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
Saturday, September 18, 2010
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!
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...
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.
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.
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...
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!
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!
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