Diary of a Third-Year Vet Student: My Study Group Plus Bonus Terriers

Last night my study group (dubbed "The Inclusion Bodies") gathered at my house to argue our way through three or four hours' worth of Large Animal Medicine lecture notes in preparation for an exam on Thursday. It's the way we work--each one of us catches a key bit, and by talking it all through, we can put together a bigger, more complete picture.

It's spring here, and we have had a couple of sunny days which makes everyone want to be outside as much as possible, so we decided to spend our first study hour sitting out in the backyard. Of course, since it's spring, it's still freakin' cold, so I ran around the house scooping up clean blankets for everyone. (With only a few exceptions, blankets in my house are used by both people and dogs.)

We are drinking Brad's home-brewed cider.

Shortly after this photo was taken, Archie peed on Brad's blanket (and his foot) so once I stopped laughing, I had to rustle up another blanket for him!

Later, Archie made up for being so naughty by wriggling his way onto Claudia's lap and being adorable. He loves belly rubs!

Diary of a Third-Year Vet Student: Up Close and Personal

My junior clinical rotation in Rural Veterinary Practice ended today. But the entire week amazed, astounded, and challenged me.

Yesterday, I rode with the vet, technician, and fourth-year student to a farm call for a horse euthanasia. Turns out those three had been to that particular farm just the day before. Their diagnostic work had led to a very poor prognosis for the horse, and the owners called the vet even before she and the team had returned to campus to request the euthanasia.

Veterinarians confront death on a near daily basis. It is a significant element in compassion fatigue, and contributes to the high suicide rate in our profession. I think that this link should be sufficient to highlight what a real problem this is, and how AVMA is trying to address it.

But we can't stick our heads in a hole and pretend that euthanasia doesn't exist. With that awful power comes an even larger responsibility. Now, when we are students, is the time for us to learn what we can about euthanasia. On the way to the farm, the vet lectured me and the fourth-year about how the euthanasia should go, what variations in procedure were reasonable, what could go wrong, and what contingency plans we might need.

To the credit of the team, the euthanasia went very well. Some contingency plans had to be activated but because the vet had prepared us well, the clients were not aware that we had to shift to plans B and even C. For me, the bar for this procedure has been set very high. It is so important that we learn how to perform euthanasias respectfully and humanely. Every member of the team was wiping their eyes, so I know that we were all grieving for the loss of this beautiful animal along with the owners, but the vet med team was professional and respectful--and I got to see first-hand that that doesn't mean they were cold or distant. It was a good lesson.

Today, I spent the morning at another dairy. I didn't admit this in my earlier post, but two days ago, my success rate at diagnosing pregnancies was 50%. Today, I palpated six cows and I was 100% successful. I predicted pregnancy AND in which horn the fetus was lodged (left or right). After I had palpated her, a very tall, lanky Holstein farted in my face, speckling poop all over my hair and goggles (that $10 investment to protect $400 eyeglasses was incredibly smart), to the great amusement of the vet. But I didn't let that stop me. I am becoming much more confident in recognizing physical indicators of pregnancy in cows. A little poop won't slow me down.

I also got to perform a field castration of a young male calf. I won't go into the details of the specific procedure, since I don't think that is appropriate here. But I will say that when a university vet does one of these castrations, the procedure includes sedation of the animal sufficient to drop them to the ground, a focused nerve block to the spermatic cord, a quick rough scrub of the scrotum using chlorhexidine then alcohol, and tetanus toxoid, long-acting antibiotics, and analgesics afterwards. Not one of those things are used in the real world. Why not? It's all about cost and time (since time = money, it is just another cost).

I was describing the procedure to a classmate who is only interested in small animal medicine, and she was shuddering and shaking her head, saying, no, no, not for me. What factors make her say, my god, castrating a calf like that in a pen in a barn is my worst nightmare, and make me say, wow, that's really cool, can I do the next one?

I am positive that my horrible experience in small animal surgery at the hands of a very poor instructor has colored my perspective for a long time to come. He made me cry during my dog spay surgery, and fucked with my head enough to make my classmates worry about my state of mind for several days afterwards. I will not name him, but I will shame him: to make all of the women in that lab cry, but to openly encourage the men, is to be a fucking misogynistic asshole. I promise you, here, now, that if I have a clinical rotation with him in the next 12 months, I will call him out.

What has changed? How do I have mojo now when I apparently lacked it in fall term? My experiences in the large animal side of vet med are responsible. To date, all of my experiences with large animals have been positive and successful, supported in full by the clinicians in charge of my learning. Sure, those learning events aren't always taking place in a nice, clean clinic or a sterile surgical suite. But I see that as part of the challenge: how to deliver humane, thoughtful, cost-effective medical treatment in a herd/flock setting.

Sometimes we learn by good examples of bad examples. And sometimes we are challenged to do our best by supportive and thoughtful teachers. I choose the latter path.

Diary of a Third-Year Vet Student: Getting Closer

At our vet school, in the last term of their third year, vet students spend three weeks participating in "junior clinics." They are intended to prepare us for the real thing, our fourth-year clinical rotations that will begin in just a few short weeks. Not all schools arrange this, and it is an amazing feat of scheduling on the part of the faculty, but as I am finishing up the last of my three junior clinics, I have to say that I feel so much more prepared for what I will be facing in June.

The fourth year of all vet med programs is spent in clinical rotations: one- to four-week rotations in different parts of the hospital such as cardiology, large animal medicine, and anesthesia. I have chosen to pursue a "general" track (my other options were large animal, small animal, and non-traditional). None of the choices will directly help me pursue a career in poultry medicine, but the general track will give me the most well-rounded perspective. I will be getting my poulty-specific education during my preceptorships and internships (students have to arrange those on their own, and that's a whole 'nother blog post in itself).

Back to the junior clinics. I was assigned cardiology (mostly small animal), large animal medicine, and RVP (rural veterinary practice). The junior clinics only approximate the real thing. We only spend five mornings with each of our assigned areas. But if you get lucky, those five mornings can be jam-packed!

I am surprised to tell you that, despite my suburban upbringing, I am much more comfortable with cows and goats than I am with dogs and cats. On Monday, I helped perform physical exams on two 10-day old pygmy-Nubian cross goats and then supported one while it was sedated and debudded (the specialized cells that grow horn were removed from its head). They were the size of small cats, and just as cute as they could be.

I spent several hours yesterday doing pregnancy checks on dairy cows. Pregnancy checks are done via rectal palpation. You usually have to empty a fair bit of poop from the cow's colon first, and no matter how careful you are, you get poop all over you. And some of them like to pee on you as well. Preg checking is a messy undertaking. You always make sure to wear decent clothing under your coveralls because nobody will let you back in the vehicles covered with that much poop. When I was able to correctly diagnose not just a pregnancy but in which uterine horn the fetus was located, it felt like a major achievement. Our instructors always check our "work" via palpation or ultrasound, so no management decisions are made solely on the say-so of a student. It's an amazing learning opportunity.

Today I spent a couple of hours putting special ear tags onto dairy heifers who had been vaccinated against Brucella abortus, a bacterial disease that can cause abortion in cows and make people very sick as well as cause abortions in women. People usually get exposed by consuming unpasteurized milk or cheese. The vet, the fourth-year student, and I divided that task up--vaxxing 51 heifers--and made it into no work at all. The vet administered the vaccines (not that we students couldn't have done the poking but it was a bit of a safety issue--it is a modified live vaccine and an accidental needle stick could have made us very sick, plus annoyed lots of people because of the reams of paperwork that would have had to be completed), the fourth-year put in an ear tattoo, and I finished up with the bright orange metal tag (ear tags are great but can easily get pulled out and lost; tattoos are permanent but impossible to see from a distance; redundancy is the goal here). Oregon has a surveillance and eradication program for this particular pathogen, and keeps tight records on vaccinations and outbreaks. Our work today will end up in state and federal databases in a few days.

As we were working our way down the narrow aisle of heifers with their heads locked into stanchions, we had to climb over mounds of feed that were piled in front of them. The cows were constantly sniffing us, licking us, and nibbling at our coveralls. I was covered in cow slobber from waist down. They were very curious! 

I know that some of my classmates shudder at the thought of having to touch anything other than a dog or cat. But I think herd medicine is fascinating! The vaccine we were giving to the heifers protects both them and us from a really serious pathogen. It is a perfect combination of production animal medicine and public health. That's the kind of vet med I want to be involved in.

Diary of a Third-Year Vet Student: An Amazing Big Thing

I recently got a chance to observe a very cool cardiac surgery. The pup came into the teaching hospital with a severe congenital defect in her heart. She had a grade 5 out of 6 murmur, which even inexperienced vet students could hear! Grade 5 murmurs also have something called a palpable thrill, which means you could feel the murmur by putting your hand on her chest. It felt like an electric buzzer was tucked in there.

This particular defect needs to be corrected. If it is not treated, animals die young of congestive heart failure. This pup had the severe murmur, extremely deranged blood flow patterns that we could see on echocardiography, and a greatly enlarged left heart that we could see on radiographs (x-rays). She didn’t have any obvious clinical signs of heart failure but it was only a matter of when, not if.

The defect was a persistent duct between her pulmonary artery and her aorta that should have closed a few days after birth. There are two common ways to correct this defect. The first method is to open up the chest and tie a suture around the persistent duct. Amazingly, this is the cheaper option!

The other method is to place a device called an Amplatz Occluder. This neat little device is specifically designed to resolve this particular defect in dogs, and placement of this device was the option that the owners of this pup chose. To place the occluder, a large catheter is first inserted into the dog’s femoral artery (in its thigh) and pushed all the way up to the aorta and then through the defect. The device is threaded into the catheter and pushed into the pulmonary artery. When it is deployed, it opens up like a mushroom-shaped umbrella. It is pushed up against one end of the duct by the pressure of the flowing blood. The device is made of a special metal mesh that encourages clots to form in and on it, and with time, fibrotic tissue forms around the device. All of this combines to close off that duct. The occluder becomes a permanent part of the dog’s body.

This surgery was a perfect combination of technology, medicine, and physics. Placing the catheters into the persistent duct requires a lot of real-time imaging and a steady hand on the part of the cardiac surgeon. Choosing the right size of occluder requires a lot of tests and imaging even before surgery begins. Here’s the cool physics part: the surgeon deployed the mushroom umbrella and in two heartbeats, the pup’s diastolic blood pressure increased from 30 (way too low) to 80 (in the normal range). In other words, the pattern and pressure of the blood flow through her heart became more normal in just two heartbeats. When she woke up from surgery, her murmur was completely gone. I listened to her new, normal heart rhythm myself. 

This is what makes vet med such a visceral experience. Students were involved in the entire procedure from the beginning. We could ask as many questions as we wanted. We helped obtain the physical exam and imaging data used to diagnose the problem. We watched the surgical procedure from just a couple of meters away. We were responsible for the aftercare of this pup (minimal, she woke up from anesthesia ravenous and ready to go home). And this was just another day in the cardiology unit at our vet school.