sliced it off (goodbye, reproductive capabilities!) and set it aside. There was some bleeding going on, apparently a little more than usual, but my senior deemed it okay to close the dog's abdomen anyway. She sutured up the body wall (which is a really important part, so I was glad to let her do it).

I sutured the subcutaneous tissue (my first time ever suturing live tissue, and although a banana is good practice, it is WAY not the same), then she did an intradermal suture pattern to close the skin. We "shared" placing the line block (injections of local anesthetic along either side of the incision, in the muscle layer).

(It's funny, but what a lot of clients base their opinion of your surgical skill on is how nice the incision looks afterward. That, and how neatly the skin was shaved [which the techs usually do, not even the vet]. Not too many owners are really worried about how pretty or effective your actual surgery inside the animal was.)

A couple drops of tissue glue to help bury the knots in the skin, a pretty line of green tattoo ink along the incision, and we were done!

All in all it took most of the morning (from 9:50 or so, when we went to help the anesthesia team get the dog under anesthesia, till 11:50 when we actually finished the surgery) to get that dog spayed, but only about 50 minutes of that was actual surgery time, which I guess is pretty good considering that I was definitely slowing down my poor senior with my laborious efforts to not jab the dog in the wrong places.

Little miss Beagle had a rough awakening -- she came to very dysphoric (disoriented and panicky) which is usually more of a bad reaction to the anesthesia than an indication of pain, especially since she was loaded up with all sorts of pain drugs. She calmed down pretty quickly with a little extra sedation, but I felt a little more responsibility for her disorientation and upset having been one of the two people that potentially caused it.

Overall it was a really neat experience, and I'm definitely looking forward to getting in on another surgery tomorrow (I don't know what -- a cat maybe?). I now know that at least I won't pass out every time I scrub in (although it could still happen, who knows). And I managed to do some things surgically, and not mess them up too much. But it's definitely going to be a lot more stressful when I'm the senior in charge of the surgery, and my little junior assistant has no idea what they're doing!

Friday, September 3, 2010

What I'm SO glad I'm not doing

In my copious free time (haha) there are several blogs written by other vets or vet students that have pretty entertaining posts about the industry and what their lives are like.

For a few months I've been following this blog, written by a vet student who graduated this past spring. She's been looking for jobs and entertaining some offers, but recently announced that she's going to be opening her own new vet clinic.

Holy cow. I SO cannot imagine doing that, possibly ever, but especially as a brand new graduate who's never been in practice before. I can't even comprehend the vast number of things you have to think about and know about and prepare for and do in order to start up a business, much less a veterinary hospital.

I really hope it works out for her. For sure I will be reading her posts regularly, and I'm really interested to see how things go. I guess you never can tell where you'll end up in your career.

No more large animals!

My sole week of large animal rotation came to a close at 11:30 am today. Finally!

No, really, it was okay. I did end up surviving, and it wasn't even that bad. In fact, sometimes it was even fun.

I am still really uncomfortable around horses, although less so than I was a week ago. They are just so huge and flighty and unpredictable and easily spooked and strong. Plus they can fall on you, or kick you in the head, or bite you.

Now, cows and sheep, I like those guys a LOT better. (However, I have to keep reminding myself that all of the ovines/bovines we worked with over the last 2 days were sedated, so I guess that might be a factor.)

Highlights of Thursday and Friday's food animal experience include: drawing blood from a cow's tail; drawing blood from a sheep's jugular vein; extruding a ram's penis; successfully placing a halter on a cow; and doing a rectal exam on a cow.

It's really funny to think about the differences between small and large animals when it comes to something as simple as moving them around. For example, it has taken us a solid hour each morning to bring the 5 Holstein cows and 3 rams (of indeterminate breed but obvious gender) in from the outdoor pens, and get them situated in the food animal barn in an indoor pen (the rams) or individual mobile stocks (the cows).

Cows are generally pretty predictable in their movement. They have a "pivot point" at which point they will walk past you, i.e. you start out walking towards the cow, and she will back up a little as you get really close, but as you pass her shoulder or so, she'll jump forward and start walking a bit. That's a heck of a lot easier than trying to push or pull.

Sheep are hilarious. They always want to be together, together, together. Our 3 rams loved to bury their faces under each other or go hide in the corner together. Sheep have such a strong flock instinct that if you try to separate one, it will pretty much freak out. Even taking one sheep 10 feet away from the other 2 in the same pen is a struggle (till you drug them).

I'm glad that I was forced to take this one week of large animal rotation, just for the learning experience. But I'm equally glad that it's over and I can soon go back to small animal surgical anatomy, small animal internal medicine, small animal anything!