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!

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!

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.

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!