My closest colleague at work is a Chinese guy. He has a BSVM from a Chinese university, which is educationally equivalent to a DVM. He has not completed the (difficult and expensive) program that would certify him to practice as a DVM in the U.S. But he has the same job title as me, and in the 18-month gap when they were looking to fill my position that also included the 6 or so months that they had to wait for me to finish vet school, he conducted nearly all of the non-poultry necropsies that came through the lab. And for the last three months of that period, he had to do the poultry necropsies too. (For the record, he doesn't like working with birds, which is fine by me as I really like doing avian necropsies.)
Since I started working in July, I have completed over 150 necropsies in multiple species. I split each week's cases with my colleague. Using those numbers, by my back-of-the-envelope-calculation, he likely handled over 500 necropsies during the period that he was on his own. This gave him an incredible breadth and depth of experience, and a deep understanding of pathology of disease.
I find working with him to be quite enjoyable. He's got a dry sense of humor and a keen eye for detail. He and I have different styles on the necropsy floor (one time he put the entire head of a cat in formalin for reasons I still haven't been able to discern), but our styles are compatible so we work very well together. We discuss our active cases every day. We trade cases. We ask each other to look over necropsy reports before they get sent out. We argue about differentials (the director is particularly amused by this as we can get rather excited and loud). We cite papers at each other. We call the other one down to necropsy if we have a particularly interesting finding. I was able to ramp up my own performance very quickly by relying on him for advice, which he shared freely. He is professional, courteous, smart, thinks outside the box, and is happy to indulge in black humor when we need to blow off steam. What's not to like about having a colleague like that?
All of this is an introduction to what I really wanted to rant about. I have learned that my predecessors did not regard my colleague in the same way that I do. When one of the pathologists took him on the necropsy floor to teach him the basics, the other two pathologists ran to the director clutching their pearls, aghast and appalled, complaining that he was transgressing a sacred space. It's of a piece with those two refusing to share any details of their cases with anyone else. I also suspect microaggressive racism lurking around the edges of their behavior, but that is only my opinion. In short, my colleague was dismissed, overlooked, and treated quite unprofessionally.
In contrast, I have come to rely on my colleague. And the feeling is mutual! He tells me often how much he enjoys working with me, that he and I make a great team, that he has my back as I take over as supervisor of our section of the lab. He has no interest in being a visible leader himself, but without a doubt he leads by his actions.
The director has told me several times about a police K9 case from a few years ago that was handled quite poorly by one of the aforementioned pearl-clutchers. I don't have all the details but the necropsy wasn't done promptly, the necropsied body was kept for months instead of being released, and the report was treated like it contained state secrets. The mishandling and delays resulted in bad publicity for the lab.
Yesterday, on Christmas Eve, around noon, I got a call from the police chief of a small Arkansas town about 75 miles from Little Rock. A police K9 had been found dead and they wanted to bring him in for a necropsy. I don't typically have to work nights or weekends or holidays, but there are a few rare exceptions, and police K9s are one. The chief and I worked out details of timing. And the very next person that I called was my colleague. "I know you are on vacation, and it's a holiday on top of that, but I need your help," I told him. He said, "Absolutely, we are a team. When do I need to be there?" My second call was to the director to assure him that we had this case well in hand.
I ran the necropsy and my colleague acted as my tech, fetching things, taking pictures, managing my necropsy table. The gross findings were definitive, and we were able to determine a cause of death, document it properly, and get the two police officers back on their way home in about an hour. The director will be over the moon. As I drove home, I reflected on how much I have learned from my colleague in the past few months. Our job is unusual and can be physically and emotionally difficult at times. We are going to be more successful if we work together.
I am ashamed that my colleague was treated so poorly in the past, and even though I know that it wasn't my fault or my doing, and that I can't make up for years of poor treatment, I am reaping the benefits of choosing to treat him with the respect and professionalism that he is due.
Thursday, December 26, 2019
Wednesday, December 25, 2019
Orange Basil Lentil Salad
I haven't posted a recipe in quite a while. This is a salad that I've now made twice, with good repeatability. The first time I came up with it, I took it to a party where it was complimented by all. No leftovers either. Yes, it was a bit risky to take a dish I literally created on the spot to a party, but I'm pretty confident in my cooking skills. I made it again last night for my Xmas Eve dinner. Total prep time is about an hour if you take time to drink a glass or two of pinot gris while you are puttering about in the kitchen.
Lentils, 1 to 2 cups dried
Fresh basil, lots
Red onion
Feta cheese crumbles, 6 oz or so (one small container)
Navel orange (one or two depending on size)
Dried cranberries, about 1/2 to 2/3 cup
Fresh greens (arugula, spinach, mixed greens, etc)
Olive oil
Honey
Apple cider vinegar (optional)
Black pepper, fresh ground
Rinse the lentils in a strainer. Cook 1 to 2 cups of lentils on low to medium heat (simmer, don't boil). Don't worry about having extra water as you can drain that off. Use French green lentils if you want to be fancy. Set the lentils aside to cool. When cool, put 1 to 2 cups cooked lentils, drained, in a large salad bowl. The lentils don't take long at all to cook. You can make them ahead of time if you want.
Finely slice a red onion and caramelize with some olive oil. This will take about 20 minutes on low to medium heat. Stir often. Set aside to cool. When cool to the touch, add to the large salad bowl.
Put the feta cheese into the large salad bowl.
Add a large handful of dried cranberries to the large salad bowl.
Finely dice a very large handful of fresh basil leaves. Put 1/3 of the leaves in a measuring cup and put the rest in the large salad bowl.
Note that the order in which you add things to the salad bowl is not actually all that important. Don't add the lentils and onions until they are cool though.
I find this recipe only needs 1 large navel orange but you could use two if you wanted. You might want to increase honey and basil if you use two oranges. Cut the navel orange into quarters and peel two of the quarters and divide into sections. Slice the sections into 1 cm-long pieces and add to the large salad bowl. Squeeze the juice out of the other two quarters into the measuring cup.
To the measuring cup, add some olive oil, a tablespoon of honey, and lots of fresh ground black pepper. If you want the dressing to have more of a bite, add 1/2 tablespoon of apple cider vinegar. Otherwise, it will be fairly sweet. Stir very well to dissolve the honey and mix the oil and orange juice.
Add your greens to the salad bowl. Fill that bowl up! Give the dressing another good stir and pour over the top. Gently mix everything well. Enjoy!
Lentils, 1 to 2 cups dried
Fresh basil, lots
Red onion
Feta cheese crumbles, 6 oz or so (one small container)
Navel orange (one or two depending on size)
Dried cranberries, about 1/2 to 2/3 cup
Fresh greens (arugula, spinach, mixed greens, etc)
Olive oil
Honey
Apple cider vinegar (optional)
Black pepper, fresh ground
Rinse the lentils in a strainer. Cook 1 to 2 cups of lentils on low to medium heat (simmer, don't boil). Don't worry about having extra water as you can drain that off. Use French green lentils if you want to be fancy. Set the lentils aside to cool. When cool, put 1 to 2 cups cooked lentils, drained, in a large salad bowl. The lentils don't take long at all to cook. You can make them ahead of time if you want.
Finely slice a red onion and caramelize with some olive oil. This will take about 20 minutes on low to medium heat. Stir often. Set aside to cool. When cool to the touch, add to the large salad bowl.
Put the feta cheese into the large salad bowl.
Add a large handful of dried cranberries to the large salad bowl.
Finely dice a very large handful of fresh basil leaves. Put 1/3 of the leaves in a measuring cup and put the rest in the large salad bowl.
Note that the order in which you add things to the salad bowl is not actually all that important. Don't add the lentils and onions until they are cool though.
 |
| I like feta cheese and used an entire small container. Feel free to exercise more restraint. |
I find this recipe only needs 1 large navel orange but you could use two if you wanted. You might want to increase honey and basil if you use two oranges. Cut the navel orange into quarters and peel two of the quarters and divide into sections. Slice the sections into 1 cm-long pieces and add to the large salad bowl. Squeeze the juice out of the other two quarters into the measuring cup.
To the measuring cup, add some olive oil, a tablespoon of honey, and lots of fresh ground black pepper. If you want the dressing to have more of a bite, add 1/2 tablespoon of apple cider vinegar. Otherwise, it will be fairly sweet. Stir very well to dissolve the honey and mix the oil and orange juice.
Add your greens to the salad bowl. Fill that bowl up! Give the dressing another good stir and pour over the top. Gently mix everything well. Enjoy!
Sunday, December 22, 2019
"You mean they are calling to talk to you about patients that are still living?"
Even though I'm a brand new veterinarian and shiny new gross pathologist, I've got more than two decades of experience as a scientific professional behind me. As a result, I just assumed that I should be doing certain things in my own workflows. For example, I always call the referring veterinarian when I finish a necropsy, usually even before I write my report, and let them know my preliminary findings. Sometimes I don't have a veterinarian contact, so I talk to the poultry house manager or the owner of the beef cow. But the important point is that within a few hours of submitting animal remains for necropsy, our stakeholders get a brief report directly from me. I also started calling vets who submit biopsies, mostly to let them know they sent us an alien baby tissue sample in a woefully inadequate amount of formalin and it would take us a few more days to properly fix the tissue before we could cut it in.
Since making these phone calls seemed to be reasonable and minimally professional, and really didn't take much time at all, you can imagine how astonished I was to learn that the previous holders of my particular job never did these things. Never. Necropsy cases might be open for weeks, and the results never discussed with anyone. One previous pathologist put a sign on his closed office door (the office that I occupy now) stating that he was not to be disturbed for any reason. He never answered his phone either.
My office door is always open. The super nice but very large microscope that I use was deliberately positioned on the desk so that it formed an imposing physical barrier facing the door. I moved it to a small desk on the other side of the room. The light from the windows can be a bit bright sometimes, but I felt that was a small price to pay for getting rid of the physical wall that was between me and everyone else.
I'd been happily rolling along for several months, picking up the phone just about every day to talk to our referring vets, who are located all over the state (I had to put up some maps of counties and cities in Arkansas so I could figure out where these folks were located). Since I assumed this was basic professional courtesy, I was unprepared when one of those vets, who works in a three-vet, mixed animal practice that sends us a ton of necropsy cases, told me that I was a "breath of fresh air" and that I couldn't ever leave the lab. She called me a "treasure." Not much can leave me speechless but I found myself stammering out a reply. And in fact, this happened more than once. Nobody else called me a treasure, but several vets told me that they were extremely appreciative of my efforts to reach out to them about their cases.
Shortly after that, I noticed that vets were calling me. And they were calling to... chat. They would describe some puzzling case they were working on in their clinic then ask my opinion on this or that diagnosis or treatment, often prompting me to look at the phone handset and think, wow, they think I know what I'm doing here. But my geological science background made me very comfortable with exploring a problem with multiple hypotheses that may be overlapping or even mutually exclusive. I can do that with vet med problems too. I am not a naturally glib person, but I love to gab about science, and I always learn new things when I talk to fellow scientists. It seems that my veterinarian colleagues out there in clinics across the state like to gab too, and have decided that I'm either a resource with decent suggestions, or at least a good listener.
I relayed this to the lab director, and he paused then somewhat incredulously said, "You mean to tell me that the vets are calling to talk to you about patients that are still living?" I paused, surprised, and said, "Yes, I think that's exactly what I'm telling you." And he said, "Nobody in your role in this lab has ever accomplished this."
Accomplished simply because I chose to be an engaged professional.
Since making these phone calls seemed to be reasonable and minimally professional, and really didn't take much time at all, you can imagine how astonished I was to learn that the previous holders of my particular job never did these things. Never. Necropsy cases might be open for weeks, and the results never discussed with anyone. One previous pathologist put a sign on his closed office door (the office that I occupy now) stating that he was not to be disturbed for any reason. He never answered his phone either.
My office door is always open. The super nice but very large microscope that I use was deliberately positioned on the desk so that it formed an imposing physical barrier facing the door. I moved it to a small desk on the other side of the room. The light from the windows can be a bit bright sometimes, but I felt that was a small price to pay for getting rid of the physical wall that was between me and everyone else.
I'd been happily rolling along for several months, picking up the phone just about every day to talk to our referring vets, who are located all over the state (I had to put up some maps of counties and cities in Arkansas so I could figure out where these folks were located). Since I assumed this was basic professional courtesy, I was unprepared when one of those vets, who works in a three-vet, mixed animal practice that sends us a ton of necropsy cases, told me that I was a "breath of fresh air" and that I couldn't ever leave the lab. She called me a "treasure." Not much can leave me speechless but I found myself stammering out a reply. And in fact, this happened more than once. Nobody else called me a treasure, but several vets told me that they were extremely appreciative of my efforts to reach out to them about their cases.
Shortly after that, I noticed that vets were calling me. And they were calling to... chat. They would describe some puzzling case they were working on in their clinic then ask my opinion on this or that diagnosis or treatment, often prompting me to look at the phone handset and think, wow, they think I know what I'm doing here. But my geological science background made me very comfortable with exploring a problem with multiple hypotheses that may be overlapping or even mutually exclusive. I can do that with vet med problems too. I am not a naturally glib person, but I love to gab about science, and I always learn new things when I talk to fellow scientists. It seems that my veterinarian colleagues out there in clinics across the state like to gab too, and have decided that I'm either a resource with decent suggestions, or at least a good listener.
I relayed this to the lab director, and he paused then somewhat incredulously said, "You mean to tell me that the vets are calling to talk to you about patients that are still living?" I paused, surprised, and said, "Yes, I think that's exactly what I'm telling you." And he said, "Nobody in your role in this lab has ever accomplished this."
Accomplished simply because I chose to be an engaged professional.
Sunday, December 15, 2019
For Now, I Have To Pass On That
Cooking has been a hobby of mine for years. Combined with all the travel that I've done, I consider myself a fairly adventurous eater. I pay attention to what I eat, and if I like a dish, I try to recreate it at home. I consider myself reasonably experienced in the kitchen to the point that, with the exception of pastries, I consider recipes to be more suggestive than prescriptive. (Why pastries? That shit has tighter engineering tolerances than manufacturing medical equipment.)
I've also been interested in vegetarian cooking for a very long time. I first learned of this way of cooking when I lived in a strict vegetarian, clothing-optional, coed co-op during my first pass through college almost 4 decades ago. I kept my clothes on but paid close attention when I was on kitchen duty with my housemates. Some of their ideas had a pretty big influence on me. For example, I rarely eat packaged food. I prefer to cook using good quality raw ingredients. It takes longer because all those raw ingredients have to be prepped in various ways, but I refer you back to my first point--cooking is a hobby. It's something in which I invest time and emotional energy. And my diet has always included a decent proportion of vegetables and grains. One of my go-to comfort meals, tofu sauteed with onion and spinach then sprinkled with fresh lime juice, is all the way onto the vegan side of the scale.
Fast forward to now. About a month ago, I realized that I hadn't purchased any meat in the previous couple of months. Somehow, in a shift that was subtle enough that I didn't consciously recognize it for months, I've become vegetarian.
I realized it had a lot to do with my new job. I handle dead animals regularly. Well, that's a flat-out euphemism. I cut them up. I cut up dead animals of all species. I surgically take them apart. After I remove entire organ systems, I cut those up too to make sure no lesions are overlooked. That was all soaking into my head too, just like those early cooking lessons, so that when I was at the grocery store doing my shopping on the weekends, I'd walk past the meat section and just...keep walking.
It's not a moral issue. I'm not a smug vegan judging you for your choices. You will have to pry the half-and-half in my morning coffee and yogurt and eggs from my cold, dead hands. Grated parmesan is a perfect garnish for just about anything.
For now, I still eat meat if someone makes it and serves it to me. It seems to be the handling of it that bothers me the most. And I've finally found the perfect agility training reward for Archie--boiled beef. Low fat, low sodium, freezes well, and he just goes nuts for it. I buy the pre-cut stir-fry strips and I don't even have to handle them when raw, just dump them in a saucepan and add water.
Is it just a phase? Does it matter if it isn't? It's sure a lot cheaper. Maybe I'll lose some weight too.
I've also been interested in vegetarian cooking for a very long time. I first learned of this way of cooking when I lived in a strict vegetarian, clothing-optional, coed co-op during my first pass through college almost 4 decades ago. I kept my clothes on but paid close attention when I was on kitchen duty with my housemates. Some of their ideas had a pretty big influence on me. For example, I rarely eat packaged food. I prefer to cook using good quality raw ingredients. It takes longer because all those raw ingredients have to be prepped in various ways, but I refer you back to my first point--cooking is a hobby. It's something in which I invest time and emotional energy. And my diet has always included a decent proportion of vegetables and grains. One of my go-to comfort meals, tofu sauteed with onion and spinach then sprinkled with fresh lime juice, is all the way onto the vegan side of the scale.
 |
| A sample of the things I cooked this weekend for the upcoming week: cornbread muffins; white beans with roasted garlic, carrots, and fresh basil; white rice; and roast cauliflower and mushrooms with black pepper. |
Fast forward to now. About a month ago, I realized that I hadn't purchased any meat in the previous couple of months. Somehow, in a shift that was subtle enough that I didn't consciously recognize it for months, I've become vegetarian.
I realized it had a lot to do with my new job. I handle dead animals regularly. Well, that's a flat-out euphemism. I cut them up. I cut up dead animals of all species. I surgically take them apart. After I remove entire organ systems, I cut those up too to make sure no lesions are overlooked. That was all soaking into my head too, just like those early cooking lessons, so that when I was at the grocery store doing my shopping on the weekends, I'd walk past the meat section and just...keep walking.
It's not a moral issue. I'm not a smug vegan judging you for your choices. You will have to pry the half-and-half in my morning coffee and yogurt and eggs from my cold, dead hands. Grated parmesan is a perfect garnish for just about anything.
For now, I still eat meat if someone makes it and serves it to me. It seems to be the handling of it that bothers me the most. And I've finally found the perfect agility training reward for Archie--boiled beef. Low fat, low sodium, freezes well, and he just goes nuts for it. I buy the pre-cut stir-fry strips and I don't even have to handle them when raw, just dump them in a saucepan and add water.
Is it just a phase? Does it matter if it isn't? It's sure a lot cheaper. Maybe I'll lose some weight too.
Saturday, December 07, 2019
Polishing That Resume
I was busy this week buffing up the resume credentials.
I am now certified to operate our forklift. I'm sure you are asking why I would ever need this skill. Well, we generate a fair bit of biological waste in the Necropsy unit, and we've got to dispose of it somehow. And "somehow" has to conform to an array of laws and regulations. We have a brand-new incinerator in a maintenance yard across the street from the lab, and we use the forklift to lift a specialized bag containing said biological waste out of a container and up into the incinerator. We typically burn between 1000 and 1500 lb of material at a time. That's not really a lot, since an average horse or cow weighs 1000 lb. Nobody at the lab was certified to run the forklift, so I arranged for the training and now 8 of us are certified. Plenty of hands to help whenever we need to burn a load of waste.
This week I also attended a day-long continuing education event on Arkansas aquaculture. I learned about the species that are cultivated in the state, and about important commercial fish diseases and parasites. After lunch, we had hands-on activities doing necropsies and looking over some lab testing procedures. I successfully pulled 3 mL of blood from my little catfish.
The necropsy part was great. I knew absolutely nothing about fish anatomy before the class, and boy, are fish weird. There are only two chambers in their hearts, although they kind of cheat on the chamber count and add a third structure that acts as a pressure regulator out of the ventricle. They have two long kidneys tucked up near their spine like mammals. In some fish, the function of the cranial part of the kidney can be different than the posterior part. Their kidneys have an excretory function but freshwater fish lack the structures to create concentrated urine, for example. And of course they don't have lungs or a diaphragm. They have very simple guts, basically a stomach and intestine. I was surprised to learn that they do not have cloacas like birds but have two separate outlets, one for urogenital things and one for poop. Comparative anatomy for the win!
I am now certified to operate our forklift. I'm sure you are asking why I would ever need this skill. Well, we generate a fair bit of biological waste in the Necropsy unit, and we've got to dispose of it somehow. And "somehow" has to conform to an array of laws and regulations. We have a brand-new incinerator in a maintenance yard across the street from the lab, and we use the forklift to lift a specialized bag containing said biological waste out of a container and up into the incinerator. We typically burn between 1000 and 1500 lb of material at a time. That's not really a lot, since an average horse or cow weighs 1000 lb. Nobody at the lab was certified to run the forklift, so I arranged for the training and now 8 of us are certified. Plenty of hands to help whenever we need to burn a load of waste.
This week I also attended a day-long continuing education event on Arkansas aquaculture. I learned about the species that are cultivated in the state, and about important commercial fish diseases and parasites. After lunch, we had hands-on activities doing necropsies and looking over some lab testing procedures. I successfully pulled 3 mL of blood from my little catfish.
The necropsy part was great. I knew absolutely nothing about fish anatomy before the class, and boy, are fish weird. There are only two chambers in their hearts, although they kind of cheat on the chamber count and add a third structure that acts as a pressure regulator out of the ventricle. They have two long kidneys tucked up near their spine like mammals. In some fish, the function of the cranial part of the kidney can be different than the posterior part. Their kidneys have an excretory function but freshwater fish lack the structures to create concentrated urine, for example. And of course they don't have lungs or a diaphragm. They have very simple guts, basically a stomach and intestine. I was surprised to learn that they do not have cloacas like birds but have two separate outlets, one for urogenital things and one for poop. Comparative anatomy for the win!
Friday, November 29, 2019
For Public Consumption
I've been struggling lately to find blog-worthy topics. I absolutely love my job. I look forward to getting into the lab every day. There's no way to predict what will walk in the door! Unfortunately, most of the stories that I can spin these days, based on events at work that I find interesting or amusing, are inappropriate for public retelling. And I don't think that I want to turn this blog into "Tales From The Necropsy Floor." Even most veterinarians don't want to see endless photos of diseased tissues in dead animals.
As an example of a story that isn't suitable for public consumption, consider the rabbit we received last week. Most of the small animal submissions we receive are wrapped in bags or tarps then placed in a cooler or box or some other opaque container. The rabbit arrived in a small cardboard box, taped up for shipping. The necropsy techs were at lunch so I told Receiving I'd carry the remains back to necropsy. I opened the box to look for the paperwork...and found the submission form folded up and laid on top of the rabbit. No other packaging, not even a WalMart bag. Just the dead rabbit and a folded up piece of paper in an otherwise empty cardboard box. There are several layers of subtext as to why this was funny...but I don't think I can spin any of them into an acceptable party tale.
Here's another example. My interest in laying hens and ovarian/oviductal cancer is underlain by a deeper interest in reproduction. I now have access to many different species of animal, and I've begun building a library of fixed tissues and slides of reproductive tissues, both with disease and without. We recently received a male sugar glider for necropsy. I did some research and learned that, like most marsupials, sugar gliders have some freaky ass reproductive organs. I walked in to necropsy, pulling on the heavy gloves we wear and snapping them in place just like they do on the TV, and announced to my two techs, "Sugar gliders have a forked penis. I'm adding this one to my collection." They just laughed. Yes, I am perfectly aware that writing it out like this makes me sound like a psychopath. But I've explained to them my interest in reproduction and my desire to understand both the gross and the microscopic appearance of reproductive tissues of all kinds of animals. So I deliberately collect those tissues even if they don't have anything to do with the cause of death of the animal. This is another aspect of my job that I can't discuss outside of work.
Here's a third example. Besides animal remains for necropsy, we also get surgical biopsies submitted by veterinarians located all over the state. These are lumps and bumps and masses that they remove from their patients and send to us so we can make slides and have a pathologist look at them to make a diagnosis. The basic process is for the submitting veterinarian to place the tissue in formalin. This chemical causes proteins in the tissue to become cross-linked so the tissue becomes stiff and sort of rubbery. We then cut thin pieces from the tissue, embed that in paraffin wax, then cut even thinner slices of that and mount it on a glass microscope slide. The tissue is stained, a cover slip is glued on, and then the pathologist gets that slide for interpretation.
When I took over supervisory duties for the Pathology section, I instituted several new QC processes, especially for the surgical biopsy submissions. There had been none in place before--apparently it was left up to the techs to decide how to cut up the submitted tissues. They would often slice up tumors in ways that suited them, but that did not produce diagnostic samples or slides. I now examine every biopsy submission and give the techs written instructions for key areas to focus on. Sometimes I give instructions to leave submissions in formalin for another 24-48 hours, or note that the sample is extremely fatty and needs to be placed in a different fixative.
Last week, we received a tissue sample from a young Great Dane bitch. It was an external "mass" that was growing adjacent to the vulva of the dog. The vet excised it and sent it to us in a pill bottle. Not a good choice--pill bottles leak, and formalin is hazardous. They didn't put enough formalin in the bottle and most of the tissue sample was uncovered. Suspecting that it wasn't adequately fixed, I pulled it out to take a look and promptly bonked my forehead on the glass door of the fume hood as I yelped "My god, it's an alien baby!" The tissue was so complex and so confusing that I immediately called the submitting veterinarian to find out more. Turns out she was just as perplexed as I was, and was hoping that we would tell her what it was. I tweaked her a bit for sending the damned thing in a leaking pill bottle, which she took with good grace.
I drew a picture of the alien baby with trimming instructions for the techs. Then I sent a wordy email to the pathologist I was sending the slides to so he would have some context about why I was sending him 10 slides for a single biopsy submission (most only require a single slide). I described the alien baby in great detail. He replied with a mock histopathology report with phrases like "mixture of reptilian and insectoid features." It was hysterical. And I'll never be able to tell this story in public.
As an example of a story that isn't suitable for public consumption, consider the rabbit we received last week. Most of the small animal submissions we receive are wrapped in bags or tarps then placed in a cooler or box or some other opaque container. The rabbit arrived in a small cardboard box, taped up for shipping. The necropsy techs were at lunch so I told Receiving I'd carry the remains back to necropsy. I opened the box to look for the paperwork...and found the submission form folded up and laid on top of the rabbit. No other packaging, not even a WalMart bag. Just the dead rabbit and a folded up piece of paper in an otherwise empty cardboard box. There are several layers of subtext as to why this was funny...but I don't think I can spin any of them into an acceptable party tale.
Here's another example. My interest in laying hens and ovarian/oviductal cancer is underlain by a deeper interest in reproduction. I now have access to many different species of animal, and I've begun building a library of fixed tissues and slides of reproductive tissues, both with disease and without. We recently received a male sugar glider for necropsy. I did some research and learned that, like most marsupials, sugar gliders have some freaky ass reproductive organs. I walked in to necropsy, pulling on the heavy gloves we wear and snapping them in place just like they do on the TV, and announced to my two techs, "Sugar gliders have a forked penis. I'm adding this one to my collection." They just laughed. Yes, I am perfectly aware that writing it out like this makes me sound like a psychopath. But I've explained to them my interest in reproduction and my desire to understand both the gross and the microscopic appearance of reproductive tissues of all kinds of animals. So I deliberately collect those tissues even if they don't have anything to do with the cause of death of the animal. This is another aspect of my job that I can't discuss outside of work.
Here's a third example. Besides animal remains for necropsy, we also get surgical biopsies submitted by veterinarians located all over the state. These are lumps and bumps and masses that they remove from their patients and send to us so we can make slides and have a pathologist look at them to make a diagnosis. The basic process is for the submitting veterinarian to place the tissue in formalin. This chemical causes proteins in the tissue to become cross-linked so the tissue becomes stiff and sort of rubbery. We then cut thin pieces from the tissue, embed that in paraffin wax, then cut even thinner slices of that and mount it on a glass microscope slide. The tissue is stained, a cover slip is glued on, and then the pathologist gets that slide for interpretation.
When I took over supervisory duties for the Pathology section, I instituted several new QC processes, especially for the surgical biopsy submissions. There had been none in place before--apparently it was left up to the techs to decide how to cut up the submitted tissues. They would often slice up tumors in ways that suited them, but that did not produce diagnostic samples or slides. I now examine every biopsy submission and give the techs written instructions for key areas to focus on. Sometimes I give instructions to leave submissions in formalin for another 24-48 hours, or note that the sample is extremely fatty and needs to be placed in a different fixative.
Last week, we received a tissue sample from a young Great Dane bitch. It was an external "mass" that was growing adjacent to the vulva of the dog. The vet excised it and sent it to us in a pill bottle. Not a good choice--pill bottles leak, and formalin is hazardous. They didn't put enough formalin in the bottle and most of the tissue sample was uncovered. Suspecting that it wasn't adequately fixed, I pulled it out to take a look and promptly bonked my forehead on the glass door of the fume hood as I yelped "My god, it's an alien baby!" The tissue was so complex and so confusing that I immediately called the submitting veterinarian to find out more. Turns out she was just as perplexed as I was, and was hoping that we would tell her what it was. I tweaked her a bit for sending the damned thing in a leaking pill bottle, which she took with good grace.
I drew a picture of the alien baby with trimming instructions for the techs. Then I sent a wordy email to the pathologist I was sending the slides to so he would have some context about why I was sending him 10 slides for a single biopsy submission (most only require a single slide). I described the alien baby in great detail. He replied with a mock histopathology report with phrases like "mixture of reptilian and insectoid features." It was hysterical. And I'll never be able to tell this story in public.
Thursday, October 31, 2019
Trained For This
Our small animal necropsy submissions usually arrive at the lab in coolers or cardboard boxes. This means that the folks in Receiving don't deal with actual animal remains, only with containers.
When I walked into the Receiving area after I returned from lunch on Tuesday, I found our bacteriology supervisor standing there paralyzed in place with eyes the size of dinner plates. We've had some staff turnover in Receiving, and she was covering the phones for the lunch hour. There was a young couple, who looked to be in their mid- to late twenties, both crying. The guy was holding a dead cat in his arms. No box or bags in sight. To be fair, he had a towel but he was holding the kitten on it as if it was lying in state. The bacteriology supervisor was in no way going to touch the dead cat. Clearly the submission part of the process had ground to a halt.
I immediately thought, hey, I've been trained for this. I went to school for four years to learn about things like this. I think I can help out here. I set my things down, and told the bacteriology supervisor that everything was okay. I went over to the couple and talked with them for several minutes. Their kitten had died suddenly after a night of seizures. They were terrified it was because he ate a plant from their yard, or got into some household cleaner or poison. They had several baggies with samples of all of the suspected items--seeds, a mothball, leaves. I asked them questions about what they wanted us to help them with, and I helped them understand what a necropsy could and could not do (it's not magic, in short). I told them that Amy would help them finish the paperwork. Then I gently took the kitten in my arms, and asked them if they were sure they had said goodbye to their beloved pet. They started sobbing while petting him for the last time. The bacteriology supervisor started sobbing. I was tearing up too. I carried kitten back to the necropsy floor, startling my tech when I came in carrying a dead cat in my arms along with a handful of baggies full of plants. I set him down on the table and told her, it's all okay, I will change into scrubs and be right back.
Besides this poor kitten, I've had a couple of really emotionally challenging cases recently, and decided to call a classmate that night to blow off some steam. She is a GP in a small animal clinic in Oregon. She loves her job, and some clients are even starting to request her as the doctor they want to see. We talked about the millions of different ways that compassion is a part of our daily work. Dark humor is never far away, always bubbling along, but it is more than offset by the moments when we are totally in the moment with our clients and patients.
When I walked into the Receiving area after I returned from lunch on Tuesday, I found our bacteriology supervisor standing there paralyzed in place with eyes the size of dinner plates. We've had some staff turnover in Receiving, and she was covering the phones for the lunch hour. There was a young couple, who looked to be in their mid- to late twenties, both crying. The guy was holding a dead cat in his arms. No box or bags in sight. To be fair, he had a towel but he was holding the kitten on it as if it was lying in state. The bacteriology supervisor was in no way going to touch the dead cat. Clearly the submission part of the process had ground to a halt.
I immediately thought, hey, I've been trained for this. I went to school for four years to learn about things like this. I think I can help out here. I set my things down, and told the bacteriology supervisor that everything was okay. I went over to the couple and talked with them for several minutes. Their kitten had died suddenly after a night of seizures. They were terrified it was because he ate a plant from their yard, or got into some household cleaner or poison. They had several baggies with samples of all of the suspected items--seeds, a mothball, leaves. I asked them questions about what they wanted us to help them with, and I helped them understand what a necropsy could and could not do (it's not magic, in short). I told them that Amy would help them finish the paperwork. Then I gently took the kitten in my arms, and asked them if they were sure they had said goodbye to their beloved pet. They started sobbing while petting him for the last time. The bacteriology supervisor started sobbing. I was tearing up too. I carried kitten back to the necropsy floor, startling my tech when I came in carrying a dead cat in my arms along with a handful of baggies full of plants. I set him down on the table and told her, it's all okay, I will change into scrubs and be right back.
Besides this poor kitten, I've had a couple of really emotionally challenging cases recently, and decided to call a classmate that night to blow off some steam. She is a GP in a small animal clinic in Oregon. She loves her job, and some clients are even starting to request her as the doctor they want to see. We talked about the millions of different ways that compassion is a part of our daily work. Dark humor is never far away, always bubbling along, but it is more than offset by the moments when we are totally in the moment with our clients and patients.
Monday, September 30, 2019
Inspissated
Today I wrote a necropsy report using the word "inspissated." It's a word that I didn't even know existed before vet school. But I have a job where using cool words like that is a regular occurrence.
The necropsy/autopsy is a very old medical tool. There are some fairly strict rules for how to go about it, and it would be easy to dismiss these rules as a bit old fashioned. Our understanding of the pathology of disease at the molecular level has exploded in the past few decades. But here we are, still examining animal remains with our eyes and fingers (and noses--I've made some interesting diagnoses based on characteristic odors). And while in plenty of cases I will request additional diagnostics such as PCR (polymerase chain reaction) for a specific virus--a tool that was only developed in the early 1980s--I can often reach a conclusion in my necropsy cases based only on gross findings (in this case, gross means obtained by visual examination).
So in no particular order, here are some of my recent cases which required no additional testing:
I always try to approach a case with some differentials in mind, and I do this to help focus my attention on particular organs or tissues. Before I do the necropsy, I read the submission form and whatever history I am provided. I might call the producer or referring veterinarian to get more history. I often look at papers or pull a textbook off the shelf and skim a chapter or two. And when I perform the necropsy, I follow the old fashioned rules--be thorough, be systematic. Look at everything. You might decide it is normal but you still need to look at it.
Sometimes following the old fashioned rules are all you need to close a case.
The necropsy/autopsy is a very old medical tool. There are some fairly strict rules for how to go about it, and it would be easy to dismiss these rules as a bit old fashioned. Our understanding of the pathology of disease at the molecular level has exploded in the past few decades. But here we are, still examining animal remains with our eyes and fingers (and noses--I've made some interesting diagnoses based on characteristic odors). And while in plenty of cases I will request additional diagnostics such as PCR (polymerase chain reaction) for a specific virus--a tool that was only developed in the early 1980s--I can often reach a conclusion in my necropsy cases based only on gross findings (in this case, gross means obtained by visual examination).
So in no particular order, here are some of my recent cases which required no additional testing:
- heat prostration in dogs (5 cases in September alone)
- a dog whose chest was pierced by small caliber bullet or sharp object (nicked a large vessel, dog died of shock due to loss of blood, although the lungs were also collapsed which probably didn't help this pup); I found the 2mm entry wound because I always do a complete physical examination of the exterior of my cases before I begin the necropsy, and I was able to follow the damaged tissue trail into the chest
- pyometra (bacterial infection in the uterus) in an unspayed female pitbull (backyard breeder)
- chronic, severe footpad dermatitis in some commercial broiler breeder hens and roosters (the pus in the abscesses in their feet became inspissated)
- a dog whose chest and abdomen were filled with blood due to a very large, ruptured hemangiosarcoma on its spleen (dog also died of shock due to sudden loss of blood; I estimated the volume of blood inside its abdomen alone to be 3 L, which was over half the blood in its body)
- a middle-aged male Boxer with progressive neurological signs--when the case came in, I predicted a mass in its brain and I was right: it was an aggressive oligodendroglioma (Boxers are considered textbook models for brain tumors)
- two backyard laying hens (different owners) with astonishingly advanced ovarian/oviductal carcinoma
- a goat with anemia that had horrible intestinal parasites--anemic small ruminants have Haemonchus in their abomasums (one of the forestomach compartments) until proven otherwise, and there was no proving otherwise in this case
- a dog that died suddenly--it had so many whipworms in its cecum that I called it a "Trichuris burrito"--whipworms are common intestinal parasites but are easily controlled with modern parasiticide products which this dog had not received
- a cat with a SINGLE heartworm in its right atrium and horrific heart disease (one heartworm is enough to kill a cat)
- a calf that had been banded improperly so that the testicles were pushed back inside and an infection developed at the site where the band was placed; the band and empty scrotum fell off but the infection ascended into the abdomen, and ultimately the calf died of bacterial sepsis (I only figured this out when I found the infected testicles inside his abdomen; all evidence of the scrotal sac and band were gone; it was a bit of an awkward moment when I called the producer and asked, "Um, did you castrate this animal? Because I found both testes inside it..."
I always try to approach a case with some differentials in mind, and I do this to help focus my attention on particular organs or tissues. Before I do the necropsy, I read the submission form and whatever history I am provided. I might call the producer or referring veterinarian to get more history. I often look at papers or pull a textbook off the shelf and skim a chapter or two. And when I perform the necropsy, I follow the old fashioned rules--be thorough, be systematic. Look at everything. You might decide it is normal but you still need to look at it.
Sometimes following the old fashioned rules are all you need to close a case.
Saturday, September 07, 2019
Just Look At This Dude!
Look at this bug trying to pass himself off as some dried up pine needles hanging off the wires. He's been there all day.
Inappropriate
Taken out of context, nearly every conversation that I have at work makes me sound like a psychopath or totally unhinged. Either way, when added to the general funk that hangs about my person on most necropsy days, I am now mostly unfit for normal adult society.
During our first night in Archie's agility class, I was asked by the teenaged daughter of one of the women if I saw mostly dogs. She thought I was a small animal clinician. I told her, "Oh, no, I work with all species, as long as they are dead." Which in the nanosecond between thought and words leaving my mouth seemed like a funny joke. In reality, neither the girl nor her mother spoke to me again that night. (I've since mended things with the mother.)
The director of the lab mentioned the fancy photography table out on the necropsy floor. He wanted to know if I wanted to use it. I told him, "I have indeed been stepping up our game on photographs but I've been having quite a bit of success with rinsing the tissues and posing them on a clean cutting board." And he just nodded like this was a normal thing to say.
A woman brought in a gecko for a necropsy around 3pm on Friday. That's kind of late in the day--everyone is thinking about heading home, what they will make for dinner, what they will be doing for the weekend. But in my limited experience with reptiles and amphibians, I know they autolyse extremely quickly. The gecko would have melted into a puddle of gecko goo if I left it until Monday. So I grabbed it from Receiving and went skipping down to necropsy to get set up. One of the lab techs from bacteriology saw me and said, "Wow, so much energy for Friday afternoon." And I replied with considerable enthusiasm while brandishing the small, already rather smelly box at her, "I get to necropsy this gecko!" She nodded slowly, eyes widening, and said, "Oh" while walking away more quickly than necessary.
I've had considerable success at arriving at some sort of diagnosis for most of my cases to date. But I had a case with a cat last week that completely stumped me. The director asked me about my conclusions for the cat, and I said, "Well, the only problem I could find is that she's dead." He's starting to get used to me, but that reply even stopped him for a couple of seconds.
To a much greater degree than most human medicine practitioners (with the exception of certain specialists), veterinarians directly confront death on a daily basis. Compassion fatigue is a very real problem in vet med. Suicide rates for veterinarians exceed those of human medicine doctors. Clinicians have to euthanize animals every single day. Every. Single. Day. In a busy emergency clinic, they will be performing several euthanasias per day. They have to deal with grieving owners, who may be in shock, may be enraged, may be distraught with grief. It's a heavy burden. Finding the middle path between becoming emotionally upset yourself and not having any emotional reaction at all is very hard.
I am somewhat shielded from that. I do not have to euthanize animals, but I do deal with upset and grieving owners and with upset and grieving fellow veterinarians who had to euthanize the animal they are submitting to the lab. And my own job is to then perform very invasive actions on the remains of the animals. It is always jarring to me to see someone's beloved pet lying on the metal table, still with an IV catheter in place covered with vet wrap.
The way I deal with my personal emotions is to take a couple of minutes and carefully examine the exterior of every animal. I run my hands over every inch of them. Of course that is just good pathology practice, but it also gives me time to think about the life each animal had. Was it cared for? Was it loved? It's a way for me to honor that animal, and thank them for letting us try to learn what happened to them. Nobody I work with knows that I do this.
My inappropriate comments are a release valve that let me blow off emotional steam. But they are not intentionally disrespectful. Vet school is so immersive that it is hard to remember that the black humor so common in our profession is usually not appropriate outside of those settings. Now that I'm out in the real world more often, it's hard to be mindful of how others perceive my job.
During our first night in Archie's agility class, I was asked by the teenaged daughter of one of the women if I saw mostly dogs. She thought I was a small animal clinician. I told her, "Oh, no, I work with all species, as long as they are dead." Which in the nanosecond between thought and words leaving my mouth seemed like a funny joke. In reality, neither the girl nor her mother spoke to me again that night. (I've since mended things with the mother.)
The director of the lab mentioned the fancy photography table out on the necropsy floor. He wanted to know if I wanted to use it. I told him, "I have indeed been stepping up our game on photographs but I've been having quite a bit of success with rinsing the tissues and posing them on a clean cutting board." And he just nodded like this was a normal thing to say.
A woman brought in a gecko for a necropsy around 3pm on Friday. That's kind of late in the day--everyone is thinking about heading home, what they will make for dinner, what they will be doing for the weekend. But in my limited experience with reptiles and amphibians, I know they autolyse extremely quickly. The gecko would have melted into a puddle of gecko goo if I left it until Monday. So I grabbed it from Receiving and went skipping down to necropsy to get set up. One of the lab techs from bacteriology saw me and said, "Wow, so much energy for Friday afternoon." And I replied with considerable enthusiasm while brandishing the small, already rather smelly box at her, "I get to necropsy this gecko!" She nodded slowly, eyes widening, and said, "Oh" while walking away more quickly than necessary.
I've had considerable success at arriving at some sort of diagnosis for most of my cases to date. But I had a case with a cat last week that completely stumped me. The director asked me about my conclusions for the cat, and I said, "Well, the only problem I could find is that she's dead." He's starting to get used to me, but that reply even stopped him for a couple of seconds.
To a much greater degree than most human medicine practitioners (with the exception of certain specialists), veterinarians directly confront death on a daily basis. Compassion fatigue is a very real problem in vet med. Suicide rates for veterinarians exceed those of human medicine doctors. Clinicians have to euthanize animals every single day. Every. Single. Day. In a busy emergency clinic, they will be performing several euthanasias per day. They have to deal with grieving owners, who may be in shock, may be enraged, may be distraught with grief. It's a heavy burden. Finding the middle path between becoming emotionally upset yourself and not having any emotional reaction at all is very hard.
I am somewhat shielded from that. I do not have to euthanize animals, but I do deal with upset and grieving owners and with upset and grieving fellow veterinarians who had to euthanize the animal they are submitting to the lab. And my own job is to then perform very invasive actions on the remains of the animals. It is always jarring to me to see someone's beloved pet lying on the metal table, still with an IV catheter in place covered with vet wrap.
The way I deal with my personal emotions is to take a couple of minutes and carefully examine the exterior of every animal. I run my hands over every inch of them. Of course that is just good pathology practice, but it also gives me time to think about the life each animal had. Was it cared for? Was it loved? It's a way for me to honor that animal, and thank them for letting us try to learn what happened to them. Nobody I work with knows that I do this.
My inappropriate comments are a release valve that let me blow off emotional steam. But they are not intentionally disrespectful. Vet school is so immersive that it is hard to remember that the black humor so common in our profession is usually not appropriate outside of those settings. Now that I'm out in the real world more often, it's hard to be mindful of how others perceive my job.
Tuesday, August 27, 2019
The New Vet in The New Job
I'm settling in to the new job. I've had to make some mental adjustments--I still feel a twinge of anxiety when I leave at 5pm, after everyone else already left at 4:30pm. Vet school leaves deep scars, that's for sure.
I have had a string of very interesting cases these past few weeks and have really been knocking out some cool diagnoses based only on what I see in the animal remains--which are later confirmed with ancillary tests or by looking at microscopic slides of tissue. I think it's a combination of beginner's luck and a fairly decent vet med foundation.
There is a rule of thumb in vet med that goes like this: "don't go looking for zebras." I've also heard it expressed as "common diseases present uncommonly." In other words, if you see strange things, you shouldn't be thinking strange problems, although those are always possible. You should be thinking about common, garden-variety problems first.
Here are two good examples of this.
Case 1: intact female pit bull mix, 5 years old, history of vomiting, died suddenly. Before I even touched her, I took one look at the dog on the table and told my tech, "it's pyometra." Sure enough, there was more than 400 mL of brown, cloudy fluid in her left uterine horn. She died of sepsis as the bacteria and their toxins started leaking out into the rest of her body. It was not a good death. But it is a very common one for intact female dogs with this signalment and history. Her breed was one red flag. Her age was another. Five years old and still intact? Either a stray or a backyard breeder. A rescue org or a shelter would have spayed her. Sure, a foreign body or gastric volvulus (twisting) would have caused untreatable vomiting and death. And both were certainly on my list. But vets are trained to make a ranked list of differentials. And pyometra was at the very top of the list for this dog.
Case 2: neutered male Boxer, 5 years old, progressive neurological signs over period of 18 months that were not responding to anti-seizure meds. I told my colleague, "it's a brain tumor, probably a glioma." Sure enough, I found a huge gelatinous tumor in the left cerebral hemisphere, confirmed by a board-certified pathologist to be a malignant oligodendroglioma. Boxers are poster-children for gliomas. I also found changes in the valves and right side of this dog's heart that I carefully described in my report. The pathologist confirmed a right-sided cardiomyopathy of a kind that is very specific to Boxers. While in school, I learned about diseases that are more common in certain breeds of animal, and I went looking for those particular lesions. And found them, to my great satisfaction. This was a good case because it gave a lot of closure to both the referring veterinarian and the owners--there was nothing they could have done differently to change the course of disease or the outcome.
Cases 3 and 4: backyard laying hens, history of losing weight, died suddenly. Both submitted today from different owners. I told my tech, "it's either ovarian/oviductal carcinoma or it's yolk peritonitis. Equally likely." It was aggressive ovi carcinoma in both cases. In a surprise zebra finding, one of the birds had right-sided dilational cardiomyopathy and ascites. Didn't expect that, it's more common in broilers and even then you rarely see it in the U.S. But this hen had what I think is a metastatic tumor in her left ventricle, which appears to have caused upstream problems in the right side of her heart and so on and so forth. Histopathology on the heart nodule will confirm whether I'm just making shit up or whether I'm right.
Don't misinterpret these tales. This is not some game of pool where I'm calling 8-ball in the corner pocket. It is appropriate to think of differentials for any case before you begin the necropsy. You want to be prepared.
For example, whenever I am presented with an exotic animal (for example, I've worked on a snake, a bobcat, and a kangaroo), I research possible zoonoses before I even walk onto the necropsy floor. Zoonoses are diseases (or parasites) that humans can get from animals. We can get zoonoses from pet dogs and cats but there are some increased risks when you work with exotic animals. I want me and my support staff to be prepared with appropriate protective gear. I want to be able to specially identify samples if there could be a risk to other lab personnel.
As a newly minted veterinarian, it's validating to do a necropsy, find lesions, describe them, suggest some possible diagnoses, and have other tests confirm my analysis so definitively. Sure, I make mistakes. Sometimes I miss important lesions. Sometimes I don't collect the right samples. But I'm learning, and I'm gaining confidence in my ability to recognize when something is not normal. I may not always identify the disease process in detail, and I may not always properly rank what I see (abnormal doesn't mean important). But I'm getting exposed to a wide array of disease processes in lots of different species.
And I am slowly learning that I can leave work at 4:30pm and everything is just fine.
I have had a string of very interesting cases these past few weeks and have really been knocking out some cool diagnoses based only on what I see in the animal remains--which are later confirmed with ancillary tests or by looking at microscopic slides of tissue. I think it's a combination of beginner's luck and a fairly decent vet med foundation.
There is a rule of thumb in vet med that goes like this: "don't go looking for zebras." I've also heard it expressed as "common diseases present uncommonly." In other words, if you see strange things, you shouldn't be thinking strange problems, although those are always possible. You should be thinking about common, garden-variety problems first.
Here are two good examples of this.
Case 1: intact female pit bull mix, 5 years old, history of vomiting, died suddenly. Before I even touched her, I took one look at the dog on the table and told my tech, "it's pyometra." Sure enough, there was more than 400 mL of brown, cloudy fluid in her left uterine horn. She died of sepsis as the bacteria and their toxins started leaking out into the rest of her body. It was not a good death. But it is a very common one for intact female dogs with this signalment and history. Her breed was one red flag. Her age was another. Five years old and still intact? Either a stray or a backyard breeder. A rescue org or a shelter would have spayed her. Sure, a foreign body or gastric volvulus (twisting) would have caused untreatable vomiting and death. And both were certainly on my list. But vets are trained to make a ranked list of differentials. And pyometra was at the very top of the list for this dog.
Case 2: neutered male Boxer, 5 years old, progressive neurological signs over period of 18 months that were not responding to anti-seizure meds. I told my colleague, "it's a brain tumor, probably a glioma." Sure enough, I found a huge gelatinous tumor in the left cerebral hemisphere, confirmed by a board-certified pathologist to be a malignant oligodendroglioma. Boxers are poster-children for gliomas. I also found changes in the valves and right side of this dog's heart that I carefully described in my report. The pathologist confirmed a right-sided cardiomyopathy of a kind that is very specific to Boxers. While in school, I learned about diseases that are more common in certain breeds of animal, and I went looking for those particular lesions. And found them, to my great satisfaction. This was a good case because it gave a lot of closure to both the referring veterinarian and the owners--there was nothing they could have done differently to change the course of disease or the outcome.
Cases 3 and 4: backyard laying hens, history of losing weight, died suddenly. Both submitted today from different owners. I told my tech, "it's either ovarian/oviductal carcinoma or it's yolk peritonitis. Equally likely." It was aggressive ovi carcinoma in both cases. In a surprise zebra finding, one of the birds had right-sided dilational cardiomyopathy and ascites. Didn't expect that, it's more common in broilers and even then you rarely see it in the U.S. But this hen had what I think is a metastatic tumor in her left ventricle, which appears to have caused upstream problems in the right side of her heart and so on and so forth. Histopathology on the heart nodule will confirm whether I'm just making shit up or whether I'm right.
Don't misinterpret these tales. This is not some game of pool where I'm calling 8-ball in the corner pocket. It is appropriate to think of differentials for any case before you begin the necropsy. You want to be prepared.
For example, whenever I am presented with an exotic animal (for example, I've worked on a snake, a bobcat, and a kangaroo), I research possible zoonoses before I even walk onto the necropsy floor. Zoonoses are diseases (or parasites) that humans can get from animals. We can get zoonoses from pet dogs and cats but there are some increased risks when you work with exotic animals. I want me and my support staff to be prepared with appropriate protective gear. I want to be able to specially identify samples if there could be a risk to other lab personnel.
As a newly minted veterinarian, it's validating to do a necropsy, find lesions, describe them, suggest some possible diagnoses, and have other tests confirm my analysis so definitively. Sure, I make mistakes. Sometimes I miss important lesions. Sometimes I don't collect the right samples. But I'm learning, and I'm gaining confidence in my ability to recognize when something is not normal. I may not always identify the disease process in detail, and I may not always properly rank what I see (abnormal doesn't mean important). But I'm getting exposed to a wide array of disease processes in lots of different species.
And I am slowly learning that I can leave work at 4:30pm and everything is just fine.
Tuesday, August 20, 2019
Archie, The Delicate Flower
For weeks, the outside temperature has been only a couple of degrees cooler than the surface temperature of the Sun. Nonetheless, Archie is convinced that he is not able to get even a moment of proper sleep at night unless his entire body is in contact with mine and he is covered with a blanket. As soon as Archie is ready to sleep (there's always play time first!), he will begin pawing at my arm, which means he wants me to lift up the edge of a blanket so he can slide under it, preferably right next to me. A complicated dance ensues as I try to cover him without having the blanket cover any part of me. Why would I need a blanket? I’ve got a 12-kg, fur- and blanket-covered heat factory attached to me all night long.
I'm quite excited that Archie starts agility class this week. The local club holds its agility classes outside, so I hope that it cools off as predicted in the next couple of days. I am not sure my delicate flower from the PNW is ready for the heat and humidity. I bought him a cooling vest, and plan to have plenty of cold water and a fan for him. For us both!
I introduced Archie and myself to the club via email. They asked me to do a brief skills test with Archie and one of their instructors. I thought that was reasonable and readily agreed. The instructor had come up with a rather difficult Jumpers-style course that was 17 obstacles in length but that only used 9 obstacles so most were repeated in various tricky ways. Archie of course crushed it. She then said, what about his contacts? I ran him up and down the Aframe a couple of times. He nailed that too. Weaves?, she asked. To show off a bit, I rear-crossed him as he flew through a set of 12 poles. No surprise, then--we are in the Advanced Class. It will be interesting to see how this goes for us.
I'd like to find a private instructor but that is going to take more time. We are going to need to start going to trials, get known by the AKC agility community out here, let word get out that I'm looking for that.
Tuesday, August 06, 2019
I Smell Funny
So it's really hot and humid here in Little Rock. The necropsy floor opens onto a loading dock and temperature in there is only tolerable at best.
I wear business casual clothing to work, but change into scrubs for necropsies in the afternoon. I add a swaddling, impermeable, disposable lab coat and long-cuff, heavy-duty gloves. And I sweat like a beast of burden.
Humidity, sweat, and dead animals create a potent odor combo. I wash my hands and face. I change back into normal clothes.
And I still smell funny when I get home.
Thankfully I live with dogs and a cat. They don't seem to notice. They probably think that I smell better.
I wear business casual clothing to work, but change into scrubs for necropsies in the afternoon. I add a swaddling, impermeable, disposable lab coat and long-cuff, heavy-duty gloves. And I sweat like a beast of burden.
Humidity, sweat, and dead animals create a potent odor combo. I wash my hands and face. I change back into normal clothes.
And I still smell funny when I get home.
Thankfully I live with dogs and a cat. They don't seem to notice. They probably think that I smell better.
I Discover A Superpower
Convo, regular version:
"Happy Pets Animal Hospital. Can I help you?"
"Hi, yes, is Dr. X available?"
"She is in a room with a client/not here/gone home/not available. Can I take a message?"
Convo, superpower version:
"Happy Pets Animal Hospital. Can I help you?"
"Hi, this is Dr. A at the Veterinary Diagnostic Lab in Little Rock. Is Dr. X available?"
"Oh yes, just a minute, she really wants to talk to you!"
When I interviewed for this job, I got the impression that communication is one aspect that previous occupants of this particular job have not performed well. This has been confirmed more than once in my discussions with the director. Our clients are better served when they get information sooner. The reputation of the lab is bolstered when we add an invested, concerned name and voice to our necropsy cases. So I've been trying to call every referring veterinarian (or commercial producer) as soon as I complete their necropsies to chat about my preliminary findings.
This is how I discovered that I now have a superpower. It turns out that they quite value having a peer give them a ring to chat about their difficult cases. And I don't even have to wear a cape.
"Happy Pets Animal Hospital. Can I help you?"
"Hi, yes, is Dr. X available?"
"She is in a room with a client/not here/gone home/not available. Can I take a message?"
Convo, superpower version:
"Happy Pets Animal Hospital. Can I help you?"
"Hi, this is Dr. A at the Veterinary Diagnostic Lab in Little Rock. Is Dr. X available?"
"Oh yes, just a minute, she really wants to talk to you!"
When I interviewed for this job, I got the impression that communication is one aspect that previous occupants of this particular job have not performed well. This has been confirmed more than once in my discussions with the director. Our clients are better served when they get information sooner. The reputation of the lab is bolstered when we add an invested, concerned name and voice to our necropsy cases. So I've been trying to call every referring veterinarian (or commercial producer) as soon as I complete their necropsies to chat about my preliminary findings.
This is how I discovered that I now have a superpower. It turns out that they quite value having a peer give them a ring to chat about their difficult cases. And I don't even have to wear a cape.
Tuesday, July 30, 2019
Lions and Tigers and...Snakes
Yesterday I did a necropsy on a 16-year old albino corn snake. In vet school, our lectures on snakes and reptiles and amphibians were cursory at best, and covered nothing at all on the anatomy of these animals. When I got the email that the snake was coming in, I hustled over to the bookcase and grabbed the first relevant textbook that I saw. It took me about an hour to read and take notes on the chapter on snake anatomy. There was a decent figure in there, so I photocopied it to take down to the necropsy floor. I skimmed other chapters to get an idea of what kinds of diseases were most common in snakes. I also specifically researched zoonoses. I already knew about Salmonella (any reptile can give you salmonellosis), but I also learned that snakes commonly have cryptosporidia in their gut and those little parasites don't care who or what you are, they will make you so fucking sick with the vomiting and shitting that you will wish you had salmonella instead. Right--everyone on the floor was going to wear full PPE (personal protective equipment) including face masks.
And of course, I also immediately sent up the bat signal to one of my classmates who keeps snakes as pets. He was super helpful, giving me tips on how to determine a body condition score for snakes (that's an important thing in vet med, we do it for all species but you look at different parts of the animal depending on the species, and we never talked about determining a BCS for reptiles during school). He also kindly shared other miscellaneous bits of knowledge that one can only acquire by actually keeping snakes around all the time. Not my cup of tea, snakes, but this is my job now.
Snakes appear to have gone out of their way to make their anatomy as weird and difficult as possible (no diaphragm, one lung, three-chambered heart, two aorta, no urinary bladder, tongue hidden away in a pouch in the mouth; I could go on). Thankfully, livers and kidneys are fairly recognizable organs in most species and serve as good landmarks. I did my best, and to be honest, I found some surprises in this snake that may actually provide a cause of death. That's a rare enough outcome for any necropsy in any species, but even better because this one was so unusual.
And today I did a necropsy on a bobcat. The bobcat came in last week but we had to submit brain tissue for rabies testing before we could proceed with the necropsy. It was negative.
So when I was in vet school, still in second or third year, a cougar came into necropsy. Everyone was super excited and it was the talk of school...until that darned thing tested positive for Yersinia pestis, otherwise known as The Plague. Yeah, THAT plague! That's a reportable disease and Homeland Security got involved because bioterrorism. All students in necropsy at the time had to take a course of antibiotics (no opt-out on that), and a mountain of paperwork was created. The pathologist in charge of the case still tells stories about it.
The director of the lab told me during my first week here that tularemia was pretty common in Arkansas. Tularemia? That is a horrible disease! It affects rabbits, but also quite often affects felids. Felids...like bobcats.
So I spent this morning researching gross lesions that I might expect to see for Francisella tularemia, Yersinia pestis, and what the hell, Bacillus anthracis too (anthrax). Going for the full apocalypse. All three are zoonotic (nasty deaths for humans) and reportable. I made notes on the tissues I needed to collect, what tests I needed to request, and where I might send all this shit because we don't test for any of those diseases at our own lab.
I emailed one of my mentors at Oregon State (had some questions about the snake) and told her I had read up on these three diseases before doing the bobcat necropsy. She replied, "I'm so proud that you are considering the absolute worse case scenario before going on the floor!" Snark? Humor? True compliment? All of the above! I'm nothing if not cynically thorough.
So the bobcat had a femur fracture and likely died of starvation/dehydration. No evidence of infectious disease. Even so, I was ready.
And of course, I also immediately sent up the bat signal to one of my classmates who keeps snakes as pets. He was super helpful, giving me tips on how to determine a body condition score for snakes (that's an important thing in vet med, we do it for all species but you look at different parts of the animal depending on the species, and we never talked about determining a BCS for reptiles during school). He also kindly shared other miscellaneous bits of knowledge that one can only acquire by actually keeping snakes around all the time. Not my cup of tea, snakes, but this is my job now.
Snakes appear to have gone out of their way to make their anatomy as weird and difficult as possible (no diaphragm, one lung, three-chambered heart, two aorta, no urinary bladder, tongue hidden away in a pouch in the mouth; I could go on). Thankfully, livers and kidneys are fairly recognizable organs in most species and serve as good landmarks. I did my best, and to be honest, I found some surprises in this snake that may actually provide a cause of death. That's a rare enough outcome for any necropsy in any species, but even better because this one was so unusual.
And today I did a necropsy on a bobcat. The bobcat came in last week but we had to submit brain tissue for rabies testing before we could proceed with the necropsy. It was negative.
So when I was in vet school, still in second or third year, a cougar came into necropsy. Everyone was super excited and it was the talk of school...until that darned thing tested positive for Yersinia pestis, otherwise known as The Plague. Yeah, THAT plague! That's a reportable disease and Homeland Security got involved because bioterrorism. All students in necropsy at the time had to take a course of antibiotics (no opt-out on that), and a mountain of paperwork was created. The pathologist in charge of the case still tells stories about it.
The director of the lab told me during my first week here that tularemia was pretty common in Arkansas. Tularemia? That is a horrible disease! It affects rabbits, but also quite often affects felids. Felids...like bobcats.
So I spent this morning researching gross lesions that I might expect to see for Francisella tularemia, Yersinia pestis, and what the hell, Bacillus anthracis too (anthrax). Going for the full apocalypse. All three are zoonotic (nasty deaths for humans) and reportable. I made notes on the tissues I needed to collect, what tests I needed to request, and where I might send all this shit because we don't test for any of those diseases at our own lab.
I emailed one of my mentors at Oregon State (had some questions about the snake) and told her I had read up on these three diseases before doing the bobcat necropsy. She replied, "I'm so proud that you are considering the absolute worse case scenario before going on the floor!" Snark? Humor? True compliment? All of the above! I'm nothing if not cynically thorough.
So the bobcat had a femur fracture and likely died of starvation/dehydration. No evidence of infectious disease. Even so, I was ready.
Sunday, July 28, 2019
Schmoozing
I was quite shy as a young child. Later I became bookish and nerdy, which added an air of stand-offishness. Neither is a winning formula for social popularity.
But my first pass through graduate school changed things significantly. My advisor had a large group of advisees, 7 or 8, with about half of the group working on master's degrees and half on PhDs. He held regular weekly meetings during which one of his students had to report on their research progress and results, and then subsequently defend themselves, with no props other than maybe a chalkboard, against the bloodletting that followed from the rest of the group. It was brutal. It was exhilarating. It was eye-opening. After a couple of years of that, the dissertation defense was a breeze.
Don't start thinking that this was in any way abusive--it was well managed, and no personal attacks or calling people poopy-heads were allowed. The result was that I learned how communicate my research ideas clearly and effectively. But that is only one part of being a functional monkey in the monkey troupe.
The job that I took after that graduation required me to convince petroleum companies to part with their dollars to fund research projects based on ideas that my colleagues and I would come up with. Within the budgets of those projects, I had to cover my salary, including sick leave and vacation, the salaries of colleagues and support staff, and overhead. I had to convince the companies that the results would be of greater benefit to them than the relatively modest cost of paying us to do the work. The first few years were a bit rough but eventually I learned the art of schmoozing. And I got pretty darned good at it. I came to enjoy being good at it. I'm still bookish and shy, but when I turn on the schmooze, I can be formidable.
I have little interest in social schmoozing, although a bit of that is necessary. I'm more interested in technical schmoozing, in which me and other monkeys talk about science-y things.
Now I am working again. Although the role is different (public sector veterinarian), this week I learned three things about my new job: there is plenty of schmoozing to be done, it's been a long time since I was able to schmooze, and I really missed doing it.
I have started lurking around the receiving area when people bring in submissions (that is, animals for necropsy) so I can chat with them. I learn a lot about production practices and problems that are of concern to them, not to mention I get a much better history than the clients write down on the submission form. I was initially worried that I might be annoying the receiving staff, who do an excellent job and whose toes I definitely do not want to step on. But I got an email from them yesterday thanking me for talking to clients! And as soon as I complete a necropsy that has a fairly definitive finding, I call the referring veterinarian and chat with them on the phone. The lab director told me last week he was so pleased to hear all the "hubbub" (that's the actual word he used) coming from my office as I chat on the phone to veterinarians and owners.
How lucky I am to have found a job that lets me do fun vet med things then chat with people about those things all day long.
But my first pass through graduate school changed things significantly. My advisor had a large group of advisees, 7 or 8, with about half of the group working on master's degrees and half on PhDs. He held regular weekly meetings during which one of his students had to report on their research progress and results, and then subsequently defend themselves, with no props other than maybe a chalkboard, against the bloodletting that followed from the rest of the group. It was brutal. It was exhilarating. It was eye-opening. After a couple of years of that, the dissertation defense was a breeze.
Don't start thinking that this was in any way abusive--it was well managed, and no personal attacks or calling people poopy-heads were allowed. The result was that I learned how communicate my research ideas clearly and effectively. But that is only one part of being a functional monkey in the monkey troupe.
The job that I took after that graduation required me to convince petroleum companies to part with their dollars to fund research projects based on ideas that my colleagues and I would come up with. Within the budgets of those projects, I had to cover my salary, including sick leave and vacation, the salaries of colleagues and support staff, and overhead. I had to convince the companies that the results would be of greater benefit to them than the relatively modest cost of paying us to do the work. The first few years were a bit rough but eventually I learned the art of schmoozing. And I got pretty darned good at it. I came to enjoy being good at it. I'm still bookish and shy, but when I turn on the schmooze, I can be formidable.
I have little interest in social schmoozing, although a bit of that is necessary. I'm more interested in technical schmoozing, in which me and other monkeys talk about science-y things.
Now I am working again. Although the role is different (public sector veterinarian), this week I learned three things about my new job: there is plenty of schmoozing to be done, it's been a long time since I was able to schmooze, and I really missed doing it.
I have started lurking around the receiving area when people bring in submissions (that is, animals for necropsy) so I can chat with them. I learn a lot about production practices and problems that are of concern to them, not to mention I get a much better history than the clients write down on the submission form. I was initially worried that I might be annoying the receiving staff, who do an excellent job and whose toes I definitely do not want to step on. But I got an email from them yesterday thanking me for talking to clients! And as soon as I complete a necropsy that has a fairly definitive finding, I call the referring veterinarian and chat with them on the phone. The lab director told me last week he was so pleased to hear all the "hubbub" (that's the actual word he used) coming from my office as I chat on the phone to veterinarians and owners.
How lucky I am to have found a job that lets me do fun vet med things then chat with people about those things all day long.
Sunday, July 14, 2019
My Money Is On The Shitty Greek Yogurt
On Thursday night, I spent several hours in one of the local vet ERs with Archie. He had been vomiting for about 18 hours, and wasn't keeping any food down. He would eat food but he would vomit it right back up. He was also lethargic and not his usual cuddly, interactive self. I had some bloodwork done just to be prudent (although I declined the pancreatic lipase blood test since hanky panky pancreatitis was pretty low on the differential list). All of his bloodwork was totally normal. He got a shot of maropitant (Cerenia) and was back to his usual bouncy hijinks the next morning. He did have some fairly violent, watery diarrhea the following evening but as far as I can tell, it was only that once.
But then Mimi started vomiting yesterday afternoon. She refused to eat any dinner. During the night, she got me up every hour with dry heaves, producing only a little bit of foamy bile every so often. And boy, was she fighting the nausea. Archie just opened his mouth and bleagh! Out came the food and that was that. Mimi made such a production out of it. We got no sleep at all. Mimi's eyes became sunken and she became slightly wobbly and disoriented. She was drooling and groaning in pain when I had to pick her up or move her. She was passing horrific gas all night and had a bit of bloody diarrhea this morning. So off again we went to the vet ER. We waited for over an hour but they had a couple of emergencies come in so they sent us off to another vet ER.
Poor Mimi was not doing well at all by the time we arrived at the second vet ER. I had full bloodwork run on her too, including the pancreatic lipase test. I was actually more worried about acute kidney disease than pancreatitis but all of her bloodwork came back normal. She got a shot of maropitant too, but we all agreed that she was clinically dehydrated so she got a big slug of subQ fluids. She wasn't quite sick enough to warrant an IV catheter and IV fluids although I was considering it.
I declined abdominal imaging (they suggested rads and I would have also requested ultrasound if possible). But if Mimi doesn't get better by the morning, I will probably have to get this imaging to rule out some pretty scary things such as an abdominal mass (GI lymphoma would be at the top of the list). And we'd probably have to do some aspirates of lymph nodes to go along with that. And we'd also have to get chest rads because lymphoma fucking loves to met to the lungs. What a mess.
Mimi definitely became more sick faster than Archie. Several possibilities could explain that--whatever was making her sick was different than what made Archie sick (unlikely, but possible), and she's old and slightly underconditioned so she doesn't have a lot extra to expend in being sick (most likely).
So let's hope she starts feeling better! She's been resting and seems to have stopped the dry heaving, which is a relief.
What could have caused this? If we assume that both terriers got sick from the same thing, then we have to look at environment and diet. With respect to diet, they eat different kibbles, and I brought their kibble with me from Oregon, so that hasn't changed. But I was not able to find a good quality yogurt to add to their morning meal and was giving them a store-brand greek-style yogurt. Personally, I detest greek yogurt. It is too thick and tastes like paste. I like real, full-fat yogurt with live bacteria, and that is what the terriers have been eating for years (Nancy's brand). I've tossed the shitty greek yogurt and am on the hunt for some decent yogurt that they can eat. They could have become sick from some toxin in the yard. If that were the case, I might expect Azza to show some signs of exposure as well, especially since she spends more time out there than the terriers but so far she seems fine. I did learn from the ER vet this morning that campylobacter infections are somewhat common here and can be passed back and forth in a multi-pet household. Nothing in the test results for either dog suggested an infectious agent but that certainly doesn't rule one out. And of course, the dogs were uprooted from their home and dragged out here and they have no idea what's going on. Stressful for all involved. Right now, our presumptive diagnosis for both is acute (hemorrhagic) gastroenteritis of unknown cause. My money is on the shitty greek yogurt.
I start work tomorrow so all of this has been taking place with fairly crappy timing. More stress for everyone!
But then Mimi started vomiting yesterday afternoon. She refused to eat any dinner. During the night, she got me up every hour with dry heaves, producing only a little bit of foamy bile every so often. And boy, was she fighting the nausea. Archie just opened his mouth and bleagh! Out came the food and that was that. Mimi made such a production out of it. We got no sleep at all. Mimi's eyes became sunken and she became slightly wobbly and disoriented. She was drooling and groaning in pain when I had to pick her up or move her. She was passing horrific gas all night and had a bit of bloody diarrhea this morning. So off again we went to the vet ER. We waited for over an hour but they had a couple of emergencies come in so they sent us off to another vet ER.
Poor Mimi was not doing well at all by the time we arrived at the second vet ER. I had full bloodwork run on her too, including the pancreatic lipase test. I was actually more worried about acute kidney disease than pancreatitis but all of her bloodwork came back normal. She got a shot of maropitant too, but we all agreed that she was clinically dehydrated so she got a big slug of subQ fluids. She wasn't quite sick enough to warrant an IV catheter and IV fluids although I was considering it.
I declined abdominal imaging (they suggested rads and I would have also requested ultrasound if possible). But if Mimi doesn't get better by the morning, I will probably have to get this imaging to rule out some pretty scary things such as an abdominal mass (GI lymphoma would be at the top of the list). And we'd probably have to do some aspirates of lymph nodes to go along with that. And we'd also have to get chest rads because lymphoma fucking loves to met to the lungs. What a mess.
Mimi definitely became more sick faster than Archie. Several possibilities could explain that--whatever was making her sick was different than what made Archie sick (unlikely, but possible), and she's old and slightly underconditioned so she doesn't have a lot extra to expend in being sick (most likely).
So let's hope she starts feeling better! She's been resting and seems to have stopped the dry heaving, which is a relief.
What could have caused this? If we assume that both terriers got sick from the same thing, then we have to look at environment and diet. With respect to diet, they eat different kibbles, and I brought their kibble with me from Oregon, so that hasn't changed. But I was not able to find a good quality yogurt to add to their morning meal and was giving them a store-brand greek-style yogurt. Personally, I detest greek yogurt. It is too thick and tastes like paste. I like real, full-fat yogurt with live bacteria, and that is what the terriers have been eating for years (Nancy's brand). I've tossed the shitty greek yogurt and am on the hunt for some decent yogurt that they can eat. They could have become sick from some toxin in the yard. If that were the case, I might expect Azza to show some signs of exposure as well, especially since she spends more time out there than the terriers but so far she seems fine. I did learn from the ER vet this morning that campylobacter infections are somewhat common here and can be passed back and forth in a multi-pet household. Nothing in the test results for either dog suggested an infectious agent but that certainly doesn't rule one out. And of course, the dogs were uprooted from their home and dragged out here and they have no idea what's going on. Stressful for all involved. Right now, our presumptive diagnosis for both is acute (hemorrhagic) gastroenteritis of unknown cause. My money is on the shitty greek yogurt.
I start work tomorrow so all of this has been taking place with fairly crappy timing. More stress for everyone!
Monday, July 08, 2019
Woes of the New Homeowner 2
Well, one of the PODS arrived. Not entirely sure where the other one is (the one with all of the furniture). And yes, I'm quite annoyed. I posted a very unhappy one-star review on google. PODS quickly tried to get me to contact them but I'll let them stew for another day. The unpacking will help to refocus my ire.
And it seems like I am going to take a million photos like this:
Archie is a delicate flower and having reactions to his mosquito bites. The other dogs don't seem to be having the same problems although the mosquitoes are astonishingly numerous. I'm looking into having the yard and house regularly serviced for insects. I've never seen so many fucking insects in my life. Most are benign, I'm sure. I just don't want them anywhere around me or the dogs.
And it seems like I am going to take a million photos like this:
Archie is a delicate flower and having reactions to his mosquito bites. The other dogs don't seem to be having the same problems although the mosquitoes are astonishingly numerous. I'm looking into having the yard and house regularly serviced for insects. I've never seen so many fucking insects in my life. Most are benign, I'm sure. I just don't want them anywhere around me or the dogs.
Friday, July 05, 2019
Soaking Up the Sun
Here are the dogs in the trash-strewn, tick-infested, mosquito habitat of the backyard. Happy as clams.
Mimi laid down first. Archie stood next to her for a while surveying his domain then stretched out. Azza did a quick perimeter check then joined them. It's really sweet how they like to be together.
They all got a very good brush-down before I let them back in the house.
Mimi laid down first. Archie stood next to her for a while surveying his domain then stretched out. Azza did a quick perimeter check then joined them. It's really sweet how they like to be together.
They all got a very good brush-down before I let them back in the house.
Wednesday, July 03, 2019
Woes of the Homeowner
Holiday coming up! That means a house or animal crisis is sure to happen!
Oh, look, there's now a big, ragged hole in the ceiling of my laundry closet. The ceiling started sagging and water started dripping from two small holes sometime yesterday morning. Of course, I immediately turned off the water to the two sinks that are directly above this spot. Then I frantically called the home warranty company. Just like a health insurance provider, you need to use a contractor that they have approved, not just any old plumber that can, you know, show up and fix the fucking problem. So I won't be seeing the approved plumber until next Tuesday...a week from the day I called.
I was worried about water pooling in the ceiling and causing a much larger area of damage, so this morning I climbed up on to the washing machine and poked the ceiling with a screwdriver. Most of the mess went into my handy bucket but it was rather splashy for 30 seconds or so. I widened the hole to take a look--the sheetrock is saturated and is going to have to come out anyway.
When I carried the bucket outside to dump it, to my horror I saw a hornet floating in the water. Was it alive? Is there a nest up there? Will those horrible insects now have access to the inside of my house? I jumped in the car and headed to Lowe's for some industrial-strength wasp killer. I haven't seen any of those vicious bastards but I remain vigilant.
The dripping seems to have stopped now, which means I successfully drained the pooled water, and the leak was probably coming from one of the upstairs sinks. I've moved my daily ablutions to the downstairs sink, which I hope is not similarly leaking into the crawlspace.
And the dogs have plenty of time to get into trouble before the holiday is over.
Oh, look, there's now a big, ragged hole in the ceiling of my laundry closet. The ceiling started sagging and water started dripping from two small holes sometime yesterday morning. Of course, I immediately turned off the water to the two sinks that are directly above this spot. Then I frantically called the home warranty company. Just like a health insurance provider, you need to use a contractor that they have approved, not just any old plumber that can, you know, show up and fix the fucking problem. So I won't be seeing the approved plumber until next Tuesday...a week from the day I called.
I was worried about water pooling in the ceiling and causing a much larger area of damage, so this morning I climbed up on to the washing machine and poked the ceiling with a screwdriver. Most of the mess went into my handy bucket but it was rather splashy for 30 seconds or so. I widened the hole to take a look--the sheetrock is saturated and is going to have to come out anyway.
When I carried the bucket outside to dump it, to my horror I saw a hornet floating in the water. Was it alive? Is there a nest up there? Will those horrible insects now have access to the inside of my house? I jumped in the car and headed to Lowe's for some industrial-strength wasp killer. I haven't seen any of those vicious bastards but I remain vigilant.
The dripping seems to have stopped now, which means I successfully drained the pooled water, and the leak was probably coming from one of the upstairs sinks. I've moved my daily ablutions to the downstairs sink, which I hope is not similarly leaking into the crawlspace.
And the dogs have plenty of time to get into trouble before the holiday is over.
Monday, July 01, 2019
Getting Old
I've been keeping this blog for over 10 years now, and I could swear I've written a post with this same title. (I in fact did, in December 2011, about Harry.)
I was watching Mimi sleeping the other morning, and I started thinking about all of the places that she has lived: two different houses in Texas, Saudi Arabia, Oregon, and now a new house here in Arkansas. She dipped her toes in the Pacific Ocean and the Arabian Gulf. She has traveled a lot in her long life (2 months shy of 14 years old).
Old age is not a disease. But it certainly comes with relatively inevitable physical and mental changes. Mimi has lenticular sclerosis, a very common thing in older dogs (and people) in which proteins start depositing in the lenses of the eyes. Not cataracts, not associated with disease. Just age. She needs help navigating her world, which unfortunately at the moment changes daily, when light levels are low or there are poor lighting contrasts at doors and stairs. She is also nearly deaf. This is a bit of a blessing--Mimi is so high strung in general that not being able to hear things like neighbor dogs barking or thunder is better for her.
Sadly, Mimi is also starting to lose the thread of things now and then. She is a bit slower to wake up. She can get confused in chaotic settings, made worse because she can't hear verbal cues or reassurances. She is not experiencing dementia but I can see subtle signs of decline.
I also noticed just the other morning that the top of Azza's head and ears are starting to go white. She turned 7 years old in December 2018. She's not even close to being classified as "senior" but she's a larger dog and I'm not surprised to see signs of aging showing up now.
Our companion pets are with us for such a short time. It makes me sad to see them age. Older, maybe a little bit wiser, my dogs (and the Beast cat) have been through so much with me, and I'm grateful that they seem to be willing to keep on going, to see what the next adventure might be.
I was watching Mimi sleeping the other morning, and I started thinking about all of the places that she has lived: two different houses in Texas, Saudi Arabia, Oregon, and now a new house here in Arkansas. She dipped her toes in the Pacific Ocean and the Arabian Gulf. She has traveled a lot in her long life (2 months shy of 14 years old).
Old age is not a disease. But it certainly comes with relatively inevitable physical and mental changes. Mimi has lenticular sclerosis, a very common thing in older dogs (and people) in which proteins start depositing in the lenses of the eyes. Not cataracts, not associated with disease. Just age. She needs help navigating her world, which unfortunately at the moment changes daily, when light levels are low or there are poor lighting contrasts at doors and stairs. She is also nearly deaf. This is a bit of a blessing--Mimi is so high strung in general that not being able to hear things like neighbor dogs barking or thunder is better for her.
Sadly, Mimi is also starting to lose the thread of things now and then. She is a bit slower to wake up. She can get confused in chaotic settings, made worse because she can't hear verbal cues or reassurances. She is not experiencing dementia but I can see subtle signs of decline.
I also noticed just the other morning that the top of Azza's head and ears are starting to go white. She turned 7 years old in December 2018. She's not even close to being classified as "senior" but she's a larger dog and I'm not surprised to see signs of aging showing up now.
Our companion pets are with us for such a short time. It makes me sad to see them age. Older, maybe a little bit wiser, my dogs (and the Beast cat) have been through so much with me, and I'm grateful that they seem to be willing to keep on going, to see what the next adventure might be.
Friday, June 28, 2019
The Fence!
The lot for the house that I purchased is oddly shaped, like an elongated trapezoid. It is fenced along the property line with old chain link. To put up a 6 foot wooden privacy fence along the entire perimeter would have cost me almost $9,000! That's a lot of money that I don't have. I decided to fence half of it, getting 6-foot tall sides and a shorter, four-foot section across the middle. Eventually I will fence all of it but this keeps the dogs safe and allows me to pretend that the dense, dark jungle of the "lower forty" isn't a problem I need to deal with right now.
And today, after 7 days of hard work by mainly two guys, the fence is completed! They placed it inside the existing chain link, so they only had to remove the parts of the chain link that were visible from the street. They had to do a lot of brush clearing and tree chopping, which contributed to the long job duration. Normally a fence of this size would have been up and done in two days, maybe three.
Anyway, I let the dogs out to investigate their new backyard. It's a real mess--tons of trash, broken glass, rocks, dead trees, brush, dead leaves. It hasn't been cared for in quite a while. No poison ivy that I've seen yet. Of course I'm worried about snakes but I bought a big bag of SnakeAway granules at Home Depot that I plan to put out on Sunday. Having the fence guys tramping around for a week helps too--snakes don't like that kind of commotion. They said they didn't see any but I remain vigilant. The AT&T internet guy told me that he's mostly seen black rat snakes, and those are the good kind of snakes. Even so, I think I want them far away along with the venomous ones. And the gnats and mosquitos and flies are horrible, but I can't spray for those until I get some of the brush and leaves cleared up. A big job, that's for sure.
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| This photo doesn't even begin to capture the trashy, underbrushy mess that is most of the backyard. And despite the fact that the fence is the topic of this post, this is the only photo I decided to post showing the nice, new fence. |
And today, after 7 days of hard work by mainly two guys, the fence is completed! They placed it inside the existing chain link, so they only had to remove the parts of the chain link that were visible from the street. They had to do a lot of brush clearing and tree chopping, which contributed to the long job duration. Normally a fence of this size would have been up and done in two days, maybe three.
Anyway, I let the dogs out to investigate their new backyard. It's a real mess--tons of trash, broken glass, rocks, dead trees, brush, dead leaves. It hasn't been cared for in quite a while. No poison ivy that I've seen yet. Of course I'm worried about snakes but I bought a big bag of SnakeAway granules at Home Depot that I plan to put out on Sunday. Having the fence guys tramping around for a week helps too--snakes don't like that kind of commotion. They said they didn't see any but I remain vigilant. The AT&T internet guy told me that he's mostly seen black rat snakes, and those are the good kind of snakes. Even so, I think I want them far away along with the venomous ones. And the gnats and mosquitos and flies are horrible, but I can't spray for those until I get some of the brush and leaves cleared up. A big job, that's for sure.
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| Enjoying some time on the deck at last. |
Thursday, June 27, 2019
Road Trip Part 2: Starting to Settle In
I still haven't put my bed together although I hauled the futon upstairs to the bedroom. The space is slowly starting to come together. Unloading the trailer didn't take long, but it took me two days before I was able to get the kitchen clean enough, and before I was able to find all of the requisite equipment to make some coffee.
I've been getting the place cleaned and organized before the PODS arrive on Monday. I've got a week to unload them, plus another week after that to at least partially unpack before I start my new job.
The cat has finally starting showing up regularly for meal times, and is sleeping with the rest of us upstairs at night. The fence is not completed, so the dogs have to potty in the front yard on leash, and they are none too happy about that. They are all still a bit jumpy--the trip was hard on them too, and they are just starting to get used to the new environment. It will take time for all of us to settle in.
I've been getting the place cleaned and organized before the PODS arrive on Monday. I've got a week to unload them, plus another week after that to at least partially unpack before I start my new job.
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| This cheerful space will be my office. I finally got internet set up last night. |
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| I think you can tell that one of my priorities was dog beds! |
Road Trip Part 1: "It Was Fairly Horrible"
So exactly how does one get three dogs and a cat from Oregon to Arkansas? Driving was the best option but it came with some unique risks and problems. That's a long trip for just one driver. Plus I was going to pull a 5x8 foot trailer. And my plan wasn't too clear on lodging options. I figured that I would just pack it all up, hit the road, and figure things out on the way.
It was a marathon event. I drove 2350 miles in three days. I did a bit less than 600 miles the first day, just under 900 miles the second day, and around 850 miles the third day. It was fairly horrible.
The cat was not doing well. He was in a large crate with room for a small bed, litter box, and bowl of food, but he was by no means happy or comfortable. He wasn't eating, drinking, or using the litter box, and that can be a big problem for cats. I was worried about him, and decided the sooner we reached Arkansas, the better. I was going to spend the same number of hours on the road, and whether we pushed through in three days or four wasn't going to change that.
And about those sketchy lodging plans? After wasting an hour or more trying to sort out a hotel on the first night (when I was already exhausted), I gave up and slept in the van in an interstate rest stop, buried in a pile of dog blankets and the two terriers. With four crates in the van, there was just enough room for me to sort of stretch out along one side. I could only let the terriers out--no way would I have been able to lie flat and let Azza out too. I did the same thing the second night too. In a way, it was easier. I could feed the dogs in their crates and didn't have to shuffle a hundred bits of crap in and out of a hotel room. Sure, I didn't shower for three days. And it was really cold both nights, around 45F. But I have plenty of dog blankets and the terriers are used to sleeping right next to me. So it worked out.
I stuck to major interstates for 99% of the trip. It was a good plan because I was able to stop often, let the dogs out and stretch my legs.
Here are some random observations from the trip:
So after three days, we arrived at the new house. My bed was in the trailer, but after that trip, I was too exhausted to even contemplate trying to unload anything. Plus we rolled in close to midnight and that's no time to be toting boxes and bales. So I slept on the floor of the house for yet a third night in the same pile of dog blankets, although this time Azza was able to join us.
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| Taken in Utah. |
The cat was not doing well. He was in a large crate with room for a small bed, litter box, and bowl of food, but he was by no means happy or comfortable. He wasn't eating, drinking, or using the litter box, and that can be a big problem for cats. I was worried about him, and decided the sooner we reached Arkansas, the better. I was going to spend the same number of hours on the road, and whether we pushed through in three days or four wasn't going to change that.
And about those sketchy lodging plans? After wasting an hour or more trying to sort out a hotel on the first night (when I was already exhausted), I gave up and slept in the van in an interstate rest stop, buried in a pile of dog blankets and the two terriers. With four crates in the van, there was just enough room for me to sort of stretch out along one side. I could only let the terriers out--no way would I have been able to lie flat and let Azza out too. I did the same thing the second night too. In a way, it was easier. I could feed the dogs in their crates and didn't have to shuffle a hundred bits of crap in and out of a hotel room. Sure, I didn't shower for three days. And it was really cold both nights, around 45F. But I have plenty of dog blankets and the terriers are used to sleeping right next to me. So it worked out.
I stuck to major interstates for 99% of the trip. It was a good plan because I was able to stop often, let the dogs out and stretch my legs.
Here are some random observations from the trip:
- There is a lot of empty country out there.
- Wyoming is fucking enormous. And empty. But amazingly beautiful.
- Even after three days, I would look up at the rearview mirror and think, damn, that car behind me is too close, before realizing it was the trailer. I packed the shit out of that trailer. It was about the same size as the van and didn't move an inch even in high winds.
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| Dogs along the driver side, cat in the dark red crate. |
- Kansas has the best rest stops I have ever seen. Large grassy areas surrounded by trees, places to pull the van and trailer into the shade, clean bathrooms.
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| Enjoying some early morning Kansas sunshine. |
- Oklahoma doesn't even bother with interstate rest stops. Disappointing.
- It takes a pile of five thick fleece dog blankets to muffle the seat attachment brackets on the floor of the van but once they were in place, and I was wrapped in another king-size fleece blanket with two terriers snuggled in with me, I slept pretty comfortably.
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| There was snow on the ground at the rest stop outside of Laramie, WY. Mimi is not amused by the cold winter wind. |
- I can't come up with a good reason for this, but with respect to traffic, the east-west corridors were the most empty and the north-south corridors the most crowded.
- While I can confirm that the coffee culture of the Pacific Northwest has not fully penetrated The Big Empty of the western US, decent coffee can be found.
So after three days, we arrived at the new house. My bed was in the trailer, but after that trip, I was too exhausted to even contemplate trying to unload anything. Plus we rolled in close to midnight and that's no time to be toting boxes and bales. So I slept on the floor of the house for yet a third night in the same pile of dog blankets, although this time Azza was able to join us.
Monday, June 17, 2019
Diary of a New Veterinarian: We Did It!
The Oregon State University College of Veterinary Medicine Class of 2019 graduated yesterday. I'm glad I went to the ceremony--it was just the right amount of emotion and tradition. I think we were all quite surprised at how nervous we were. The important part was walking across the stage, being hooded by two faculty members that our class voted on to do this task, then being handed a fancy diploma by the dean. Once that was done, the rest was downhill. I suppose that my perspective is skewed since I am at the start of the alphabet and was the second of our class to cross the stage. The last person had to watch the other 53 of us cross before it was her turn--I'm sure she was far more wrung out by that point than I was.
I was fine until it was all over and I was saying goodbye to my pocket pet, my best friend in our class. She started her internship this morning. I'm still packing, planning to head out this weekend. When we realized that we might not see each other again for months, maybe longer, things got a bit teary. I will miss her fiercely.
This photo was taken before the ceremony when we were all nerves and smiles.
Over the past four years, I got to know most of my classmates, particularly those in my surgery groups and in my fourth-year clinical rotations. As we now scatter to all kinds of interesting jobs and internships, I hope that I can keep up with all the exciting things they are doing and learning.
I was fine until it was all over and I was saying goodbye to my pocket pet, my best friend in our class. She started her internship this morning. I'm still packing, planning to head out this weekend. When we realized that we might not see each other again for months, maybe longer, things got a bit teary. I will miss her fiercely.
This photo was taken before the ceremony when we were all nerves and smiles.
Over the past four years, I got to know most of my classmates, particularly those in my surgery groups and in my fourth-year clinical rotations. As we now scatter to all kinds of interesting jobs and internships, I hope that I can keep up with all the exciting things they are doing and learning.
Wednesday, June 05, 2019
Diary of a Fourth-Year Student: "Stefan and His Bestie"
One of my classmates is going to do a presentation on Stefan, the alpaca with perplexing skin issues. He and I visited Stefan's stall so I could show him the nodules, and he took this pic and sent it to me with the title "Stefan and His Bestie."
Stefan was recently sheared so the weird carpet-like texture of his coat is the result of that. Nothing to do with his skin nodules.
Stefan was recently sheared so the weird carpet-like texture of his coat is the result of that. Nothing to do with his skin nodules.
Saturday, June 01, 2019
Diary of a Fourth-Year Vet Student: The End is Nigh
Not that anyone is counting, but I only have 7 1/2 days of clinics left, including one evening ICU shift and one ICU on-call shift. The Class of 2019 will be released on Wednesday, June 12, at noon, and I heard a rumor that there is a plan for the group to decamp to the parking lot across the street for some public alcohol consumption. I'm up for that.
I just finished my RVP (Rural Vet Practice) rotation. That is one of the most highly rated rotations, even for small animal folks, because it is so hands-on, and the clinicians and techs are great. You spend one week doing horse dentals, and one week doing a lot of pregnancy checks on cows.
Let's break those two things down a bit. Horse dentals, at least when they are done according to recent standards of care, involve honking big power tools with scary grinding surfaces. The clinician shows you how to do it on the first patient, then lets you do all the work for the rest of the week. Horse teeth grow continuously, not like human teeth, and they can develop some really crazy points and sharp corners and waves and wonky bits that result in malocclusions and ulcers on oral mucosa and tongue. They also get fractures, abscesses, and other things that require tooth extraction. The extraction tools look just like the ones we use for dogs and cats except they are many times larger and enormously heavy. Think medieval torture implements except these are clean and shiny. Horse dentals are extremely satisfying because with just a bit of training and 20 minutes of work, you can make that horse so much more comfortable. But the actual procedures? The best metaphor I can come up with is thrash rock--lots of yelling and hammering and blood and spit flying around. When you are done, you are covered in tooth dust, spattered in blood and bits of feed, and sweating like a, well, a horse. It is exhilarating.
Preg checking cows takes a lot more practice to become proficient. It is done via rectal palpation. By feeling through the rectum, you have to find the cervix then pull the uterine horns up onto the pelvic rim and palpate along each horn to the ovaries. You often have to shovel poop out of the rectum before you can feel anything. As a bonus, the cows also pee, poop, and fart on you. The first dozen times you put your arm up a cow's butt, it feels like nothing more than a huge, very warm bag of gooey guts in there. For some people, that's true for the first hundred times they do a rectal palpation. But managing pregnancy, particularly for the dairy industry, is a critical component of that business. Misdiagnosing a pregnancy, saying a cow is pregnant when she is not and vice versa, is a costly mistake. It is quite challenging to work at this procedure and get better and better every time you do it.
The RVP rotation also offers plenty of other kinds of exciting opportunities for students to do procedures on large animals. For example, I did a field castration of two yearling horses...by myself. The only part that I did not do was tie them up once they were sedated and on the ground--that was a matter of safety for all personnel so the clinician did this part himself. Field castrations are not sterile, although they are done as cleanly as possible. We use devices called emasculators, which do exactly what you think they do based on that name: they crush the tissue of the spermatic cord and other bits in that area. One of the yearlings was an Arabian who was so nasty that his owner was covered in bruises from his hooves. It was super satisfying to cut his testicles off, let me assure you.
And I got to help manage a bull who needed some serious hoof trimming. He was so large, weighing in at well over a ton, that he would not fit in our squeeze chutes. Although he was used for breeding, he was treated like a pet and was quite docile, so we walked him out to a horse paddock and did the procedure outside. Here's a picture of me keeping a hold of one of his legs so he didn't decide to wake up and kick the clinician working on his hooves:
The RVP service rarely has in-patients since most animals are treated during farm calls, but I happen to have one this weekend that I'm taking care of following a procedure we did on Thursday. A friend pointed out to me that this alpaca is the very last patient that I will ever have in vet school. So to honor that bittersweet milestone, here's a quick pic of me and Stefan:
We are getting so close, so very close, to being done.
I just finished my RVP (Rural Vet Practice) rotation. That is one of the most highly rated rotations, even for small animal folks, because it is so hands-on, and the clinicians and techs are great. You spend one week doing horse dentals, and one week doing a lot of pregnancy checks on cows.
Let's break those two things down a bit. Horse dentals, at least when they are done according to recent standards of care, involve honking big power tools with scary grinding surfaces. The clinician shows you how to do it on the first patient, then lets you do all the work for the rest of the week. Horse teeth grow continuously, not like human teeth, and they can develop some really crazy points and sharp corners and waves and wonky bits that result in malocclusions and ulcers on oral mucosa and tongue. They also get fractures, abscesses, and other things that require tooth extraction. The extraction tools look just like the ones we use for dogs and cats except they are many times larger and enormously heavy. Think medieval torture implements except these are clean and shiny. Horse dentals are extremely satisfying because with just a bit of training and 20 minutes of work, you can make that horse so much more comfortable. But the actual procedures? The best metaphor I can come up with is thrash rock--lots of yelling and hammering and blood and spit flying around. When you are done, you are covered in tooth dust, spattered in blood and bits of feed, and sweating like a, well, a horse. It is exhilarating.
Preg checking cows takes a lot more practice to become proficient. It is done via rectal palpation. By feeling through the rectum, you have to find the cervix then pull the uterine horns up onto the pelvic rim and palpate along each horn to the ovaries. You often have to shovel poop out of the rectum before you can feel anything. As a bonus, the cows also pee, poop, and fart on you. The first dozen times you put your arm up a cow's butt, it feels like nothing more than a huge, very warm bag of gooey guts in there. For some people, that's true for the first hundred times they do a rectal palpation. But managing pregnancy, particularly for the dairy industry, is a critical component of that business. Misdiagnosing a pregnancy, saying a cow is pregnant when she is not and vice versa, is a costly mistake. It is quite challenging to work at this procedure and get better and better every time you do it.
The RVP rotation also offers plenty of other kinds of exciting opportunities for students to do procedures on large animals. For example, I did a field castration of two yearling horses...by myself. The only part that I did not do was tie them up once they were sedated and on the ground--that was a matter of safety for all personnel so the clinician did this part himself. Field castrations are not sterile, although they are done as cleanly as possible. We use devices called emasculators, which do exactly what you think they do based on that name: they crush the tissue of the spermatic cord and other bits in that area. One of the yearlings was an Arabian who was so nasty that his owner was covered in bruises from his hooves. It was super satisfying to cut his testicles off, let me assure you.
And I got to help manage a bull who needed some serious hoof trimming. He was so large, weighing in at well over a ton, that he would not fit in our squeeze chutes. Although he was used for breeding, he was treated like a pet and was quite docile, so we walked him out to a horse paddock and did the procedure outside. Here's a picture of me keeping a hold of one of his legs so he didn't decide to wake up and kick the clinician working on his hooves:
The RVP service rarely has in-patients since most animals are treated during farm calls, but I happen to have one this weekend that I'm taking care of following a procedure we did on Thursday. A friend pointed out to me that this alpaca is the very last patient that I will ever have in vet school. So to honor that bittersweet milestone, here's a quick pic of me and Stefan:
We are getting so close, so very close, to being done.
Diary of a Fourth-Year Vet Student: No-Willy Willy
Sure, we vet students can succumb to the charms of cute puppies and lambs as much as the next person. But show us a truly broken little nugget and we can come to blows about who will hold that precious baby next.
Willy is an adult male chihuahua. He was found wandering in the desert, severely dehydrated, with his eyeballs hanging out of the sockets. Those were duly removed and the sockets sewn closed. He is mostly deaf. His jaw was broken some time in the past and the top and the bottom don't line up anymore. He's missing most of his teeth, so his tongue sticks out of his mouth all the time. He's got terrible allergies. And he had a mast cell tumor on his prepuce, so his prepuce and the distal part of his penis had to be removed. Our soft tissue surgery service did that procedure last week, i.e., they removed Willy's willy. He has a new pee hole a little farther back along his belly, closer to his anus. In short, Willy is a mess. But oh my, he is exactly the kind of mess that gets vet med people worked up.
Willy spent a couple of days in our regular wards for all of his pre-operative testing and imaging, and then a couple of days in ICU after his surgery to make sure he was recovering nicely. I wasn't kidding about people arguing who was going to hold him next. This dog never touched the ground except to pee or poop for four days. I repeatedly overhead people say "You've held him long enough. It's my turn."
I would take him without hesitation. I'd put him in a baby sling and carry him like that everywhere. One of the clinicians said "Cuddles CRI. That's what he needs. Cuddles CRI." Which has to be one of the funnier vet med jokes I've heard in a while. A continuous rate infusion or CRI is how we deliver certain drugs that get metabolized very quickly. With an IV catheter and pump, we can drip a continuous flow of these drugs, usually pain meds or sedatives, into an animal to keep them comfortable. Willy needed cuddles, stat.
I am utterly amazed and grateful that I go to school with and work with the kind of people that get emotional over dogs like Willy.
Willy is an adult male chihuahua. He was found wandering in the desert, severely dehydrated, with his eyeballs hanging out of the sockets. Those were duly removed and the sockets sewn closed. He is mostly deaf. His jaw was broken some time in the past and the top and the bottom don't line up anymore. He's missing most of his teeth, so his tongue sticks out of his mouth all the time. He's got terrible allergies. And he had a mast cell tumor on his prepuce, so his prepuce and the distal part of his penis had to be removed. Our soft tissue surgery service did that procedure last week, i.e., they removed Willy's willy. He has a new pee hole a little farther back along his belly, closer to his anus. In short, Willy is a mess. But oh my, he is exactly the kind of mess that gets vet med people worked up.
Willy spent a couple of days in our regular wards for all of his pre-operative testing and imaging, and then a couple of days in ICU after his surgery to make sure he was recovering nicely. I wasn't kidding about people arguing who was going to hold him next. This dog never touched the ground except to pee or poop for four days. I repeatedly overhead people say "You've held him long enough. It's my turn."
I would take him without hesitation. I'd put him in a baby sling and carry him like that everywhere. One of the clinicians said "Cuddles CRI. That's what he needs. Cuddles CRI." Which has to be one of the funnier vet med jokes I've heard in a while. A continuous rate infusion or CRI is how we deliver certain drugs that get metabolized very quickly. With an IV catheter and pump, we can drip a continuous flow of these drugs, usually pain meds or sedatives, into an animal to keep them comfortable. Willy needed cuddles, stat.
I am utterly amazed and grateful that I go to school with and work with the kind of people that get emotional over dogs like Willy.
Saturday, May 04, 2019
Diary of a Fourth-Year Vet Student: Doing Amazing Things
We are getting so close, so very close, to being done with our fourth year of vet school. Most of us have obvious clinical signs of advanced senioritis. I have a countdown timer on my phone--39 days and 1.25 hours, not that I'm keeping close track or anything.
I only have a couple of rotations left. I started my Small Animal Medicine rotation two weeks ago with quite a bit of trepidation. I felt that my clinical and diagnostic skills were weak and that I would be struggling in this rotation. I certainly have had some extremely challenging cases so far, and a couple have brought me to tears. I've had patients in the ICU for most of the two weeks, which means I have to be at school by 6am every morning, including weekends, to do morning treatments and take care of paperwork.
But to my surprise, I am really enjoying this rotation. The techs are great, the clinicians that I'm working with are incredibly patient teachers, and to be honest, I have been surprised to learn that I'm actually pretty good at internal medicine. I think it helps that this rotation is coming at the end of my fourth year when I've actually managed to learn some things, including how to think about complicated disease cases. Also, I came into this rotation without worrying about all the stupid quotidian stuff you worry about in your first rotations, such as where to find things in the hospital, how to create proper medical records, who to ask for help--chasing down these things takes time away from working out cases and treating patients. I've got all that stuff sorted out now so I can focus a lot of time and effort on my cases.
Yesterday, in a quiet moment in our rounds room, I told the clinician in charge of internal medicine about my concerns coming into this rotation, but then told her how much I am enjoying it, and how much I am learning from my many challenging cases. She looked at me with a moment of disbelief, and said, "Really? You felt you were weak? You are doing absolutely amazing." And I can't tell you how good that made me feel.
One thing that I've learned is how to find the balance between what the patient needs and what the client wants. That balance may not always fall the way you think it should. I had a kitty with bloody mucus coming from her nostrils for a couple of months. Two bad signs already: chronic and bloody. Turns out kitty has a very large tumor in her nasal passages and sinus cavities that has metastasized to her brain. I diagnosed it myself by staining a slide that we made by smearing a bit of the tumor across the glass (it was of course definitively confirmed by our clinical pathologist, nobody was going to rely on just my say-so). Kitty has a very poor prognosis, maybe just a few more weeks at best.
Making this case even more complicated and emotionally fraught, when she was recovering from anesthesia, she went into respiratory arrest then cardiac arrest. Basically, she died. The alert anesthesia student on the case was watching her recovery closely, and against all odds, they restored respiration and heartbeat in this cat. But kitty continued to struggle to breathe, and I was convinced she would not make it. We put her in an oxygen cage in the ICU and I sat in front of it for two hours waiting for the owners to show up because I didn't want her to die alone. I think every single student on the small animal side of the hospital drifted by during those two hours to check on me and the cat.
Her owners eventually decided they wanted us to try to stabilize her overnight so they could take her home the next day. I was convinced this was the wrong plan. But that wasn't the balance this case needed. My clinician agreed to try to meet the owner's wishes. We came up with an overnight treatment plan, and to the amazement of all, kitty survived the night. We weaned her off oxygen the next morning and by noon she was breathing room air. Her owners took her home that afternoon. I've spoken with them a couple of times since. They are sad about her prognosis because of course we didn't cure her (no treatment would be effective at this point). But we gave them something very important: a few more good days with their beloved kitty. I would have taken that away from them if I had advocated for euthanasia that night. Medically complex and emotionally and ethically challenging--that's small animal internal medicine. I am really grateful that I have clinicians willing to help me learn how to work with these amazing cases.
I only have a couple of rotations left. I started my Small Animal Medicine rotation two weeks ago with quite a bit of trepidation. I felt that my clinical and diagnostic skills were weak and that I would be struggling in this rotation. I certainly have had some extremely challenging cases so far, and a couple have brought me to tears. I've had patients in the ICU for most of the two weeks, which means I have to be at school by 6am every morning, including weekends, to do morning treatments and take care of paperwork.
But to my surprise, I am really enjoying this rotation. The techs are great, the clinicians that I'm working with are incredibly patient teachers, and to be honest, I have been surprised to learn that I'm actually pretty good at internal medicine. I think it helps that this rotation is coming at the end of my fourth year when I've actually managed to learn some things, including how to think about complicated disease cases. Also, I came into this rotation without worrying about all the stupid quotidian stuff you worry about in your first rotations, such as where to find things in the hospital, how to create proper medical records, who to ask for help--chasing down these things takes time away from working out cases and treating patients. I've got all that stuff sorted out now so I can focus a lot of time and effort on my cases.
Yesterday, in a quiet moment in our rounds room, I told the clinician in charge of internal medicine about my concerns coming into this rotation, but then told her how much I am enjoying it, and how much I am learning from my many challenging cases. She looked at me with a moment of disbelief, and said, "Really? You felt you were weak? You are doing absolutely amazing." And I can't tell you how good that made me feel.
One thing that I've learned is how to find the balance between what the patient needs and what the client wants. That balance may not always fall the way you think it should. I had a kitty with bloody mucus coming from her nostrils for a couple of months. Two bad signs already: chronic and bloody. Turns out kitty has a very large tumor in her nasal passages and sinus cavities that has metastasized to her brain. I diagnosed it myself by staining a slide that we made by smearing a bit of the tumor across the glass (it was of course definitively confirmed by our clinical pathologist, nobody was going to rely on just my say-so). Kitty has a very poor prognosis, maybe just a few more weeks at best.
Making this case even more complicated and emotionally fraught, when she was recovering from anesthesia, she went into respiratory arrest then cardiac arrest. Basically, she died. The alert anesthesia student on the case was watching her recovery closely, and against all odds, they restored respiration and heartbeat in this cat. But kitty continued to struggle to breathe, and I was convinced she would not make it. We put her in an oxygen cage in the ICU and I sat in front of it for two hours waiting for the owners to show up because I didn't want her to die alone. I think every single student on the small animal side of the hospital drifted by during those two hours to check on me and the cat.
Her owners eventually decided they wanted us to try to stabilize her overnight so they could take her home the next day. I was convinced this was the wrong plan. But that wasn't the balance this case needed. My clinician agreed to try to meet the owner's wishes. We came up with an overnight treatment plan, and to the amazement of all, kitty survived the night. We weaned her off oxygen the next morning and by noon she was breathing room air. Her owners took her home that afternoon. I've spoken with them a couple of times since. They are sad about her prognosis because of course we didn't cure her (no treatment would be effective at this point). But we gave them something very important: a few more good days with their beloved kitty. I would have taken that away from them if I had advocated for euthanasia that night. Medically complex and emotionally and ethically challenging--that's small animal internal medicine. I am really grateful that I have clinicians willing to help me learn how to work with these amazing cases.
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