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.