You can make soup out of anything (really, you can)

Warning: graphic post to follow.

My independent study rotation this week is a cadaver lab at the end of which I will have some preserved bone specimens to keep for my future educational and client needs.

Bones, right? Sounds fun. And not too messy.

Well, yeah, as long as somebody else gets the bones out of the dog for you.

Which was what had happened when we showed up yesterday morning for the first day of our rotation (there are 7 of us this week, 2 others besides me working on small animal skeletons). The instructor had graciously boiled a batch of canine hindlimbs for us on Friday night, hydrogen peroxide-d them on Saturday night, and left them out to dry on Sunday night so they would be all clean and white for us on Monday morning.

Good deal.

Except the instructor has been extra busy with a lot of other things going on. So last night he made some cat & dog soup for us (no joke, we are talking mesh laundry sacks full of dog and cat bits [skin, muscles, tendons, bones, eyeballs, and all] in a commercial soup cooker), and we got to clean the flesh off this morning.

OK, I knew this would be our first task of the day, so I arrived garbed in coveralls, overboots, and dissection smock.

I was also fully prepared to encounter an aroma similar to that referenced in a previous post during small animal surgical anatomy.

However, I was alarmed, and perhaps even more disgusted, to find that our bone soup looked and (especially) smelled almost exactly like pot roast.

(Note to self: I will not be eating pot roast any time soon.)

Now, that's not quite true. Yes, it definitely smelled like pot roast. (One of the worst feelings I've ever had in vet school is getting hungry during an anatomy lab.)

But from the outside it didn't really look like pot roast. The heads looked like, well, a dog head that had been dunked in a pot of water. Didn't look that different from a sleeping dog with a wet head (well, and decapitated, of course).

Until you try to pull the heads out of the mesh laundry bags (4 heads per bag). And the skin and muscles fall off in your fingers. And you just keep grabbing at things till you get through all the musculature and finally reach bone. And then you get the big part of the skull out, but you still have to fish around in the melting pile of flesh for the two mandibles and two cervical vertebrae.

And then you try not to throw up, and wish you hadn't eaten breakfast.

Once you get the bones out, it's not that bad. Yes, it still smells horrible (or horribly delicious, however you prefer to see it). But you just wash off the bones in a nearby sink to remove any tenacious bits of flesh.

But then there's the skull. And what does the skull have inside? The brain.

For any aspiring veterinarians out there, let me share with you a valuable life lesson I learned today -- something I will never forget for the rest of my career:

When using a high-pressure water sprayer to flush a cat's brain out the back of its skull, keep your mouth closed.

Another important lesson I learned in small animal surgical anatomy, and thankfully retained through this point is: double-glove. Then your hands will smell like death for merely 24 hours or (with some luck) less.

On a brighter note, I can use power tools! What we started yesterday and finished this morning was wiring together all the bones of the canine hindlimb: ilia, ischium, pubis, sacrum, 3-4 lumbar vertebrae, all of the tail vertebrae, femur, tibia, patella, fibula, fabella, tarsal bones, metatarsals, phalanges, and sesamoids.

Which requires drilling holes into the bones so you can pass wire.

Which means that, yes, *I* used a power drill. And I didn't even hurt myself (much)! Nor did I crack or shatter any of the bones in my dog's skeleton (unlike the 2 guys I was working with).

My dog leg is pretty much done, just needs to sit overnight so the glue on the sesamoids can dry, then it will be coming home to live in the attic (away from the cats) until such time as I can use it to teach my clients things.

Well, that's about as positive as I can be about this week's lab. At least it's all uphill from here, i.e. we have our bones in H2O2 for the day, they'll dry overnight, and then we'll be back to nice clean bony specimens for the rest of the week. No more face full of flesh-filled water spray!

The Toilet Paper

"The Toilet Paper" ("Get the Scoop While You Poop") is my class's new monthly bulletin started earlier this semester. You can guess where it's posted.

It contains such monthly features as:

* The Two Flusher ("This Month's Really Big News")
* Queen (or King) of the Throne
* What the Deuce is That? ("Testing your poo ID skills one scat at a time")
* The Last Gas

You may be thinking, Aren't vet students really busy? Particularly juniors, with both clinics and classes? How did they have time to put this together with their heavy course schedule?

Well, I am 90% sure that most of the work that goes into publishing this fine piece of literature each month is actually done during class.

I remain amused by the endlessly creative activities my classmates and I can come up with to kill time.

Pet Hospice rocks

I'm sure I've posted about it before (and if I weren't too lazy, I'd go back on my blog and link my previous posts -- but hey, it's Thanksgiving break, what do you want from me?) but I love, love, love my school's Pet Hospice program.

I start a new Pet Hospice case -- my fourth -- on Tuesday. The patient is a sweet little old man dog, a 14-year-old Pekingese/Poodle cross. (I refuse to call him a Peekapoo. I will not do it.)

As with my last hospice dog, this guy is in kidney and liver failure -- unlucky him. Unlike my last hospice dog, this guy is doing about a thousand times better. He's had kidney problems for over 2 years, and the liver issues are just a recent development.

Hospice Dog #4 (HD4) is supposed to be having SQ fluids every 2-3 days, which for awhile HD4's mom had been driving to a clinic 15 miles away to have done, but the drive and the time at the hospital were really stressful for poor little HD4, so his rDVM put his mom in contact with Pet Hospice -- enter me and my hospice partner.

And what a world of different. We've visited twice now, and HD4 does fantastically with his fluids at home. He sits quietly in his mom's lap, winces when the needle goes in, and then is perfectly happy for the next 2-3 minutes while we load him up with fluids. It's all over in less than 5 minutes, with almost zero stress for HD4.

To make things even more rewarding, I talked to HD4's mom on Wednesday, after our first visit the evening before, and she reported that HD4 was like a completely different dog. He'd been up and about, asking for attention, eating well, and even playing with the other dog (well, as much as he can, since he's pretty wobbly and prone to fall down any time the 18-month-old Chihuahua jumps on him).

It's a neat example of how much difference something as seemingly minor as staying well-hydrated can make. I'm sure HD4 feels like crap when he just can't drink enough water to keep up with the amount of uber-dilute urine that's coming through his failed kidneys, so when we can give him just a couple hundred cc's of fluid SQ, it's like he's a new dog.

As with all my hospice cases, I know it won't last forever. After all, HD4 is 14 years old. Even if he didn't already have known renal and hepatic failure, he'd still only have a couple more years at most. And HD4's mom feels like HD4 has had a good last few years, especially since she was told at the time of his diagnosis of renal disease >2 years ago that he would only have 6 months to at most 2 years to live.

But for now it's pretty heartwarming to see how much Pet Hospice can help HD4 to stay happy and comfortable in his own home. Based on what I've learned from all the hospice families and patients I've worked with, every vet student should get the opportunity to have these kinds of experiences before getting out into practice. It's too easy to see the sick old dogs and cats in the clinic and then just send them out the door without really knowing how life is for them (and their owners) at home.

P.S. This is my 4th hospice case in the last 9 months. And before that, it was about 14 months until I got my first case last February! Guess I'm packin' 'em in junior year....

Clin Path = meh

Sorry no posts for awhile. As you might have guessed from said lack of posts, last week's Clinical Pathology rotation wasn't super-exciting.

Which is too bad. Because Clin Path was pretty much my favorite class from sophomore year. If you know me, you can guess why: reports with lots of concrete numerical values that all have a given set of explanations that you have to piece together like a puzzle and (at least in class) there's usually one right answer? Yes, please!

Junior clin path rotation was basically an intensive 18-hour review of the most relevant points from sophomore year. And since I pretty much remembered everything from sophomore year since I loved the class, that meant that junior rotation was pretty boring.

We did get to do some fun microscope stuff. It included red blood cell pathology, white blood cell pathology, WBC differential counts, platelet evaluation, fluid cytology, and mass cytology. The last thing we were supposed to do on microscopes was learn how to do urine sediment exams (which, out of all the microscopy, was the one thing I need the most practice in) -- but the darned sophomores had to use the microscope lab, so we basically just watched a PowerPoint presentation about urine sediments -- which is totally not the same as doing it yourself. But oh well.

I did gain a bit of a reputation in this rotation for being a clin path know-it-all. Since there were only 25 people, I felt a little more comfortable speaking up and offering answers than I usually do in our massed class of 135. Everybody was amazed when I came up with the answer that, yes, a 3+ positive blood pad on a urine dipstick with a specific gravity of 1.003 and no red blood cells seen on urine sediment could in fact have been hematuria (rather than only myoglobinuria or hemoglobinuria) because the specific gravity was so dilute that the osmotic forces would result in lysis of the RBCs within the urine. So there. Go me.

I guess it was a useful rotation -- well, it would be especially for anybody that didn't like or didn't do well in clin path lecture class as sophomores.

But now on to bigger and better things! I've got my first independent study coming up next week -- I'm doing a cadaver project with the semi-creepy instructor in charge of the anatomy lab and obtaining all of the 'specimens.' If all goes well, though, I'll have my own canine skull, feline skull, and canine hindlimb and forelimb to keep for my very own self at the end of next week.

Stop beating the cats!

Poor Johnny has had an acute onset of conjunctivitis in one eye (and a dendritic ulcer, as I learned today when I brought him to school). Looks like somebody sucker-punched him.

Wait -- black eyes are badass, right? Then that makes 2 of us in the family!

High five

When I blogged about my internal medicine rotation last week, I can't believe I forgot to mention the most exciting part of the week.

On Tuesday, a middle-aged large dog came in with a 9 month history of lameness and stiff, painful joints. He was accompanied by about a thousand xrays taken by his referring vet over the previous months.

The senior student and I headed over to the radiology department with the dog's xrays, to see if we could con a radiologist into helping us interpret them.

As luck would have it, one of the first-year residents (who is a very, very nice person but comes across as a total geek [not saying I don't identify with him]) wasn't busy and offered to give us a hand.

As we pondered the various shades of black, grey, and white comprising this dog's ouchy stifle, the senior student pointed out a lucency on the femur and asked what it was.

The resident said, "It's a normal anatomical structure. Any ideas what?"

I offered, "The attachment fossa for the long digital extensor muscle?"

To which the resident replied, "Badass!" and gave me a high five.

For the remainder of the week I was known as a radiology nerd, as I came up with several other correct answers to various semi-esoteric questions.

But I'm okay with it: Because nobody else got a high five.

Quackery

Most of my "Complementary & Alternative Medicine" lectures this semester have focused on particular "alternative" treatment methods, and why they are completely invalid.

Today, we talked about homeopathy.

There are several underlying principles to homeopathy.

1. You can cure your symptoms by ingesting a small amount of something that, in a larger amount, would cause those same symptoms. Case in point: If you have a cold (runny nose and watery eyes), you can ingest a tincture of onion (since onion also causes runny nose and watery eyes).

2. The substances that you use for your remedy are to be diluted greatly in water.

3. The more diluted the substance is, the more powerful it is.

Let's continue with the "I have a cold, I better take some onion" example. Here's how you make your homeopathic onion remedy.

Step 1: Grind up some onion to make onion juice. You now have a "mother tincture."

Step 2: Take 1 drop of the mother tincture and add it to 99 drops of water. Shake thoroughly. You now have a 1:100 dilution of onion tincture in water. This is called a "1C" dilution, as you have diluted your mother tincture 1 time in a 100-part (C being the Roman numeral for 100) dilution.

Step 3: Take 1 drop of the 1C dilution and add it to 99 drops of water. Shake thoroughly. You now have a 1:10,000 dilution. This is the 2C dilution.

Steps 4-infinity: Repeat the dilutions, adding 1 drop of the previous dilution to 99 drops of water. You can continue until you have anywhere from about a 6C to a 30C dilution.

Note, clever readers, that at some point before you get to a 30C dilution, you have a less than 1 in a billion chance of having even a single molecule of onion left in your dilution.

Once you have reached the desired level of dilution, you can "prescribe" the onion remedy for your cold-suffering patient with instructions such as "Take 15 drops under the tongue 4 times daily." As a seasoned homeopath, you will of course recognize that the "stronger" dilutions (30C being much stronger than 6C) can only be "prescribed" by the experts.

And voila, of course your cold will be gone!

I hope I've convinced you that this type of homeopathy is utter nonsense and can clearly have no effect other than as a placebo (which, granted, can be pretty awesome).

And, of course, when you've diluted onion (or whatever more dangerous substance you choose to use, such as lead, rabies virus, arsenic, or tuberculosis-infected cow tissue) to this degree, the odds of it doing you any harm are very slim. So a lot of mainstream veterinarians, when their clients inquire about the use of homeopathy in their pets, will advise the clients that they probably won't be hurting their animals.

The problem comes when a pet owner (or even a veterinarian or self-proclaimed homeopath) chooses to use strictly homeopathic remedies instead of pursuing a traditional diagnosis or treatment for their animal's condition.

You have got to watch this hilarious spoof video of a homeopathic ER doctor unsuccessfully treating a patient, followed by some commiserating with a fellow doctor at the bar after his patient dies. It's only 2.5 minutes long and it's totally worth your time! Click here.