Sunday, December 27, 2015

Shameless Promotion: Freshpet

Even without a TV, I know about this commercial:

Go ahead, give it a watch. I'll wait.

Pretty amusing. And it turns out, effective marketing.

When I was at the grocery store a while back, thinking that I might get something special for the dogs as a treat during the winter break, I was browsing the shelves when I noticed a small refrigerator case. Inside: Freshpet logs. After reading labels, I chose the chicken log.

The dogs just love it. Cut into appropriately small pieces, the cat hoovers it up too.

I think it is more economical than canned food since there is more content, less water per unit volume. The chicken log looks and smells like balogna with orange carrot and green bean bits embedded in it. It doesn't seem to disrupt their usually excellent digestion or make them gassy. I sometimes give it as a treat, sometimes add it to their food bowl. They never get anything close to what is defined as a "serving" on the label. I am using it only as a treat, a garnish.

Highly recommended by CircusK9.

If you liked the commercial, check out their "making of" video:

Winter Break

It's a soggy, cold winter break. But at least I am not in that dreary, windowless classroom. After mulling it over, I decided to work in the emergency vet clinic part-time for the three weeks of the break. I'm working day shifts as a general nurse assistant, helping out whomever needs help. It's a very different pace than night shifts.

The four-day holiday weekend has been particularly difficult, however. As someone remarked on xmas eve (I worked that day), dogs all over the valley are ripping open boxes of chocolate even as we speak. And so it came to pass.

We learned that nearly all the clinics from Eugene to Salem were closed on Saturday, even clinics that might usually be open. I worked 10 hours without a break on Saturday and I'm still a bit shell-shocked. Nearly thirty emergencies walked in the door between 8am and 6pm, and we had only one vet (the emergencies kept coming until 10pm, I was told this morning). He had four nurses and two receptionists, and we made a tight team with good communication, and we co-opted the boarding staff to help even though they were completely full back there too, but some people had to wait a couple of hours before we could get to them. Add to that the regular hourly treatments we had to administer to our ICU patients, which of course grew in number as some of those emergencies had to be admitted, and we were all so busy we could hardly catch our breath.

We treated and released when we could, of course, like the dapple dachshund who, upon being injected with apomorphine, promptly threw up a few pieces of kibble, lots of chocolately goo, and the nearly intact wrappers of the York peppermint patties that she had wolfed down, and the yorkie who decided to nibble a corner off a block of rat bait (the owners brought both the rat bait block and the package label in with the dog)--she refused to throw up for us (stomach of iron, that dog) so she got dosed up with vitamin K and sent home with a three-week supply of vitamin K tablets. Rat bait poisoning is so common that the vitamin K tablets are flavored chewables. (Vitamin K is an essential factor in the clotting cascade; the chemicals in rat bait prevent its synthesis so animals usually die of internal bleeding. A dog that consumes rat bait is given vitamin K for several weeks until we are sure its body is making it on its own again.) And what would a weekend at the emergency clinic be without a lab who swallowed an article of clothing? He neatly and quickly vomited up a pair of socks for us.

Sadly, two animals died under my care. One was a small grey and white hamster. The family, mother, father, two kids, found him unresponsive in his cage and brought him in. He went into heart failure while the doctor was examining him in the treatment area so the doctor jabbed epinephrine into his heart while I was pumping his chest in an approximation of CPR. His little ribs were so fragile but you still have to push hard enough to force blood in and out of his heart. The hamster's heart started again but the beat was weak and thready. Doc told me to pack some warmies around him and wait. In the meantime, I had to go into the room with the family to complete the history on the computer system. When we have severe emergencies like that, we often begin treatment with only a verbal agreement from the owner and finish the necessary info gathering later. The kids were sobbing and the mother was crying as she was telling me what had happened. I'm thinking, the animal is probably already dead, but I couldn't tell them that. I finished up and checked on the hamster. Neither I nor the doctor could hear a heartbeat. I closed the hamster back up in the blanket and warmies. The doctor finished up a phone call then headed back to the room to talk to the family. I checked on the hamster again--and he was alive. I said, shit, he's alive! Get the doctor! A nurse launched herself down the hall, grabbed the doc. He came rushing back and we set the hamster up on oxygen with his entire head in the smallest mask we have. The hamster's heartbeat never stabilized however. The doctor talked to the family, returned, and told me to draw up the phenobarbitol solution that we use for euthanasias. When I brought the hamster in to them, the girl was very upset, and the little boy was sad but also fascinated to see his former pet in this changed state. I escorted them out the side door--our lobby was packed with people waiting to see us and I thought it best for everybody if the family had a more discreet exit.

The second patient was a King Charles spaniel, an older rescue. He was in an incubator with oxygen and had a tube stapled to his head feeding oxygen directly into his nose. He had heart disease, some combination of congestive heart failure and a mechanical problem--he had a distinct murmur. He had an IV catheter but wasn't on a huge pile of drugs. We had pushed small wires through his skin in three places to attach ECG leads. They can be placed directly on skin but the clips slip off pretty easily and we wanted continuous monitoring. Around 5pm, I untangled the ECG cords so I could weigh him. As I lifted him from the incubator, I noticed he was limp. I saw his tongue had turned blue and just then he started to code--wildly irregular heartbeat, gasping for breath. I called the doc for what seemed the thousandth time that day while drawing up epinephrine for the dog. We gave the dog two epinephrine injections and another of atropine. His heart stabilized but the beat remained thready and weak. The doctor called the owner, thinking the dog might hold on until they could get to the clinic. But while he was on the phone to them, the dog's heart stopped. Despite additional resuscitation efforts, we never got it started again.

It was a trying day but doing that kind of veterinary nursing gives me exposure to an incredible array of clinical problems and solutions. We are covering cardiology in physiology next term. There's the lecture then there's the application in the clinic. I'm not working during the break for the money, although it is helpful, but for the experience.

Saturday, December 19, 2015

Comfort Food

During the week before finals, I spent most of my spare time cooking large volumes of some of my favorite comfort foods. As a result, during finals week, I only had to dip into one or another of the plastic containers in my fridge or freezer for sustenance.

One of my regular fallbacks is the oatflake-zucchini loaf that I make following a recipe in my old and beloved copy of Laurel's Kitchen (the 1976 edition). The recipe uses an egg and cheese to bind the thing together and is decidedly old-school vegetarian. If you were dedicated to the effort of being vegan, you could use soy cheese and whole wheat flour or flax seed instead of the egg. I am not so dedicated. I often make the recipe in double volume. It keeps for many days and freezes well. I frequently add a squirt of ketchup before eating a slice.

I never said my comfort foods were haute cuisine. They are simple, cheap, easily reproducible, and reliably stored.

Another comfort meal that I quite like is a rather disgusting but extremely mouth-pleasing mound of mac-and-cheese boiled with a couple of pork sausages. Hey, I already admitted it was disgusting. Cut the raw sausages into five or six pieces and toss into the pot with the noodles and cook away. After draining, you can add the cheese and liquid (milk, butter, water, whatever floats your boat) into the same pot and mix well. There! Ready for apportioning into plastic containers for freezing. Not even close to vegetarian and not even remotely apologetic for it.

I also make a tasty bolognese sauce for spaghetti using ground beef, canned tomatoes, tomato paste, and spices. I don't otherwise eat beef in any form but this stuff can be made in very large quantities and frozen for future use. One night of cooking and I can eat for a week. It's not like the mac-and-cheese-and-sausage potage that is reserved only for my own furtive late-night meals. I've proudly served the bolognese spaghetti to guests.

A comfort meal that I regularly make is rigidly vegan. Take half an onion, slice thinly, sauté in olive oil until nearly clear. Add salt and black pepper while the onion is cooking. Finely cube 1/2 of a package of extra firm tofu (ignore the less firm varieties, they are gross). Put the other unused half of the tofu cube in a large container filled with enough water to cover it; it will keep for several days. Add the cubes of tofu to the onions. Brown slowly but thoroughly. Add red chili pepper flakes. Be liberal! Live a little! Give that chili pepper container another shake or two! Once the tofu cubes are nicely browned, add lots and lots of spinach. At least a half pound, washed, dried, de-stemmed, or just handfuls of the stuff from the pre-washed packages. Stir well, turn off the heat then cover, allowing the spinach to wilt. Serve with brown rice. A vegan's dream meal. Full of fiber and vitamins and none of those nasty animal products. Sadly, this meal doesn't store well (the rice can be made in advance in bulk quantities, however). But it is so cheap and easy to make that I keep it in regular rotation.

Despite making this meal almost once a week, I will never give up butter, yogurt, honey, eggs, and cheese. We humans are omnivores after all. But there's certainly no need to eat meat with every meal. All foods in moderation, all foods enjoyed.

Finally, the comfort food that I make on a regular basis, not just during the last week of classes, is a big pot of either black or pinto beans. I don't bother with soaking them; that is a waste of time and flavor (see this guy for one opinion on the matter). I cook them with no spices or fat of any kind, not even salt. This way I can use them in a variety of preparations and flavor them to taste as the dish requires: beans and scrambled eggs, tomatoes, and cheese; or beans sautéed with small pieces of chicken then topped with fresh mango. Yum.

Saturday, December 12, 2015

Diary of a First-Year Vet Student: Take A Deep Breath

This morning, my alarm didn't go off.

It wasn't a failure of technology nor was it human error. It didn't go off because I didn't set an alarm for this morning.

For the past several weeks, my alarm has been going off at 4am every single day, including weekends. During the week, in between feeding dogs, playing with dogs, eating breakfast, and showering, I can get in a solid two to three hours of study before I have to be in class. I would come home from class every day, play with dogs, feed dogs, play with dogs again, and put in three to four hours more study before feeding myself and falling into bed. Only for the alarm to go off at 4am the next morning. Weekends I could stuff in around 8 hours of study a day.

Vet school. Kicking the asses of first-year students everywhere.

However, my final grades are in and I am pleased. Early on, I saw the incredible flood of information that I was being asked to organize and stuff into my brain (beating one's head over and over with a handful of notes doesn't work, I'm here to report), saw that it was not going to abate at all, and I made a big decision. I decided that my goal was going to be to score "above average" on everything. This is not some twisted "Prairie Home Companion" nonsense (I hate that sad attempt at entertainment anyway). It was clear that the amount of time I would have to put into studying in order to earn top scores in every class was far beyond what I was willing to commit.

See, I like having a life. What I described above may not sound like much of a life, but I think that having time for my dogs is important. And when I say "feed myself," I mean cook meals with real food using utensils and spices, and that also implies getting fresh food at the store on a regular basis. I like having a glass of wine with my dinner. I like taking naps on the weekends. I like having time to attend cool labs and learning events in the evenings (I did a lecture and web lab on cow hoof trimming; we worked with cow cadaver legs bolted with large U-bolts and wing nuts to a wooden platform set on sawhorses, an arrangement that was just as fascinating to ponder as learning how to clean and trim their hooves). I like having time to help Jean with bleeding her calves on the weekends. I also decided that I would take one night a week off. It was a different night every week because of the exam schedule, but I did manage this for about half of the term. I also tried to consume some international news every other day or so, even if it was reading one article in depth or just scanning headlines. I like to live in a clean house (relative, since I live with animals, but I do not like squalor). I made sure that I maintained a regular sleep-wake schedule, even if it was not quite enough sleep most of the time.

Getting into vet school requires that you out-compete a lot of people. But once you get here, the notion of competition seems sort of silly. It's not a zero-sum game--she gets an A so I can't. And I'm grouped in with 55 very smart people. I simply refuse to do nothing at all except study.

We each have a locker in our classroom (we are in the same room for every class except anatomy lab, which is in an adjoining room). When some of my peers open their locker, a cartoonish waterfall of ramen noodle cups, candy bars, and bags of snacks cascades out--they eat nearly every meal every day in that windowless room. Some of my peers also seem to have eschewed showering for weeks at a time, deciding that the half hour or so it would take to shower and wash their hair on a semi-regular basis simply couldn't be carved out of their study schedule. These young people have not learned how to balance life and work. They stepped straight from undergraduate life into an environment for which most were not very prepared. We had tears and meltdowns of various sorts throughout the term, particularly before and after exams. Since we had bit exams every week for the last five weeks of the term, not including final exams, there were plenty of tears.

However, as I suspected and confirmed a couple of days ago, their study schedule is not as rigorous as it might seem. They spend more than half of their "study time" looking at youtube videos of cats and sharing links to podcasts of readings of Harry Potter fan-fic porn (don't ask; rule 34).

Anyway, I digress. My goal, to score above average, is simple. One point above the class average still counts--it's above the average. And it is in fact a functional goal that can help me gauge my progress. I was stunned as I walked out of the second gross anatomy midterm exam a few weeks back, convinced that I had failed it. I did in fact fail the lab part but managed to keep myself in the game with a good score on the written part (the written questions are based on clinical applications of knowledge of anatomy: if your dog presents with this kind of injury, I can tell you which muscles, nerves, and arteries would be affected, but ask me to identify those on a cadaver and I fail more than half of the time). My disappointing score spurred me to radically change my study program for the final exam, and I pulled out a much better score on the lab part of the final and an even better score on the written part of the final, an exam that included about 25% of the older material. Instead of lowering expectations for my performance on any quiz or exam, my goal was actually freeing. I was able to organize my study time while still making time for life outside vet school, and succeed on my own terms.

I won't be the vet that makes all Cs in vet school and still gets the diploma in the end. I will be better than that. And so far, it seems to be working. My GPA in vet school will be less than a perfect 4.0, but I have a life outside being a student that keeps me steady and sane. I suspect that I will be more successful in the long run than if my goal was to make the highest scores.

Wednesday, November 25, 2015

Vet Student Humor

Upon viewing a slide of a female cow lying on her back, cut open from anus to throat, with the two horribly swollen horns of her uterus pulled out and splayed across the rest of her viscera, the girl who sits next to me in class leaned over and whispered in a very concerned tone, "Do you think she'll be all right?"

The class uses a small whiteboard in our room (all 56 of us are in the same room every day, all day) to post weekly notices accompanied by amusing drawings. Last week it was a drawing of a uterus with a face saying "Hi! I'm Cuterus! Be an ova-achiever!" (Can you guess that we are doing reproduction units in all of our classes?)

One of our classes is gross anatomy. The adjective gross distinguishes the material from micro-anatomy and refers to features than can be seen with the naked eye (grossly visible). The puns on gross are too many to mention. On Monday afternoon, my gross anatomy partner and I were struggling to see some blood vessels and nerves in our cat that happened to coincide with a point where the diaphragm attaches to the inside of the thoracic wall. I made an executive decision to cut the diaphragm at that point. I said, there, that should give us some room to work. And my partner, master of deadpan delivery, said, yes, we cut the breathing room to make some breathing room.

A student group presentation in physiology class on reproductive cycles included a section on hormonal controls of sexual behavior. Before beginning, the student doing that part of the talk held up his phone so we could all hear the opening bars of Marvin Gaye's song "Let's Get It On." The student also happened to put on his first slide a picture he found on of a young girl sitting on a bench smiling. In the background, a male giraffe is mounting a female giraffe. The student said, oh, wait, it's not about the girl in the photo. Which of course immediately made it all about the girl in the photo.

What do you call a field full of rib cages? Thoracic Park.

We are now nearly finished with the first nine weeks of the first year of vet school. I didn't think I'd survive the five weeks of five major exams but I did. All classes are winding down to final exams, which begin December 7.

Sunday, November 01, 2015

Diary of a First-Year Vet Student: Outside the Classroom

Student clubs. So many clubs. Most have dues--oh, look, I get to spend more money on my education! But participation in the clubs looks good on the resumé. Most of them bring in special speakers or organize tours of relevant businesses or have other events that are members-only. And most of them offer opportunities to participate in or at least observe different aspects of veterinary medicine. What kind of vet do you want to be? You can use the clubs to explore that.

I joined the Shelter Medicine Club. I'm not interested in doing shelter medicine when this is all over. There's no money in it. In fact, that precise aspect of shelter medicine informs my interest in that kind of veterinary care--I want to keep my skills sharp so that no matter what I do with the DVM during the week (making a reasonable salary with it, I hope), I can volunteer at local shelters on weekends. The club helps staff the Pro-Bone-O clinics in Eugene where I have volunteered in the past. I couldn't fit any of those dates into my schedule this term but I hope to start going regularly next year. This club also held a wellness clinic for pets of homeless people in Corvallis a couple of weekends ago and I did attend that--it was mainly administering dewormers, flea treatments, and basic vaccinations. But at one point I told a woman that "this collar will help reduce flicks and teas" on her dog. As soon as the words left my mouth, I hesitated, and the woman and I locked eyes...and we both burst into laughter. It was a perfect Spoonerism, but it was also a perfect bonding of two disparate components of our community. Perfect all around. This kind of work is extremely rewarding and I know it makes a big difference for those animals and their owners.

I joined the Ag Animal Club. If I'm heading towards working with food animals, I need more experience with all of them. I'm hoping to have the club invite a USDA vet who oversees all of the meat production at the meat center at OSU to speak to us about that career path. I'm also hoping to drum up interest for a tour of a local poultry facility. There is a big table egg producer nearby but there are also some big hatcheries that produce baby chicks for other facilities. I don't think there are any big broiler operations in this part of Oregon but there are a couple of niche organic farmers that might be interesting to visit. There is also a poultry specialist vet in Portland that we could try to get as a guest speaker. There's more to "ag animals" than beef and dairy cows and I hope to add my voice to this club.

I joined the Lab Animal and Animal Research Club. Maybe I'll be a facility vet but maybe I can land a good job doing research on food animals. I'm particularly interested in exploring how nutritional management can improve performance while also addressing animal welfare and food safety and quality: a healthy animal should produce a healthier product. If we are going to eat animals, then we need to face issues of animal welfare head on, not just pretend that the current way is the only way.

This particular club, full of budding pathologists (who don't work with live animals), held a very cool event last week: hands-on experience with rat and mouse necropsies. There were nine of us led by one of the faculty of the school. We each had a normal mouse and normal rat. The prof walked us through the correct procedure for a necropsy in great detail. The methodology she showed us would work for just about any mammal or avian (fish and reptiles, not so much). The club provided all the tools and equipment. The animals came from a facility that raises rats and mice for various uses such as food for snakes, raptors, and the like (zoos, hobby enthusiasts, wildlife rescue, etc.). The rats and mice had been euthanized then frozen for a while before being defrosted for the lab.

After we spent an hour on our normal rat and mouse--turns out there's a lot to collect from even those small animals and it takes time to collect it all correctly--we were turned loose on the "abnormal" rats and mice. These animals had been culled from the donating facility because of some readily observable health issue. As we proceeded with these necropsies, an incredible array of things started turning up: enormous tumors in mammary glands, reproductive organs, muscle, skin, other organs. Animals with intestines so swollen with gas that the intestinal walls were transparent. One animal had a brain tumor that distorted its skull. I had a mouse labeled as having an "abdominal mass" who turned out to be pregnant with seven fetuses. Another student had a mouse with mummified fetuses that were pretty close to being teratomas--fully articulating vertebral column, limbs, even epithelium with hair. Most of us collected samples of the interesting bits and plopped them into plastic collection jars filled with formalin. The pathology lab will prepare the samples and place and stain sections of them on slides so we can examine them under microscopes at a future lab. All nine of us spent the evening saying "oh, this is so disgusting, here, take a look!" 

In addition to all of these fun student club events, I continue to help Jean with her beef cow study. She's got the 45 calves back in a barn on campus. We've done jugular vein and tail vein blood draws and vaccinations on them. Jean generously continues to allow students to learn on her experimental animals. For each event, I've been recruiting helpers from my first-year peers who don't have large animal experience. It's really rewarding to see them gain tremendous confidence by just putting their hands on these animals. Come third year, they are all going to be shining stars, and I'm very happy that I was part of that. After you draw blood from the tail of your tenth calf, you have a pretty good idea of how to make it work. Maybe calf 11 isn't perfect but you have enough experience at that point to make it work, which is the entire point of the exercise. And just as I wrote many months ago, I don't understand why there aren't students lining up outside the barn to participate. If the only requisite for the experience is showing up, well, that's a pretty damned low bar.

I'm an over-achiever so I've got one more component to my out-of-classroom learning. With an eye on the research project that I'd like to conduct next summer, I've been collecting blood samples from some of my former advisor's laying hens. You usually get blood from chickens from their wing vein, although the saphenous vein in their legs is another possibility. There is a small difference in gross anatomy between the left and right wing veins--I have a much higher success rate on the right wing vein. But I am also left-handed so the angle of approach is better for me on that side. Their skin is paper thin (and transparent) and the veins are just below their skin so the angle of the needle is pretty important. If your angle is too great, you simply push through the tiny vein--bam! you've blown that vein and an enormous hematoma forms under their skin. If it is too shallow, the needle slips between the skin and vein (veins are kind of tough and rolly even in birds). And chickens are fragile so you have to be patient once you are sure the needle is in the vein. If you pull back too hard on the barrel of the syringe, you can see the vein collapse, suck down to nothing. You have to time your pulls on the barrel with their heartbeat--pulse, pull, pulse, pull. The whole process could not be more different than drawing blood from beef calves and dogs. I've been told it is most like getting blood from a very old cat in renal failure. Okay! I'm ready! Pulling out venous blood from a chicken is a race between pulling too hard and getting nothing and having the blood clot in the syringe before you get a large enough sample (about 2 ml is ideal).

All in all, there are many wonderful opportunities to learn about veterinary medicine outside the classroom, many of them involving getting your hands on real animals (maybe not live, but that's okay), and all you have to do is show up. I plan to keep on showing up.

Monday, October 26, 2015

Diary of a First-Year Vet Student

Week 5. I'm not sure I'd call it exam fatigue, but when I finished our second big exam of the term, in gross anatomy, I high-fived a couple of my peers then high-tailed it home to spend an hour in the thin autumn sunshine with my pups and a glass of wine by my side. Ahh.

I did not make a perfect score on that anatomy exam--I know this because I left one question entirely blank. I know that you are supposed to throw something down no matter what, hoping for a partial point, but I had nothing to throw down. Total blank. I had spent 1.5 hours in the anatomy lab with the cadavers, then another 1.5 hours in the classroom with multiple choice and short answer questions. I happily left that question blank and moved on. On another question, I had no clue as to the instructor's intention--the question was so vaguely worded that any number of things could have possibly made some sense. For that one, I threw in some terms that may have gotten me half of that possible point. Maybe not. By that time, I was done. So very done with that exam. Not perfect, but I am pretty sure I did okay.

But there's no rest for the weary or wicked. While I was pretending to lounge on the porch in the sun, I read a chapter of physiology. I then vacuumed the house and swabbed out the toilet. (For some reason, my shower swabbing, bathroom sink swabbing, and toilet swabbing are on different schedules.) I have to catch up on micro-anatomy and take an online quiz tonight. And I plan to eat real, cooked food for dinner. 

Friday, October 23, 2015

Diary of a First-Year Vet Student: Palpation of a Live Animal

End of week 4, facing down week 5. Our second big exam is on Monday. Gross anatomy: bones, muscles (origin, insertion, and action of all of them), nerves, and blood vessels of the neck, shoulder, and forearm of the dog and cat (there are some big differences between those two species). We've had two pretty simple quizzes but this exam will be the real deal. It will have the usual written component. However, there will be a lot more to this particular exam. The instructors will pull out all of our dissected dogs and cats and use them to test us on identification. We will also have to palpate a live dog and identify specific structures.

Palpation just means feeling or manipulating something with your fingers. We have a two-page list of structures that we need to be able to identify by palpation.

Fortunately, I have the most unbelievably perfect palpation specimen right in my own home: Azza. Her limbs are exaggerated in their length and her coat is short and tight to her skin. A couple of weeks ago, I noticed that in low light falling at an oblique angle on her forelimbs, I could see the individual muscles and tendons. It's amazing. The deltoid tuberosity on her humerus bone is enormous. She has no body fat so I can feel individual vertebrae, all of the borders of the scapula, even individual bones in her sternum. I just spent 15 minutes checking off items on the palpation list: styloid process of radius bone, brachial artery, origin of sternocephalicus muscle, acromion of the scapula bone, etc.

Anticipating my need to use them for this purpose, I've been slowly working up to palpation as massage for both Azza and HellBeast. It's basic operant conditioning: hold still and I pet you, and maybe I sort of squeeze this part of your forelimb or shoulder for a second or two. Since the cat is a bit more reactive to being touched, I gently palpate his forelimb and shoulder when he's relaxed and mostly asleep in bed at night. The suprahamate process on his scapula bone is lovely.

Thursday, October 22, 2015

Experiments in Immunology: Don't Try This At Home

So I wrote the earlier post about 3 hours after I got the rabies shot. By the time I got back to campus (t plus 4 hours), I was going down like a sick cow. Fever, shivering from chills, stiffness in my neck and both arms and legs, sore lymph nodes in my neck and armpits, dizziness, nausea, dry mouth, and most strange of all, the hair on my arms and neck were completely raised up. All of this within hours of getting that shot. I managed to make it through lecture (t plus 5 hours) then asked some of my peers for help.

I was not having an allergic reaction to the rabies vaccine. Do not mistake my symptoms for any kind of histamine response. I was having a full-out immunological response to it. My body was throwing the entire fucking immunological arsenal at those killed virus proteins. Danger, Will Robinson! Intruder alert! Faster, pussycat! Kill! Kill!

Upon reflection, using myself as a lab rat, getting the flu shot on Tuesday then the rabies shot today, was probably not such a good idea. My immune system was primed and ready from the first shot, and it went just a teensy bit overboard when the second one arrived 48 hours later.

My peers recommended ibuprofen. I resisted at first because I simply didn't want to put anything else into me, but I finally gave in and took 400 mg (I always carry ibuprofen with me). And it really helped. Within half an hour (t plus 6 hours by then), the ibuprofen kicked in and started tamping down some of the more severe symptoms. It didn't eliminate them, it just made them less uncomfortable. But the hairs on my neck and arms remain raised. So very weird. I was at least able to stay and complete nearly all of the microanatomy lab.

I am now at home looking forward to a night of doing nothing at all except cooking a decent meal, playing with my dogs, and going to bed early. Oh, did I mention how vet school forces you to evaluate how many hours of sleep you really need versus how many you think you need? I've shaved nearly 1.5 hours off my normal sleep schedule--that translates into valuable study time.

To be clear, most people who have to get multiple vaccinations do not have this kind of reaction. And to also be clear, the vaccines themselves are not the problem: not the adjuvant, not the killed virus proteins. The problem lies entirely in how my delicate-flower immune system responded.  I did not give myself autism. I am not sick--I don't have the flu or rabies. My immune system is just rather flamboyant in its response to all of these new antigens. A good night's sleep and I'll be just fine tomorrow.

Diary of a First-Year Vet Student

Week 4. We had our first big exam today, a physiology midterm. It took me just over 2 hours to complete it. I felt pretty good about my answers. Not a perfect score, but a respectable showing. Better than "just enough to pass". I find it quite irritating when I hear people say "I only need to pass." What happened to excel?

After I handed my exam in, I rushed home for some puppy love. The dogs are gratefully stretched out in the flowerbeds soaking up the increasingly thin sunshine, making some vitamin D and turning their ears nice and pink inside.

The second-years colluded in a most fabulous fashion, and starting about half an hour before the exam began, they began traipsing into our classroom (there are dedicated first-, second-, and third-year classrooms) to deposit food on a table at the front of the class. Everything from fruit to chocolate to homemade cookies showed up. Someone made a quiche. Another one brought in tiny little corn muffins. Someone else brought in half a dozen jugs of juice of all kinds. Thoughtful people brought in cups, plates, napkins, plastic forks. There were dinosaur fruit jelly things and bananas and granola bars and strawberries. There were cookies with Halloween-themed frosting. There was even a bag of chips! It all made an enormous mound. Sure, a display of excess too, but it was quite a show of support--those second years, they were telling us, they've been through this, they survived, and we can survive it too. I wondered aloud to a couple of my peers if we would remember to be this generous when it was our turn next year. They all assured me yes, absolutely. I'm still a bit resistant to the kumbaya mentality but it's the vet school way. Plus treats. Who doesn't like getting treats?

On Tuesday, I did my part for herd immunity (and my personal health) and got my flu shot. Right arm because I'm left-handed. Oops...because I forgot that I was going to get my first of three rabies vaccinations this morning. Had to be in the left arm then. I'm feeling a bit light-headed now--and I can't tell if it is from all the sugar I ate instead of a healthy breakfast at home (my tiny portion of quiche hardly counted as carb input), or because the two vaccinations are now turning my immune system into a war zone.

Bizarrely, I have no problems poking animals, or even you, with sharp things. Not hesitation at all. But I am completely unable to watch myself being poked with a needle. Even watching the nurse prepare the needle makes me nauseous. I'm such a delicate flower.

No rest for the first-year vet student, weary or wicked as we might be. Our next big midterm in coming up on Monday (gross anatomy): bones, muscles, nerves, and veins/arteries of the thoracic trunk (neck and shoulder) and forelimb.

Friday, October 16, 2015

Diary of a First-Year Vet Student

Week 3. Four years minus three weeks.

Over the past few months, my dogs have become rather bored of the smell of dogs, cats, chickens, sheep, and cows on my clothes when I arrive home. Spots of blood, pee, vomit, and poop are another matter entirely: body fluids for the win. Today I came home reeking of male goat and sheep lanolin. I expected the dogs to fall on the ground in paroxysms of joy. Nope, nothing. But on Tuesday when I came home with tangible tendrils of swine barn funk waving off my hair, skin, and clothes, well, that certainly got their attention. What could possibly be the source of that fantastic odor?

Our nascent class band, tentatively named The Lacunae, has already decided to call their first hit "Speak Softly and Touch the Pig." One of the band members plays the bagpipes.

Our first big exam is next week; there will be a big exam every week after that until Thanksgiving. Some of my peers are having trouble adjusting to the pace and volume of information. From my tiny little window of class time so far, I think that the classes are not too different in the level of detail of information and expectation of performance than any other specialized STEM grad class. The real difference is that we are taking four or five of those classes each term, not one or two as we might in grad school.

I'm still trying to find a rhythm to studying and not studying. It seems like I have to make a new plan every day. But the dogs and I muddle through. As I write this, Mimi is methodically emptying the toy boxes in an effort to find the perfect toy that will drag me away from the study table. Time for a break!

Wednesday, October 07, 2015

Diary of a First-Year Vet Student

Day 3. We have each been assigned boxes that contain the disarticulated (loose) bones of a dog. We were told that we could take them home but that we must keep them away from our own dogs. Fucking cannibals. 

Day 4. Today I made a cow pee. On purpose.  

Day 5. We were told that as veterinarians, we need to have respect for all species, especially one species in particular. The speaker said, “Which one would that be?” then paused…and a girl said tentatively “…spiders?” Everyone broke into laughter. The speaker hesitated then said, “well, sure, spiders, but I was referring specifically to humans.” Everyone laughed again.

Day 6. Someone tried to start a signup sheet for Thursday Snack day. Nobody brought any snacks today. However, one girl brought apples, oranges, and bananas. That was far better than snacks. We fell on the fruit like wolves bringing down a deer.

Day 7. Hallway discussions during breaks revolve around itemized lists of all the things we are no longer doing when we aren't in class. All we do now is study.

Day 10. My gross anatomy partner and I are dissecting a male cat. (Side note: all of the cadaver dogs are pit pulls or pit mixes.) We are not the fastest partners in class by a long stretch. We spend a lot of time talking about what to do before we dive in and start doing it. But we are persistent. Today, when all but one other team had already bagged up their animals, lugged them to the freezers, and cleaned up their tables, we were reviewing the flexor muscles of the forelimb of our cat with the instructor. When we finished identifying them all, he said to us, pointing to the forelimb, “that’s a very nice dissection, by the way.” Never mind that the pectorals looked like they had been chewed off—our forelimb flexors were “very nice”!

Tuesday, September 29, 2015

First Week in the Class of 2019

As I write this, we are now a week into our new lives as first-year vet students, members of the Class of 2019. I say "we" because this cohort of 56 will be together for four years. It won't be until the fourth year when we move into different clinical rotation tracks (small animal, large animal, general, exotics) that we will begin to spend time apart. On a side note, OSU has the smallest class size of any of the AVMA-accredited schools.

I'm pretty interested in finding out how similar vet school is to grad school. Sure, our schedule is more intense (19 to 21 credit hours every term), but how much more dense is the information? A difference that I already can see is that the DVM is a professional degree. You get an MS or PhD, there is no guarantee of a job. You get a DVM and the implication is that you have been trained to perform a specific job, and you should be able to move right into it. This will likely provide more fodder for posts in the future.

I'm perfectly happy in this environment, though. I like being a student. It is a familiar routine for me, and I can easily study every day of the week. However, I won't spend 16 hours at school, ever. I did that in grad school the first time around and have learned since how to be efficient and effective at most intellectual tasks. But it also means that I don't fall behind in any one class. I can balance school work and other activities more easily.

There are lots of vet student clubs in which I can participate. I'm interested in the Ag Animal club since I'm interested in working with food animals, but I've also put my name on the email list for the Shelter Medicine club. You'll recall my previous posts about my volunteer work at Pro-Bone-O in Eugene. The vet students participate heavily in that and other volunteer activities with shelters. I want to be able to continue doing that when I can. I've already signed up to help at a free clinic here in Corvallis for pets of the homeless that will be held later this month.

In addition to vet school stuff, I've also been asked to assist with tenure/promotion review associated with two of my mentors, my advisor and another professor in Animal Sciences. I could not have quit my job with Aramco, got an MS, and made it into vet school in just 2 1/2 years without mentoring. I have to write a letter for each one, evaluating their teaching and mentoring. I was also asked to sit on the student committee that evaluates and summarizes all the student reference letters for them. As you can tell, I have a full plate already, but there is no more professional way for me to thank my mentors for their assistance and support than to return the favor.

On top of that, I spent the two weeks between quitting my job at the emergency clinic and starting classes turning my thesis into two publications. I sent the drafts to my advisor and expect that she and I will spend much of the fall engaged in numerous back-and-forth rounds of editing. No rest for the weary or the wicked!

No doubt I'll find plenty to whine about as I go, but so far, so good.

Monday, September 07, 2015

Bittersweet Success

In a perfect application of some universal law, in this last week of my job at the emergency vet clinic, I've finally found the "sweet spot" for all sorts of procedures.

I mentioned that the other night I did my first successful jugular blood draw on a non-cow, in fact a heavily coated springer spaniel. This was followed that same night by a saphenous blood draw from a very sick corgi whose veins were shit and whose skin kept sticking to the needle. I got that blood in one poke. That one was significant not only for its inherent difficulty but because before that dog, I had not had much luck with leg vein blood draws (recall that I had to poke Mimi four times, twice in each hind leg, to get a single blood sample). So double success with the corgi.

Tonight I had to draw blood twice from a yellow lab who had eaten rat poison and who had received a blood transfusion earlier in the night. Both were saphenous draws. The second one was for a clotting test. For this particular test, the stick has to be clean which means you have to hit the vein in one poke, no fishing around for the vein once you are under the skin with the needle. Even though I had already had done a one-poke blood draw on this dog, I was going to let my colleague draw the sample for the clotting test, but she already had the dog restrained, telling me, you can do it. And so I did. It was a perfect stick. Big dogs are much easier, that's for sure.

But perhaps the most amazing of all, tonight I did a jugular blood draw on an 8-week old boston terrier puppy with parvo while I was wearing a surgical gown and gloves for biosecurity. Think about that for a second--most of the time we can't see the jugular vein, especially if the animal has a lot of coat, has thick skin, or is very sick (dehydration, low blood pressure, wounds, blood diseases, heart conditions, etc. can all make the veins flabby) so we go mostly by feel alone. We weren't wearing sterile surgical gloves but the regular nalprene exam gloves which are pretty thick. I nicked the vein with the first needle but changed to the other side of the neck and hit it in one poke with the second one. I was a little freaked out by having to jab a needle into the neck of such a small and very sick animal but I think that having a little pressure helps me focus.

And I've had some success with making blood smear slides. We have machines that examine blood cells but sometimes you have to have human eyeballs on the sample. Platelets in particular can clump and be miscounted by the machine. After we draw blood into a tube with anti-clotting chemicals and analyze it, we have some perfectly good whole blood left over. Once the animal is treated and sent home, that sample is tossed. So if you want to practice making smear slides, there is usually plenty of material to practice with.

To make a blood smear slide, you take a clean slide and place a drop of blood near one end. With even pressure, drag another clean slide across the first just until you touch the drop. Capillary forces will cause the blood to flow out along the line where the second slide is touching the first. Then you quickly swipe the second slide all the way back the other direction. The goal is to make a perfectly thin layer where the cells are uniformly distributed without clumps or gaps.

My first attempts were pathetic. But once I got the hang of it--blood drop can't be too big (top slide below) nor too small (middle slide below), and the pressure of the slide that you drag across to make the smear has to be even (air bubbles in the middle slide below), and so forth--I managed to produce some very acceptable smears. My most perfect slide is the bottom one below. The slides are stained before we look at them under the microscope; these slides were not stained yet.

It's a little frustrating that all this is coming together during my last few days at the clinic. But that tells you how difficult all this is to learn and execute. It took me over three months to gain these skills and they are just the tiniest tip of the iceberg when it comes to what a good vet tech needs to know. I'm extremely pleased to have my little set of skills though. I was basically tossed into the night shifts at the clinic and I am so thankful that the nurses I worked with were patient and helpful. They deserve a lot of credit for mentoring me so effectively. Look at how much I learned from them! I'm a bit sad to be ending my job in large part because I'll miss working with those caring and dedicated vet techs.

Saturday, September 05, 2015

Happy Ending

Working nights in the emergency vet clinic, it's guaranteed that not all of the client visits will have a happy ending. Here's one that did.

The owners called around 3am. They thought their dog, an English Springer Spaniel, had bloat. We told them there was nothing they could do at home and that they needed to bring the dog in so the vet could examine her.

The other tech and I talked about this after the phone call. Bloat in a female dog could in fact by pyometra, a horrible condition in which the uterus becomes infected and fills with pus. It has to be removed surgically or the animal will die. I've seen enormous canine uteri on the table in surgery, swollen and discolored. Cut them with a scalpel and really nasty fluids come out. Bloat requires surgery too. Either way, my colleague decided to prep surgery and get things ready for an IV catheter and fluids.

Around an hour later, they arrived. We didn't have any other critical care patients at that time so I accompanied the other tech into the room with the couple and their dog. The dog was an intact female. She was panting, hypersalivating, and dribbling urine. She was visibly swollen.

Remember that at this point, we thought that it might be a fairly dire situation.

Before we wake the vets up at night, we collect as much information as we can, including basic physical data such as heart rate and temperature. The dog's temperature was only 99.9 F. Hmm. Pyometra is typically accompanied by extremely high temps (104 or 105 F).

When we took the temperature, my colleague noticed that the dog's rear end was soaked (springer spaniels in full coat have a lot of furnishings on their legs), was sticky, and smelled like tuna. Urine is usually not sticky or fishy. When I held the dog during the temperature-taking, I noticed that she didn't appear painful in the belly which is typical for bloat, her belly was very squishy (bloat would have made it hard), and her teats were gigantic.

The man told us the dog had been "rooting around" in its bedding and behaving oddly for the past few hours.

Without commenting on any of this, my colleague got the basic info into the computer and we left the room. We then looked at each other, compiled all of our observations, and said "she's pregnant. Puppies!"

When the vet came downstairs, the other nurse told him "Dr. K and Dr. D have a diagnosis for you: puppies!" He grunted and proceeded to the room.

In a perfect example of the white coat syndrome, he came into treatment with the dog a few minutes later and told us that the couple told him that the dog had been bred but they thought it didn't take.

Um, let's review, shall we? About nine weeks prior, they bred they dog. They didn't notice the weight gain. They didn't notice her teats getting swollen. They didn't realize that her water broke, soaking her rear end (that's what was dribbling out of her, not urine). They didn't connect the rooting in the bedding with nesting behavior of a bitch in early labor. They called us saying they thought it was bloat. My goodness.

The vet told us to run a blood panel and get an abdominal xray. As a brief aside, I did a perfect one-poke jugular blood draw on this heavily coated animal, my first successful jugular blood sample on a dog. We got the blood sample into the machine and trotted off to xray.

Here's a picture of the radiograph. The dog is laying on her right side with her head to the top of the image. What can you see?

It's important to count both skulls and spines. Here is a doctored image.

She was a little anemic, not surprising with eight parasites inside her and probably inadequate neonatal nutrition, but otherwise there didn't seem to be any problems. She was in the early stages of labor and didn't seem to be presenting with any birthing complications so the vet sent the hapless couple and their dog back home.

Wednesday, September 02, 2015

CircusK9's Emergency Kit

One of the home tasks I wanted to accomplish this summer was to clean up and organize the garage. Over one-third of the floor space is covered with stacks of boxes that are in turn stuffed full of folded packing paper. Even as I unpacked things back in April 2013, I wasn't sure I was going to stay here for very long so I kept all that packing paper. Boxes and boxes of it.

Well, it looks like I'm going to be here for a while (vet school is four years long), so I decided it was time to let go of all that paper. It was also time to turn the garage into a workable and organized work space.

And as part of that effort, I decided to build my emergency kit. Cleaning up the garage allowed me to allocate space for it. You've heard of these kits--plastic bins that contain things that one might need to wait out or even survive a natural disaster. Around here, that would be an earthquake. Or the zombie apocalypse. I'm putting my money on the earthquake happening first, though.

The relative risk of strong shaking isn't too high where I am, and I'm too far from the coast to worry about tsunamis. However, when (not if) the big one hits off the Pacific NW coast, we could lose power for many days. And unlike hurricanes and tornadoes that come in fixed seasons, an earthquake could happen any time of the year. What if it happened during the winter? What if my house was damaged so I couldn't stay in it?

I've been reading up on county, state, and federal recommendations for what the emergency kit should contain. If nothing else, it should have water, water, and more water. My kit has 20 gallons. Enough for me and the animals for a few days.

My kit is actually four large plastic bins stacked in a corner of the garage that I deemed to be most stable but accessible even if the garage itself collapsed. Each bin is labeled with its contents on the top and side and its lid is secured with a strap; the straps are also part of the kit.

I put in tools, including a saw, hammer, nails, screwdrivers, camping shovel, zipties, duct tape, electrical tape, rope, utility knife, tarp, and gloves. There is a flashlight in each of two bins with extra batteries. I've got a bin that contains cat food, dog food, a litter box and some cat litter, sleeping bag and inflatable ground pad, two fleece blankets, a pack of "space blankets", and a small duffel bag with clothes and shoes for me, including an old pair of boots. I put in canned food (soup and tuna and beans), dried fruit and nuts, a box of crackers, a jar of peanut butter, a can opener, and some utensils, including bowls for food and water for the animals. I tossed in some old leashes and collars for the dogs. Stacked near the kit are crates that I could use for Mimi and the cat. I included paper towels, toilet paper, plastic food containers, ziplock baggies, and trash bags. I put in some money too. I added a first aid kit, purchased online, but I added a tube of Neosporin, a box of large non-stick bandages, and tape.

These kits are not supposed to be static--you are supposed to continually revise them. If nothing else, you need to eat the food every few months and replace it with new stuff (I already know I will regret the one can of Spam that I included). I still have a couple of items that I would like to add: a radio and one of those fancy portable chargers that are supposed to stay charged for months. I've got to do some research before I lay down any money for those.

When I could, I used items I already had (like the clothes and camping stuff). But I had to purchase some new things, including the bins. My total cost for everything is around $300. I know that seems high for one person, but the animals have to have water and food too. And except for the food, most of the stuff I bought will not need to be replaced or even tended to.

I may not ever need to open those bins but I'm glad I took the time to put them together. It was interesting to think about what I might need in that kind of emergency. And it's reassuring knowing they are within easy reach.

T3i Update

It's been a while since we dropped in on the goings-on at T3i (Terrier Toy Testing Institute). I've got a vicious head cold, so lacking the ability for more energetic activities, I decided to tackle the mound of toys relegated over the past few months to "baby hospital", a mound that was gradually taking over my kitchen counter.

Most of the repairs are simple:

Just a flesh wound!
But some require more, well, radical renovations to original body plans:

Lambchop on the left originally had four paws. And two ears. And frog on the left? At least the tug game between the dogs that resulted in the loss of frog's head delivered great satisfaction to all. I moved the squeaker from the head to the body and sewed the neck hole shut.
Because these toys have been out of circulation for a while, the dogs act like they are getting new toys. But they are just pretending. I know that they know that these are recycled. 

Wednesday, August 26, 2015

Are We There Yet?

Ever since my vet school decision was made, I've been asked dozens of times if I am "excited" about starting classes this fall. For many months, my reply was "I'm too busy with finishing my masters thesis to worry about that." Then it became "I'm too busy with the emergency vet clinic job this summer to have any energy left to think about vet school."

But reality intrudes, as is its wont. In early August, the first-year students (officially, the OSU CVM Class of 2019) received from an admin person at the vet school an email with 15 attachments. First, that is just insane. The attachments refer to half a dozen different issues and the email is in clear violation of the first rule of emailing: keep the damned thing short and confined to one subject only. Second, why are they clogging up our inboxes with that nonsense? What about Dropbox? Why not link all that info to a web page and send us the address? And third, whoa--reality.

I think the excitement switch flipped when, triggered by that email, I registered for my fall classes then set up my calendar.

A week in the life of a first-year vet student. More about the French class later.

I reviewed the list of required and optional textbooks then did the requisite online price comparisons. I also emailed my "Big Sib" to ask her how optional was optional. The Big Sib is usually a second- or third-year student. They select their "Little Sib" based on a silly survey (example question: if you were stranded on a tropical island, what three things would you want with you? I answered: an eight-inch long fixed-blade knife, the complete works of Shakespeare, and dental floss). I've already purchased the three textbooks I'll be using this fall, and two of them are sitting on the worktable next to me.

One of the things I've learned from my work in the vet clinic this summer is the importance of the heart and the blood. When we monitor patients, the minimum data we collect includes heart rate, temperature, respiration rate, and capillary refill rate. Because I only see critical care patients, blood pressure monitoring is often included too. All of those things are directly linked to the heart and blood. We also collect blood, lots and lots of blood, and analyze it for an array of cell types, protein and ion concentrations, clotting rates, and so forth. While I've learned how to collect the blood and physical data and run the machines that do the analyses, I've not learned much about what it all means. I can see patterns and trends but I haven't had any physical context for them.

So, I picked up my physiology textbook and began to leaf through it. NINE chapters on the heart and circulation. Yep, that emphasis is consistent with what I'm seeing in the clinic. I've now read the first four heart/circulation chapters, taking notes, redrawing and re-annotating graphs. And even with those small steps, I'm already building a framework from which I can hang the patterns that I observe in the emergency patients. The physiology constrains cause and effect. It allows prediction and treatment. Wow. Science.

I'm closing this post with a picture of a blood sample from a dog with hyperlipidemia. Hyper means excess, lipid means fat, and -emia refers to blood. A 1 mL venous blood sample was placed in this small tube. The tube went into a centrifuge which spun the cells down to the bottom of the tube (the dark layer) and plasma up to the top (plasma is usually yellowish and clear). We extracted most of the plasma for a chemical analysis so it is missing from this picture. But what's cool about this picture is the layer of bacon fat at the top of the cells. Yes, bacon fat. Fats are lipids that are solid at room temperature. There is so much fat in this dog's blood that it forms its own layer in the tube. The dog was morbidly obese and rather revolting to handle, sort of like holding a balloon filled with cake batter. He also had pancreatitis. Acute? Chronic? Hard to say. 

A discussion of the connection between hyperlipidemia and pancreatitis and obesity is not where I want to go with this blog, ever. I only want to emphasize that blood and the heart are pretty important things to understand if we want to treat disease in humans or animals.

Eight-inch long fixed-blade knife, the complete works of Shakespeare, and dental floss. Plus I'm sure that I will get through two more chapters on blood and the heart before classes start. Yeah, now I'm excited.

Wednesday, August 19, 2015

Reaching Goals, Bananas, and the IV Catheter

As I posted a bit ago, I wanted to try my hand at setting an IV catheter. Realistically, the best choice would be a largish, calm dog that wasn't in a critical condition. I've been biding my time, carefully watching my fellow nurses set and tape IV catheters in an array of animals, and continuing to practice taping a catheter using bananas: cheap, leg-shaped, and entirely sacrificial.

An opportunity finally presented itself. I'll be ending my job with the clinic in a couple of weeks and decided to take advantage of my enormous employee discount while I've still got it and get a dental cleaning done on Mimi.

Ah, the perfect dog at last. She's in excellent health with great veins (I stare at her and Azza's veins all the time). Plus, although the goal is to stick the animal only one time (less pain, less anxiety, more professional all around), if I had to poke her more than once, I would have no guilt about it. You might find that odd but I would feel really bad practicing on someone's sick animal. Mimi? No problem poking her with needles!

I scheduled her dental for 8am Tuesday, immediately after I ended my work shift. I brought her into work with me at 1am and she got to spend the night barking in a kennel and running around the treatment office when I wasn't too busy with other tasks.

And thankfully, the nurse assigned to Tuesday morning surgeries was one that I like and trust. I told her my plan: I wanted to do the blood draws on Mimi for the pre-anesthetic blood tests and I wanted to place her IV catheter. I told the nurse that I would not keep poking Mimi indefinitely but that I wanted to try. She was quite supportive of my plan.

We started with the blood draw. I needed about 1.5 ml for the two tests. Mimi was very wiggly and I ended up poking her four times, two in each leg, before I got barely enough. Unfortunately, one of the tubes clotted too soon and we needed more. I let the other nurse do this since I figured I had already used up all my tries on blood draws on Mimi.

Now, the IV catheter.

I got out alcohol-soaked and chlorhex-soaked cotton balls, clippers, a T-port, my four pieces of carefully measured and torn tape, a catheter, some gauze.

I could see Mimi's accessory vein really well. A lot of the nurses I work with insert the tip of the catheter at the point that the accessory vein and cephalic vein join. You have to get the tip of the catheter past a valve that lies in the cephalic vein just up from this Y; inserting at the Y positions you well for this. I couldn't see her cephalic vein at first but suddenly it was like her skin went clear and I could see everything. The noise in the clinic disappeared. The entire world had telescoped down to Mimi's left front leg and the quiet murmur of the nurse holding her. The nurse had an excellent hold on Mimi, so critical when you are drawing blood or placing catheters. I slowly inserted the needle...suddenly there was a flash of blood so I pushed the catheter (a small hollow plastic tube) off the needle and into the vein. This was followed by half a dozen drops of blood flowing out of the catheter. I rushed to cap it off, and realized two things. One, I needed to remember to breathe. Two, I successfully put that IV catheter in Mimi's leg on the very first try.

I taped it up, slowly to be sure, but after my banana practice, rather neatly all things considered. The other nurse kept coaching me along, offering advice when I needed it and encouragement too.

When I finished, I carried Mimi around to show everyone. I don't care one bit if they thought I was ridiculous. It was my first IV catheter ever and it went really well. One of the doctors, a bit of a curmudgeon, high-fived me! I was so excited.

Of course an e-collar was necessary for a dog like Mimi. You can see the green vet wrap on her hind legs where I had to keep poking her for blood.

I hope that the nurses I've worked with are proud too. I have watched them, learned from them, and hopefully can execute some things with accuracy and confidence. They deserve a big, big thanks for their patience in putting up with me this summer. I will be a better vet because I worked with them.

Saturday, August 15, 2015

Playing at Agility

All summer, I've tried to set up some agility equipment for the dogs at least once a week. I know that doesn't seem like much but Mimi is too old to trial and Azza is, well, Azza is what she is. We just play at agility. But it's fun to test ourselves.

My work in the house with the cone and a jump bar during the winter really paid off. Azza has been embracing jumping, although she will only tackle jumps set to 8"; any taller and she will go around the jump. That's okay because I'd rather test her ability to learn and read my handling. She's been doing up to four jumps in sequence, she can read front crosses, serpentines, wraps, and sends to backsides, she will recall over a series of jumps, she loves loves loves the tunnel and my little table, and while she's not flying through the 2x2 weaves, she will eagerly trot through four poles that are nearly in line. She's in fact ready to have the third 2x2 added in. She seems much less worried about touching the metal base. However, she will never have lightening-fast weaves since that requires her to touch the poles, something she is careful not to do. She seems willing to play this strange game and have a bit of fun while she's at it.

A couple of weeks ago I introduced Azza to the joy of the bunny fur tug-n-treat. I play agility with Mimi with the bunny fur tug and Azza's been observing this for weeks. Using the clicker at first, then graduating to using the fur pouch itself and its delicious treats inside, Azza has learned to chase the thrown toy then return it to me for a treat, both rewarding behaviors for her. Sometimes I run with her to the toy so she gets the treat in place--as a result, she's decided the fur pouch is a rather interesting object.

I have also started working with Mimi on flipping away from me. I'm relying more on body motion signals than verbals, in particular the hand motions I use to have her spin in place in front of me. I used a flip away quite a bit with Iz but I never taught that to Mimi. She's picking it up very quickly.

My yard is small and my equipment is limited. I decide in advance what skill I'd like to work on then either find a bit of a published course or exercise that will do or I create my own. Most of the summer we've been working on going to backsides of jumps and weave entries. Even though there is a large skill gap between Mimi and Azza, if I put some thought and effort in it, I can come up with one setup that will work for both.

I generally work both dogs quite hard. Each dog gets three five-minute sessions and I alternate them so they get a chance to rest in between.

Here's the course's we've worked on in the past three weeks. I called the two shown below "Less is More." Yep, that's right, for one week, I worked the dogs for half an hour on only two jumps! Lots of practice with backsides and wraps. In the course on the left, you can barely see the two 2x2 weaves I put at the bottom of the course for Azza. Mimi did the six poles at the top of the course. That week we focused on weave entries.

I took the course section shown below out of a Clean Run article analysing the 2015 AKC International Team Tryouts Jumpers course. I only set up the part in the orange box and I added my little table at the position of the orange star. We had great fun with this. Some tough challenges if you decide to have the dog take the backside of every jump. I plan to set up the part at the top next week to work on funky tunnel entrances and exits.

You might be thinking, what's the point if we aren't competing? I would answer that agility challenges the dogs and keeps their little neurons whirring. It's good exercise for all of us. We get to run around the yard in the cool mornings. Treats and lots of praise and excitement are included, which we all like. And it's fun!

Thursday, August 06, 2015

Are You A Shruggie?

Shruggies is a term for health care providers, including doctors, nurses, and vets, who fail to challenge practitioners of SCAM (supplements and complementary and alternative "medicine"). Despite knowing there is no scientific basis, or even a chemical or physical basis, for many SCAM claims (e.g., homeopathy, acupuncture) and despite knowing that there is no clinical trial evidence for their efficacy (e.g., glucosamine), shruggies say, if the SCAM performs no better than placebo in well-designed clinical trials, then what's the harm? (More on placebo effects here.)

In the case of human doctors, the underlying deception involved in offering the patient a treatment that may make the patient feel subjectively better for a short period of time but fails to alter in any objectively measurable way their symptoms or condition is a matter of ethical debate. For example, is it ethical to not tell a patient they have a life-threatening illness so their final days will be happy and without stress? That's a deception that will certainly make them feel subjectively better for a short period of time, just like a SCAM. Most doctors would not accept the latter scenario as ethical. Then why would they accept as ethical the deception necessary for all SCAMs? And if they don't think that is ethical, then why are they willing to "shrug" it off?

In veterinary medicine, this deception that allows the owner feel better by "doing something" but leaves the animal to suffer cannot even be a matter of such debate: it is ethically wrong to that we permit this.

There is extensive peer-reviewed literature on the lack of efficacy of SCAMs. Pick any one of them that you like: detoxification, homeopathy, acupuncture, Chinese herbs, naturopathy, touch therapy, supplements. So many to choose from! Either they are described with feel-good woo words (natural, holistic, life force) or with laughably misused sciencey words (energy, quantum) or both. None of them stand up to objective, evidence-based clinical trials with a statistically significant number of participants and properly defined control groups. Some SCAMs are actively harmful, but most are simply no better than placebo. What's the harm? The SCAM of acupuncture is often offered as a pain treatment. It has been repeatedly shown in well designed clinical trials that acupuncture does not objectively and measurably reduce pain. It is ethically wrong for a SCAM practitioner to deceive a caregiver into believing their pet's pain is being reduced. It is just as ethically wrong for a shruggie to look at his colleague sticking needles into an animal and say, well, what's the harm? 

(Don't even get me started on the fact that human and veterinary acupuncturists are consistently photographed sticking needles into the skin of people and animals without wearing gloves. That is incredibly irresponsible and unprofessional.)

We humans do a very good job at finding quick justification for things that happen to us: I ate this berry then I got sick. Therefore that berry is bad. But is that the right conclusion? Does cause directly lead to effect? Perhaps the berry was not ripe--eat it two weeks later and it would not have made you sick. Perhaps you are allergic to that berry but someone else could eat it with no ill effect. Perhaps the berry had a mold or fungus on it that you could not see and that made you sick. Perhaps you ate something half an hour previously that in fact made you sick but you forgot about eating that other thing when you found the berry bush. Perhaps you were already sick with another illness and it was a coincidence that you began to show symptoms right after you ate the berry. We hate coincidences. We prefer the neat explanation, cause and effect tied up with a bow. We prefer explanations that mesh with our previously defined opinions.

Thinking through all the possibilities that could explain an event, that could sort out the cause and effect, is hard work and requires time and discipline. Setting aside our own logical fallacies and biases is even harder. Designing proper evidence-based tests with objective, quantitative measures of all the possibilities to determine which explanation was right is difficult and takes practice and time. (Correlation does not determine cause and effect, by the way. It only suggests two things are related.) Conducting the tests would take even more time. Isn't it simpler to jump to the easiest explanation: that berry is bad. 

What if you take that berry incident further? What if you now attach some sort of magical thinking to the berry or to your experience? For example, what if you concluded that a god didn't want you to eat that berry because the plant is sacred. Now not only is the berry bad for you, you've given it some additional properties. It's bad for you because it is magical.

Just imagine if your doctor or dentist or veterinarian treated your and your pet this way, using pre-scientific magical thinking instead of modern evidence-based medicine? Oops, that's exactly what SCAM practitioners do.

When it comes to SCAMs, ethical doctors and veterinarians should not shrug them off. We have the tools and the expertise to evaluate their claims of efficacy. Many studies have already been conducted and the evidence is clear. We need to speak up and educate our clients and our colleagues: belief in and use of SCAMs does cause harm (warning: this link goes to a PDF)

I've left untouched in this screed discussion of caregiver bias (see additional discussion here), one of the underlying sources of placebo effect in veterinary SCAMs; the reliance on anecdote in SCAMs in place of evidence-based inquiry; and the straw man argument that Big Pharma is only in it for the money (if your SCAM practitioner is selling you a treatment that does nothing and that is based completely and fundamentally on your acceptance of a deception, who's really in it for the money?). 

Monday, August 03, 2015

You Deserve a Cookie!

I will freely admit that I am bitterly cynical and despairing of seeing much good in most of mankind. But I am neither heartless nor hopeless. My night nurse job in the emergency vet clinic has shown me that again and again. 

With only two people awake most of the night (the vet is usually asleep upstairs), we two nurses keep constant track of each other. The clinic is a large one and just about any kind of random shit could happen, from something as trivial as needing help holding a cat to get a temperature to a 9-1-1 call to the police to deal with a belligerent and possibly drug-addled client threatening physical violence to us. In other words, I know far too much about my colleague's bathroom habits ("gotta pee, be right back"). Still, most of the time the silence and the darkened rooms can easily lead you to feel that you are completely alone.

As a result, I am often caught by my co-workers chirping silly nonsense to animals as I perform this or that procedure: "okay, little bit, let's get this catheter sorted so we can go out for a walk"; "sorry, honey bunny, I've got to poke you in the bum"; "hold still, you crazed beast, I've got to shove this down your throat". I keep telling them, tease me as much as you want, I'm not going to stop. So, not heartless. We do the best we can for the weakest amongst us. And if silly chatter gets me there, well, piss off with the teasing.

The night nurse supervisor is scheduled to leave an hour before I do, so I bridge the gap between the night and the day ICU staff. Once the night supervisor rounds the day ICU supervisor on current patients, which also happens about the same time that the vet comes back downstairs, I alternate my focus between the day ICU nurse and the doctor.

It's my personal practice to complete pre-assigned patient care tasks first, then ask the day nurse or doctor how I can help them. I explicitly say, what can I do for you? They never turn this offer down. There is always something that needs to be done, some changes in treatment plans that need to be recorded and implemented, new blood to be drawn, additional drugs to be given. So, not hopeless. I know that they are going to have the best interests of the animal and client in mind. We are a team trying to make our tiny corner of the world a little better. If there is something I can do, then I need to do it.

In short, despite my personal curmudgeonly perspective, I try my best to support my team and to care for the animals in equal measure.

The clinic I work for is large and has many employees. The management of the clinic provides these slips of papers called "cookies". You can fill them out for any employee, describing some special thing that they did that you want to call special attention to. I have done so several times for one nurse in particular that has spent a lot of time training me. I thought we were supposed to slip them into the locked box labeled "cookies", which is what I did. Turns out another common practice is to give the filled-out slips to that employee, who can choose to put them in the locked box or not. 

Here's a cookie recently given to me by a day ICU nurse whom I respect:

Okay, I have to admit, I'm a sucker for this. Of course more money in my paycheck would be better than a slip of paper. But to know directly from my co-worker that she finds me helpful certainly makes me feel invested and rewarded.

In other news, the other night I finally achieved my first successful hind-leg blood draw from the saphenous vein (scroll down for pics of the saphenous vein; the cephalic vein is usually where the IV catheter is placed). If you have a short-coated dog, you can see the saphenous vein crossing the outside of their hind leg just above their ankle (it's also there in cats, but harder to see unless you hold the vein off). Okay, it was a relatively calm Doberman bitch, so it wasn't like I could miss the damned thing. Still, I had tried this blood draw on three other dogs and failed. She was standing so the angle for the needle was a bit funky. Still, I got it in one poke! I was so pleased. Blood, beautiful venous blood!

Friday, July 24, 2015

Is That A Banana In Your Pocket?

One of my goals this summer is to learn how to set a catheter in an animal. Since I am at the mercy of the emergencies that come in, I may not achieve this goal. By that I mean that the physical condition and size of the animals that arrive at the clinic at night entirely dictate whether my experienced co-workers need to set the catheter while I hold the animal. I don't have the luxury of poking any animal in my attempts to learn. And that ideal animal or two might not walk in the door between now and the end of September.

Getting the catheter in the vein is only a small part of the process. I could write an entire post about all the things that can go wrong, and right, with this. But the catheter then has to be taped in place in such a way that it is secured to the animal's leg but the tape is not so tight that it constricts return blood flow from the limb (which leads to "mega-paw" when the paw swells up because the venous blood can't return and collects in it). 

So I decided to start my learning process with the taping part. And I decided to practice on a banana. Laugh all you want, but it turned out to be a pretty good learning tool.

Here's a picture of my third taping effort:

Not great, but not horrible! We re-used the same catheter and T-port many times since there was not a concern about keeping things sterile--we were sticking it in a banana after all--and I just cut off the tape from previous attempts and started over. And over.

There are four pieces of tape on that banana. The first is the minimum point of attachment of the catheter to the limb. The second securely attaches it. The third is what my co-worker calls the "bra": it secures the T-port (the green thing sticking out is one of the ends of the T-port; it is inserted directly into the catheter). And the fourth creates a stress loop for the short T-port line that you can see looping over the top of the tape, so that if the animal pulls on its line, the stress loop should prevent it from pulling the T-port out entirely (the IV line will attach to the clear end of the T-port that you can see on the right). But as you learned from the previous post, this can happen even if the tape job is perfect but the animal is thrashing around with unusual vigor.

Not all clinics put a T-port in the catheter. You can hook the IV line directly into it. But this clinic puts T-ports in all catheters so that determines how I am learning to tape.

Taping a catheter has some basic rules and requirements but there are quite a few acceptable, and safe, individual variations. And as my co-worker pointed out, a giant wad of tape over the thing would probably work but it is not pretty or the best solution. Learning how to tape the catheter efficiently and with consistency means that even if you are no longer at work, the current animal care team knows what to expect.

I taped the catheter into the banana four times tonight. It was a mess. Tape sticking to me, to itself, to wrong parts of the banana. Fingers fumbling--do I use my left hand or my right hand for this? Oh, that piece is too short to wrap around like I intended. It was frustrating but I kept reminding myself, there will be a living creature on the other end of this. You need to learn how to do this right.

Sure, a banana is not close to the real thing, an animal that feels pain, that bleeds, that has hair (more things for the tape to stick to), that doesn't want to hold still. But if I can get even a little bit more comfortable with the taping part, then I will be ready when and if that perfect animal comes in the door.

In case you were wondering, I tossed the banana in the trash when I clocked out. Ew.