Saturday, May 20, 2017

Diary of a Second-Year Vet Student: Tied In A Knot

My cohort is only four weeks away from becoming 50% vets. It feels like we have started taking bigger and bigger steps towards our goal. For the final lab of our Anesthesia course, working in teams of three, we have to conduct a physical exam on a dog, select and administer pre-meds, prep and sterilize the surgical site, intubate, induce, and move the patient to the operating room. We have to monitor the dog during surgery (anesthetic monitoring is a specific set of tasks that involve keeping track of nearly a dozen different patient variables such as blood pressure and heart rate as well as the rate of oxygen flow and amount of inhalant drug being delivered), extubate it, and stay with it until it wakes up. One of the fourth-year students will perform either a spay or a neuter on the dog. There's lots of moving parts there. And anesthesia is only one of the seven courses I am taking this term.

The lab midterm for our Principles of Surgery course is set for next week. Most of this lab is about doing things: scrubbing in properly, gowning and gloving using sterile techniques, folding gowns, wrapping sets of surgical instruments (called packs) so that they can be sterilized. While not an expert, I was introduced to all of these activities when I worked two summers ago at the emergency clinic--I am very grateful to KM for training me so thoroughly. I practiced these things in lab as required but I don't need extra practice for them. Identifying some 40 different instruments is also part of the midterm. I already knew the names of perhaps half of them, cutting that task down to a manageable size too.

So for me, and for most of my classmates, the most difficult part of our surgery lab will be the sutures. Given a particular surgical scenario, we have to say what suture we would use and why: the material, the diameter, and the type of needle. We have to demonstrate tying knots using the one-handed, two-handed, and instrument techniques (the latter is by far the easiest one). We have to demonstrate at least one, perhaps several, of the eight suture patterns we were required to learn. We might have to tie in a drain. Oh, and all that has to be done while wearing surgical gloves.

How exactly do vet (and human med) students learn these things? For the knots, we start with nylon rope and a standard-issue "knot tying board." We also use proxies like carpet pads with lengths of yarn strung through them to represent vessels that we need to ligate (tie off), layered cloth and foam pads with slits into which we can insert then suture in drains, the DASIE model (Dog Abdominal Surrogate for Instructional Exercise--do click through and look at the pictures), and the best tool of all, fake skin.

Knot tying board. Half of the nylon rope is dyed purple. It helps you learn the knots and to see immediately if you have tied a knot correctly. Ethicon makes sutures and other medical devices.

The best fake skins are layered in different colors for dermis, subcutis, and muscle, but quite a few of my classmates were issued a thick, rectangular, sticky, opaque pink blob that I immediately dubbed "the ham." I didn't get a ham. I got a nasty little 3x5 inch piece of tri-layered fake skin that had been used by many, many vet students before me. It was covered with their skin flakes, their dogs' hair, their tears. I could barely bring myself to touch it. But I was prepared--before the term started, I had purchased a lovely, brand new, 5x7 inch piece of fake skin from Amazon. It even came with interesting pre-cut incision shapes.

Since I've been practicing and my sutures don't look hideous, I thought I'd post some pictures. And yes, my fake skin is on an upside-down dinner plate. I want to keep it relatively clean and free of dog hair. Also, it is a bit tacky and leaves a sticky residue on my desk. I'd rather wash a dinner plate each time I practice.

Suture patterns clockwise from upper left: horizontal mattress, vertical mattress, cruciate, simple continuous with buried knots at both ends, and Ford interlocking, another continuous pattern.

Suture patterns from left: Cushing, near-far-far-near, and Lembert. I'm particularly pleased with the Lembert. I placed these with 3-0 suture, the thinnest diameter that I've attempted to use yet.




You might be wondering where we get our supplies from. We burn through a lot of suture material at this stage of learning and experimentation. Well, medical supplies like gloves and sutures have expiration dates. Vet schools will set the expired items aside for use by students and for use on cadavers. There is an entire floor-to-ceiling cabinet full of expired sutures that we can take home with us for practice. It gives us a chance to try all the different suture materials and diameters, see what they feel like, how easy or difficult they are to handle. There are even catgut sutures in there, many years past their expiration date. For the record, catgut is really hard to work with. Once I practice a sterile gloving at home, I will re-use the same pair of gloves three of four times for suture practice. My fake skin may be new, but it is far from sterile.

Friday, May 19, 2017

Tomato!

I haven't done any food-related posts in a while, and decided it was time for one. I stumbled across the rough outline of this dish in a magazine in one of the exam rooms in the local emergency vet clinic a week ago (long story, not blog-worthy). I made a small volume of it the next day, and liked it so much that I went all out and made an enormous volume of it this afternoon. This dish is perfect for parceling into lots of plastic containers, ready to microwave for a quick meal. Add a green salad, or if you are lazy and/or pressed for time (I am both), reheat a portion in a bowl, throw some greens on top then dash some of your favorite vinegar on top of everything, and you have a delicious, healthy, quick meal.

Tomato!

Here's the basic recipe that you can scale up as needed.
 
1 can white beans (I like Great Northerns)
1 can diced tomatoes
1/3 large sweet yellow onion, finely sliced (adjust to your taste, I like onion so I use a little more)
1 container (about 300 g) of cherry tomatoes (I prefer the yellow ones, they are sweeter)
fresh or dried basil
olive oil
1 package of fancy chicken sausages (I think Italian works best but you can probably use whatever makes you happy)

Heat oven to 375F. Rinse the beans if they are not low-salt. Drain well and pour can into large glass baking dish. Add the can of diced tomatoes, onion, and spices. Drizzle about a tablespoon or so of olive oil on this. Stir well. Rinse the cherry tomatoes then distribute them evenly across the top. Place the uncovered dish in the oven for about 20 minutes or until everything is bubbling. Remove the dish from the oven.

Cut the sausages in half lengthwise and submerge them under the surface without disturbing the cherry tomatoes on top. Use a fork! Don't burn your fingers! Return the uncovered dish to the oven and let it simmer until the cherry tomatoes begin to brown and burst (perhaps another 25 minutes). Let it cool a bit before serving.

Enjoy--and don't forget the greens!

Monday, May 08, 2017

Innocence

I am not a very good photographer. I don't have equipment any more specialized than what's on my phone and iPad. I occasionally use my little Canon camera but that's starting to feel more and more old school these days.

My usual photographic method consists of "take 50 pictures and toss 48 or 49 of them." It's a decently productive method, and as long as I have the discipline to throw away the shots that are blurry, out of focus, too dim, or simply fail to have a dog part in them, it doesn't clog up the memory of my devices.

But in photography as in life, we sometimes get lucky.

 

I took this photo, unaltered except for a bit of cropping, on Saturday morning at an annual public event called Pet Day put on by the College. My assigned morning tasks were completed and I was taking a quick walk through all the booths and exhibits before the event opened up. This first-year vet student was in the petting zoo area with one of the dozen or so pettable rabbits. She didn't see me taking her picture. This was the third of three that I took of her using my phone.

There is something remarkably Classical in the way her hands are arranged, the way her head is turned towards yet tilted away from the viewer. You know that I would never have been able to get such a beautiful shot if I had asked her to pose.

It doesn't hurt to be reminded that, even though they seem to be in short supply these days, there is still beauty and innocence in the world. 

Sunday, April 23, 2017

Archie, Crazed Agility Beast (Part 2)

Archie and I went to another AKC agility trial this weekend. It was in Eugene, which is a pleasant drive south of about an hour on a small state highway. The Eugene trials are small, and usually only have one judge, but the host clubs keep things efficient by setting up two rings, alternating classes between them. 

This was Archie's first trial out of the novice classes and he did very well indeed--three Qs out of four runs. I am so very close to having the crazed agility beast that I have in class in the competition ring with me. He showed me this weekend that he is starting to understand what trials are for. I have shifted to crating him inside the arena but keeping Mimi and Azza in the car if they have to come along. Archie can always see me during class, and crating him in the arena means he can see me most of the time there too.
 
So tie-tie.



As I was leaving this afternoon, I went over and told the judge that I had not shown under him before and that I really enjoyed his courses. He said, well I really enjoyed watching you run your dog. He's very fun. 

I get that a lot. I get that from complete strangers who come up and tell me, your dog is so fun to watch. It makes me feel proud to be his partner out there. Now that he is more focused, his speed in the ring is picking up, so I also got some compliments today on his weaves (he weaves like a big dog, a rare talent in a dog of Archie's size).

He nearly gave me a heart attack today by jumping on the table and nearly skidding off but he managed to hang on just as he was about to tip off the edge. Now that is a dog who understands what he needs to do! His contacts were perfect all weekend, and we managed to double-Q today with two nice runs. 

A happy fox terrier.

Saturday, April 15, 2017

Archie, Crazed Agility Beast

A couple of weeks ago, Archie finally got his third AKC Novice agility title and is now parked in the wasteland of the Open (intermediate) classes. I heard someone say once that AKC Open classes aren't designed, they are made by tossing out a couple of random obstacles from the Excellent course and renumbering it. So true, so true. But at least they offer some handling challenges.

On Thursday in class, we got to choose a sequence for our first run. I chose a relatively pedestrian sequence that only had a tricky weave entry and not much else, thinking that it would be a good warm-up for us. Well, Archie and I were out there doing some agility, but not really doing it together. I just wasn't connecting with him. My instructor said, at least you know this: he is a honest dog. If he takes an off-course, it's because you didn't give him the right information or timely information. I completely agree with this. He is exquisitely responsive to my movement and body position, even down to where my feet are pointing. I have a horrible habit of stopping or slowing down to check in with him, and it confuses him and causes him to slow down. In that brief moment, he makes decisions on his own, trying to figure out what I want him to do. Bam, there he goes off course. He is very consistent in taking off-course obstacles that are reasonable in the context (he is not running around taking random obstacles). This is my problem, not his.

So for our next sequence, I chose a segment of an international-style course and decided to handle it very aggressively. I walked it and made my plans. Ironically, it included the very same tricky weave entry that we never were able to get on the first sequence. 

Here's a map of the first half of the sequence that I made the next day from memory. I've drawn in Archie's path (solid line) and made a couple of notations about my handling choices (more on that below). The obstacles are numbered in order. The position of the number indicates the side that the dog needs to approach the jump from. So you can see that jumps 5 and 7 are "backsides" in which the dog has to take the side opposite of the one that he is directly approaching. 
 
 

The sequence started with a tunnel then into the weaves. I told him tunnel then turned and took off for the weaves. I had Archie on my right in the weaves and as he reached the last poles, I pulled laterally into a front cross at 3. As I completed that turn, I was pulling laterally again and did another front cross for 4. So Archie was on my right side again as he went over 4. There were some more sophisticated options involving a blind cross at 4. But I chose front crosses because I'm old school and feel more comfortable with them. I knew that I could execute the two back-to-back crosses smoothly. Plus they send very clear information to the dog, useful with an "honest" baby dog like Archie. And finally, he is not quite able to hang in the weaves when I make a strong lateral pull before he has finished them. This is a training issue that I know that I will resolve this summer once it stops raining and I can train outside again. Since I needed to be with him to the end of the weaves, the two front crosses worked best for us.

I pushed him to the backside of 5 by saying "back back back WRAP". Archie has a very strong, reliable wrap (it means do a very tight turn around the vertical of the jump). He also had to move across my path in front of me (he was on my right) to get to the backside, but I knew that he works very well with rear crosses. A more sophisticated move would be to have him slice 5 and turn around the far vertical instead. It is a smoother path for the dog requiring much less deceleration. Again, I went with the option that I thought would make the most sense to him. On the whole, speed is not our issue. He is demonstrating a lot more sophistication at knowing when to collect and when to extend for jumps, so even though he did have to slow down to wrap, it wasn't much of a slow down for him.

As he was wrapping around 5, I was already driving to 6. As I approached 7, I was saying "back back" and already turning laterally. He neatly sliced 7 and headed for the tunnel that my body position and movement were indicating. I began to pull away from him before he even entered the tunnel but he remained committed to the correct entrance. I sprinted, literally sprinted, to complete a blind cross before he exited the tunnel (the dashed line on the course map). It is no surprise that Archie is a lot faster than I am. This was a risky move--the chance of collision was high. And this was exactly the tricky weave entry that we were not able to get earlier in class. 

A blind cross is where the handler crosses in front of the dog but doesn't turn or face the dog. You just step from one side to the other, changing leads. I sprinted to the other side of the tunnel exit, dropped my right shoulder and arm towards the weaves, and said "WEAVE!". I barely made it in time but he had the info he needed. 

He hit those weave poles so hot I was sure that he would pop out. But he managed to stay in for the turn from pole 1 to poles 2-3, the hardest turn in that situation. When I saw that he managed his entry, I just took off, yelling "weave weave weave". 

He nailed them. 

I tossed him his precious bunny fur tug, which he proceeded to open on his own to eat all the treats inside. I was jumping up and down, yelling for joy. My classmates gave me a standing ovation. They told me later it was the best they had ever seen me handle. My instructor was laughing and said, well, I think we can also say that Archie prefers the more difficult courses! She pointed out that even though he has fantastic ability to read rear crosses, my aggressive handling kept me up front, kept me moving, and kept up a constant flow of info for him. 

It was terrifying. No time to ponder, no time or space to make a mistake. I felt like I was on the edge of losing it for the entire sequence. But it was exhilarating too. He and I were running like we were connected by a string. It was perfect agility. 

I hope this is a lesson learned for me. Archie is an incredibly smart little dog. I love doing agility with him. The burden is on me to step up my game.

Sunday, April 09, 2017

Diary of A Second-Year Vet Student: Lambing Season

I don't participate in very many of the student clubs. First, there are dozens of them, and second, I'm not that interested in most of them. But I am a dues-paying member of the Ag Animal Club. Most clubs are run by second-year students who joined as first-year students and learn how and what the clubs want to accomplish. I could not have been more excited last spring when my two gross anatomy sheep dissection partners, Becky and Sydney, put themselves forward as the vice president and president, respectively, of the Ag Animal Club. The two second-year students they were replacing are horrible young women. I refer to them as the "mean girls." If you've seen the movie by that name, you'll know exactly what I mean. 

Sydney shared my opinion of the mean girls, and decided she wanted to put her own stamp on the Ag Animal Club, make it more inclusive, have more speakers and activities. And one of the changes she made is to arrange for vet students in the club to volunteer at the university sheep center with the lambing crew. 

I eagerly signed up for my allotted number of two-hour shifts, and went to the first one yesterday. I got to bottle-feed lambs. I got to give ewes with mastitis intramuscular injections of antibiotics. And I got to milk a ewe to collect milk for a tiny little lamb, the runt of triplets, who was not nursing on her own yet. 

My total experience with milking anything was pulling some colostrum from the beef cow project a couple of years ago. But nobody else had been able to get any milk out of this ewe, so I said, sure, I'll give it a go. 

I pulled an ounce out the first time, and fed it to the little lamb. You can't see anything at all, it's all done by feel, and it was very satisfying to hear that stream of milk hit the bottom of the plastic bottle. I went back two hours later and pulled two ounces, and fed that to the little lamb. And then I pulled two more ounces on top of that for one of the volunteers to take home with her to feed the other survivor of that set of triplets.

Everyone was very impressed. I'll be the first to admit that beginner's luck was probably involved. I will also admit that I didn't know that sheep only had two teats until I started rooting around down there. But sometimes we display skills that we didn't even know we had. And just think, in order to have this experience, all I had to do was show up.

Diary of A Second-Year Vet Student: It's Starting To Get Very Real

At this point in our second year, we've completed several important foundation course series. For the most part, the "ologies" are done: virology, parasitology, bacteriology. Toxicology this term will complete that group. The first pass through clinical and systemic pathology is completed. Sys path deals with mechanisms of disease in systems like skin, kidney/urinary, liver, etc. Clin path covers many of the standard laboratory analyses, assays, and tests that vets use to diagnose disease: urinalysis, blood chemistry, that sort of thing. We've been introduced to diagnostic imaging, mostly radiography (xrays) but there's much more of that to come next year. We had a couple of brutal terms of pharmacology this year. It is extremely difficult to memorize drug things when we have no real-world contexts for them, but that's where pharm falls in the curriculum and whining won't change that. Up to this point, we've been making and memorizing lots of lists of lots of fiddly bits.

The tenor of our course work made a significant shift this term. This really became apparent Thursday afternoon with the first lab of our principles of surgery course. We all had to show up in scrubs. Divided into small groups, we got tours of parts of the teaching hospital that few of us had been in before. And we had a practical exercise to learn how to put on sterile gloves in a sterile manner, and how to perform a rough sterilization, the one that gets done before the animal is moved into the surgery suite, and how to properly drape a designated surgical field, the area where the surgeon will be making her incision.

We practiced these latter things using rubber legs, possibly meant to represent the leg of a large dog. But these objects had no pelvis, no paw or hoof, no bones, no skin, not even identifiable muscles, just tough orange-colored rubber that was vaguely leg shaped. Getting towel clamps into an object that has no skin was quite difficult. 

Even during the tour, which, to be honest, was still a tour and not all that exciting, I could sense the growing excitement in my small group. And when we were in the student teaching lab swabbing down the orange rubber legs, everyone was visibly even more amped up.

The reason was simple. Suddenly, after almost two years of "death by powerpoint" with only token nods now and then to touching real animals, we were actively doing things that we will be doing for the rest of our careers as vets.

In a few weeks, we will be intubating dogs and cats and acting as the anesthesiologist for the fourth-year vet students when they do surgeries. And in six months, we will all be making incisions in real dogs and cats. Six months. 

This vet school thing is starting to get very real.

Our entire class simultaneously came to that realization during the Thursday afternoon lab. I talked to many of my classmates on Friday, asking them in different ways what their impressions of the lab were. And they all confirmed that we had indeed experienced a hive-mind event, a collective shift in how we viewed the vet school process, and how we viewed ourselves as soon-to-be vets.

I am not surprised that we had this kind of shared emotional experience. Vet school is based on cohorts of students who take the same classes at the same time for the first three years. We are stressed and challenged together, and see each other succeed and fail close up and in uncomfortable situations. I actually expected this to happen at some point, but even so, I was just as swept up as everyone else on Thursday. 

So we move forward, still as a group, but with a much stronger shared sense of purpose.