Q: How many small animal trackers does it take to set up a horse stall?

A: Only 5. As long as there is an equine medicine resident around to supervise.

Yes, at long last, I had my first adventure in the equine barn this morning!

Thanks to the fact that horses have eyes and I am on ophthalmology, I headed out with the platoon of other wary small animal trackers, led by one semi-confident mixed animal senior, to meet a beautiful black and white paint horse being dropped off for surgical removal of his ocular squamous cell carcinoma tomorrow.

I felt better once I found out that 2 of the 3 seniors in the group had never been to the barn, either -- and they're graduating in 2 weeks!

True, all we needed to do was pick a stall, put an ID card on the front, fill up the tub with water, and spread a bunch of straw on the ground. And yes, that's probably just as easy as it sounds. But I'm proud to say that the 5 of us banded together to git 'er done (as some of the equine medicine juniors and seniors looked on in amusement, and the expression on the equine resident's face plainly said "And how did you guys get into vet school?"). In our defense, breaking up a big bale of straw seems to be a lot more fun when you're not doing it alone.

In other ophtho news, I watched an enucleation (cutting out the eyeball) on an Airedale with chronic uveitis and a recently detached retina. I also saw an entropion correction (cutting out part of the eyelid that is causing the eyelid to roll in and the eyelashes to scrape on the eye) and watched a senior student tack a cherry eye.

Although all these surgeries have been cool to see (and I'm glad I got a chance to venture into the equine facilities), I do wish that they had appointments in the morning sometimes instead of surgery -- I thought I was signing up to help work up eye problems during this week of independent study, not just stand around in surgery on my tip toes trying to see a miniscule surgical field with 3 surgeons' heads blocking my view. Oh well!

COOL-slash-Ewwwwwww

During my independent study ophthalmology rotation this morning, I got to watch a cataract removal surgery called phacoemulsification.

In a nutshell, it involves cutting a hole in the cornea, inserting a probe into the diseased lens where the cataract has formed, using ultrasound waves to "chew" up the lens, and then placing an artificial lens.

And it was simultaneously just about the most awesome and the most horrifying surgery I've ever watched.

The 'ewwwww' factor was not helped by the fact that we were watching the surgical field magnified on a huge video screen, so the eyeball was about a foot and a half across.

And I absolutely had to turn away when they were starting on the first eye and you could see a huge-looking but actually very miniature scalpel blade slicing into the eye, with aqueous fluid gushing out around it.

But once you stop thinking of the eye as an actual eyeball attached to an actual living dog that ideally wants to be able to use its eyeball after it's been sliced-and-diced, then this surgery is so, SO cool to watch.

It's also so neat to think that after just 30-45 minutes per eye, this dog, who has been blind since becoming a diabetic a year ago, will have basically "good as new" vision. (Okay, there's also the $3000 the owners are coughing up for the phacoemulsification, but if I had a few thousand dollars to burn, this might be a good investment.)

However, I'm afraid the 'ew' factor prevails. I'll never be an ophthalmologist!

Junioritis

I'd say just about every student in my class is afflicted with a serious case of Junioritis that can only be cured with 'tincture of time.'

What I mean is, we've gotten to the point of having a visceral reaction to the thought of sitting in class any more. Studying for exams now consists of a half hour skimming through the slides from the lectures you skipped, then just winging it. Papers are written by jotting down whatever thoughts you can pluck through the exhausted haze in your mind, then going back later to find references to support what you wrote.

We have two more weeks of junior year left. And in those 2 weeks, we have 3 midterm exams, a behavior final, and 12 hours of capstone. Plus regular rotations every morning this week and regular classes every afternoon this week and next week.

Capstone (affectionately dubbed "Crapstone") seems even more pointless this year than the previous two. Our freshman-year capstone exam was given the day before we started sophomore year; the sophomore capstone was given the day before starting junior year -- i.e. at the end of a long summer with (assuming proper motivation) plenty of time to brush up on material from the previous year. Although I didn't like the last 2 Capstones, I understood that they had at least some purpose.

Capstone III, coming up in 6.5 days, has lost all purpose. With a full schedule of rotations and classes, as well as ongoing exams (basically one every weekend) and homework assignments (one or two a week), there just isn't really any time to study for Capstone. They say that the other goal of Capstone is to prepare us for a cumulative, integrative exam like NAVLE? Well, the numbers are in, and this year's seniors (the first class to have taken any Capstone exams) did worse on the NAVLE than the last few graduating classes.

So, yes. We are ready to be done with junior practicum. We are ready to be done with classes. We are ready to be done with homeworks and exams. And, most of all, we are ready to be done with Capstone.

Having seen how busy and fatigued the seniors are, I never thought that by the end of this semester I'd be just about longing for senior year to begin! Four weeks on Community Practice sounds like a veritable vacation compared to the final four weeks of spring semester. (I know -- check with me when I'm about 3 days into Community Practice, and see if that's still how I feel.)

I'm so ready to be done!

Glad that's over

I have successfully (at least I think) completed Week 2 of the dreaded junior-year Client Communication Skills!

As expected, the spring semester week was less fun and more stressful and depressing than the fall semester. Our discussions focused on how to talk about end-of-life decisions, the euthanasia process, delivering bad news like a terminal diagnosis, talking about medical errors, and addressing financial concerns with clients.

So, yeah, not a lot of fun.

The simulated client scenarios they gave us were, predictably, more of a challenge. Tuesday's cases included:

-- Explaining to a reptile fanatic that the geckos he brought in were not the species he thought they were and as a result he was housing them in a desert habitat instead of a tropical habitat which was making them sick

-- Meeting with the owner of a horse after you've done a pre-purchase exam on the horse for a potential buyer, meaning the results of the pre-purchase exam are part of your confidential veterinarian-client-patient relationship with the potential buyer so you can't discuss your findings with the actual owner (and what you found caused the potential buyer to decide not to buy the horse)

-- Handling a client who brought his dog in once 6 months ago for chronic skin, ear, and eye problems (probably allergies) and now is back with "I just want to get more antibiotics and leave" (this was the case I got)

-- Discussing a physical exam finding of a fractured tooth that needs to be removed under general anesthesia with the owner of an 18 year old, hyperthyroid, chronic renal failure kitty

Tuesday's case (the allergy dog) went well for me. Knowing a little more about what to expect from having the cases in the fall semester helped to decrease the nerves a little, as did having 6 months of practice dealing with real clients on clinics.

Thursday's cases were... pretty terrible. They were:

-- A panicked horse owner who is standing in the breezeway watching her horse thrash around violently from severe colic, which isn't responsive to sedation or pain medications; you have to get the owner to sign an estimate for surgical fees *with* informed consent, meaning she truly understands the risks

-- Explaining to an owner coming to pick up his cat from CCU that the cat's IV line had been switched with another patient so that the cat had received the wrong medications for 8 hours (although thankfully there would be no lasting ill effects)

-- Delivering the news of a rapidly terminal prognosis (splenic hemangiosarcoma in the process of bleeding out) to a distraught owner, and deciding whether to euthanize or pursue treatment

-- Discussing a dog with severe maggot infestation with your technician, who wants to report the owners for animal cruelty/neglect even though there were extenuating circumstances

-- A young, previously healthy dog with serious sepsis and less than a 5% chance of leaving the hospital alive, and owners who can in no way, shape, or form put down any part of the $1000 deposit required to initiate treatment beyond emergency stabilization

I had the splenic hemangiosarcoma dog, and was that ever a doozy. The added problem (besides just giving a terminal diagnosis) was that owners often have no idea their dog has this type of cancer because the dog just grows a blood-filled tumor in its abdomen and doesn't act very sick -- until one day the tumor breaks open and bleeds and bleeds and bleeds into the dog's abdomen -- and usually the dog gets very weak or collapses. So this dog's simulated owner had no idea that the dog was even sick, and now had to get the news that without surgery and other complicated treatments that might not even fix the problem, her dog would probably bleed out and die within the next few hours.

Yep, fun times. I was nervous enough about the complicated cases (and they didn't tell us which case we would get until right before each of us started). It made me feel sick to read some of the case descriptions earlier in the week and imagine myself (a) trying to deliver this news to a client or (b) being the client getting the news.

And the case description I was given implied that the dog's owner had been told what was going on (i.e. the diagnosis) and was given some time to sit with the dog and decide what she wanted to do, and I was supposed to go in and support her through the decision. One of my first questions to the owner was "What has the doctor told you is going on with Penny?" and the answer was "Nothing." Great. Have another obstacle.

Mostly the difficulty for me with this case came from having never delivered this kind of news before and having to do it with an owner that was very in shock and emotionally shut down. I'm not great with allowing spaces and pauses in my conversations with clients, and that was exactly what this owner needed -- time to process what I was saying. And before I had had a chance to explain anything other than "Penny has cancer," she was asking me questions like "What do we do?" and "So I can just take her home now and then in a few days it might be time to put her to sleep?" -- questions that I felt I couldn't answer adequately or fairly without even given her a little bit more of an idea about what was going on with the dog.

In the end, I was the "someone always cries" person among my group of five students. It was so intensely frustrating to feel so sorry for this owner and what she was going through; to want so badly to help her through this process and yet not be able to connect with her; and to struggle to answer her questions directly without deviating off along my own path of "what I think she should know" versus "what she's telling me she wants to know." (And don't forget -- I was being videotaped and watched by my 4 classmates, my coach, and my coach's coach. No pressure, though.)

So I held it together during the actual interaction with the client -- which I was thankful for. There are plenty of stories on VIN posted by vets who've ended up with a client comforting them during a euthanasia or tough conversation, rather than the other way around -- and I didn't want that to happen, at least not on my first try.

But once the "acting" part of it was over and it was time to debrief and discuss the interaction, I did lose it a little bit. Thankfully, there was already Kleenex right there in the room for the actors who were crying! I certainly didn't have a total meltdown or anything, but there were a few tears and shaky voice for the next 15 minutes or so.

In the end, although it was a thoroughly sucky experience, I'm so glad that I had it in a simulated setting. I can't imagine what it would be like to go through that for the first time with a real client -- not able to pause when you lose direction, not able to rewind when you mess up, not able to get direct feedback from the client about how your words and actions made them feel, and not able to get support and suggestions from a great group of classmates and a coach.

And I definitely learned a lot for next time!

(Now, I'm just hoping there won't be a "next time" other than the regular stuff we have to do during senior year... but the decision about who fails their video reflection paper at the end of the rotation seems completely arbitrary this semester, so who knows -- I may 'get' another shot

Senior year countdown

We are frighteningly close to senior year, as we are reminded just about daily by the faculty who used to say "When you're in the clinics next year" and now say "When you're in the clinics in a few weeks." (At which we cringe in unison, cover our ears, and go to a happy place.)

Here are some numbers to give you an idea of what the rest of my semester looks like:

2 more weeks of junior practicum in the morning, including 5 mornings of client communications and 5 mornings of independent study in ophthalmology

2 papers to be written next week for client communications

3 more weeks of classes in the afternoon, including 30 more hours of lecture

4 more exams in Small Animal Med/Sx II

4 more "closed-book homework assignments" (= "quizzes") in Small Animal Med/Sx II

1 final in animal behavior

1 animal behavior case study paper to write

17 days(!) until our 12 hours of capstone exam begin (OK, I'm freaking out just a little bit)

125 lectures from last semester that I'd love to at least pretend to study before capstone (13 down -- gotta start somewhere)

27 days(!!!) until our first day in the clinics as seniors

Which for me means potentially 31-32 days until I start spaying and neutering dogs and cats all by my very lonesome. Yeek.

And a partridge in a pear tree.

Squeeee

I had the keeee-yoo-test little itty bitty baby puppy to anesthetize yesterday. Teensy "Molson," pictured here:



is a 9 week old, 4 1/2 lb sweet little German shepherd(?)-Husky(?) mix who came to the VTH in dire need of removal of his eensy-weensy testicles.

My other 5 cases on clinical anesthesia and Surgery C were all basically adult animals ranging from 12-180 lb, so I was a little nervous about anesthetizing such a tiny pediatric.

Fortunately, Molson did great with an atropine/hydromorphone pre-med, ketamine/valium induction, lidocaine intratesticular block, and some meloxicam and more hydro post-op. I got a 22g IV catheter into him after a couple tries (he got ferocious when I swabbed his leg with alcohol! What a tough puppy!) and successfully intubated him with a wee little 4.5 ET tube. He stayed pretty warm (thanks to a warm water blanket and a handy dandy heat lamp) and kept his heart rate up between 130 and 170. His blood pressure even stayed in a decent range, which can be an issue with pediatric patients. He was lounging in a pile of blankets and towels, basking in the glow of another heat lamp when I left him in the humane society ward. He's going to find an awesome home and grow up to be a fantastic doggie, I just know it!

Of course he's cute!

Bullwinkle, my sweet little anesthesia case from Tuesday, is now up for adoption and looking ever so darling (OK, maybe "darling" is a matter of opinion) in his adoption photo:



He's cute, I swear! I know he'll find a great family who appreciates his one-of-a-kind looks.