They Can't Make A Living

 Here is a link to a short news item from a South Dakota media group about a retiring veterinarian who can’t find another veterinarian to purchase his practice. Take a minute to read it. I’ll wait.

https://www.keloland.com/keloland-com-original/parker-veterinarian-to-retire-seeks-successor/

This tale of woe is being told over and over across the U.S. Maybe you haven’t heard this exact tale, but you probably have heard that there is a “shortage” of veterinarians. This is only partially true. There is a dramatic shortage of large animal (livestock and food animal) veterinarians.

According to AVMA, for data collected in 2024, about 73% of new DVM graduates accepted positions in companion animal practices. Around 3% of new graduates accepted jobs working with food animals. New DVMs working in private practice for livestock reported starting salaries that were around $30,000 less per year than new DVMs in private practice for companion animals. Now add in the fact that the average DVM graduated in 2024 with more than $200,000 of debt.

According to AAVMC, around 3,300 DVMs graduated from vet school in the U.S. in 2025. Around 100 of them took private practice jobs working with food animals. One hundred people. Dr. Parker has a lot of competition.

Let’s take another look at Dr. Parker’s situation. He says that his practice has been listed for sale for over a year. He says that he has hosted vet students trying to find one to take over his practice but hasn’t been successful.

Maybe the overall state of the economy is making it harder for new DVMs to finance the purchase of a clinic. Anecdotally, I’ve noticed a lot of small businesses in my area that survived COVID have been closing down in the past month or so.

Maybe his 48-year-old practice doesn’t have modern equipment. New DVMs know that the gold standard medicine that is taught in many large veterinary teaching hospitals is not always easy to reproduce in the real world, but they expect basics like in-house radiography and ultrasound, not to mention a full suite of bench diagnostics to evaluate things like fecal parasites, serology, and blood chemistry and a decently stocked in-house pharmacy.

Maybe he doesn’t have enough support staff. The article doesn’t even include the word “technician.” New DVMs know that providing good veterinary medicine requires a team of trained professionals. In high-volume companion animal practices, you might see two technicians per DVM, plus other technicians assigned to cleaning, stocking, kennel management, and so forth. Plus you will have a front office staff who handles appointments and payments.

Maybe his service radius of 20 miles is too small. Maybe there aren’t enough clients. More likely, there aren’t enough clients who can afford to pay realistic fees required by a modern veterinary practice.

Maybe his willingness to be “on call 24/7 since I’ve been open” is in direct conflict with the demand of new DVMs to have a healthier work-life balance. This is a big generational shift with no easy fix.

By far, the biggest factor preventing Dr. Parker from selling his practice is money. It always comes down to money. His mixed animal practice can’t generate enough revenue for a new graduate to pay student loans, pay support staff, purchase equipment and supplies, and support a family. Few rural practices, even if they include some companion animal clients like Dr. Parker's clinic, can.

These nuances are rarely discussed. They are barely acknowledged by veterinary schools themselves. Better to claim, there’s a shortage of veterinarians so let’s pump out more! Let’s increase class size (diluting the critical hands-on aspect of learning how to practice medicine)! Let’s increase tuition (increasing the already crushing levels of debt that most DVMs have at the end of four years)!

Those aren’t solutions because they don’t address the real problems.

 

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.

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 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 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.

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.

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.

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.

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.

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.

Diary of a New Veterinarian

Nope, despite the title, I haven't graduated quite yet. I still have a couple of hideous rotations to slog through, and a couple of fun ones right at the end. And I have to pass them, of course. Then all the credits have to be counted up and the degree awarded.

But the worst parts are over. I have been kind of serially paralyzed by some pretty big stressors. I took the national board exam in November, but had to wait until mid-January to find out if I passed. I did. Then I started to apply for jobs. That's never fun but I kept slogging away at it. Many of my classmates already know where they will go after graduation in June. If they applied for residencies or internships, they were informed of those results in January. Some of them are going back to their hometown clinics--they knew that was their destination even before they started vet school. That left the rest of us scratching our heads, wondering where we would end up.

Last week I set off for a series of interviews. Typically for this sort of thing, some went very well, some were just duds. I got home, still wondering where I was going to end up. But by Monday of this week, I had three firm offers in hand. Written offers. Good offers. Great, right? A problem of privilege to be sure. But it was also a new kind of stress!

And the three offers could not have been more different. One was from the USDA. The offer was to be a supervisor inspector at a poultry plant in Georgia. Pros: good government benefits, very low cost of living, I'd come in at GS12 with a very good starting pay, and a very pretty place to live. Cons: I'd have to stick with a rather unstimulating job for a couple of years before I could move into something more exciting. Another offer was from a small animal clinic in Texas. They wanted to hire me to work overnights. Pros: excellent salary and benefits package, lots of new challenges and learning opportunities, schedule was four nights on, four off, leaving plenty of time for daytime activities. Cons: high cost of living in that area, and my heart was just not into being a small animal clinician. But I could name half a dozen of my classmates who would have given a digit or two to get that job offer.

The final offer was from the Arkansas Veterinary Diagnostic Laboratory in Little Rock, Arkansas. I wanted that job from the moment I read the job description. I did a phone interview in January then a site visit last week. I worked my ass off in that interview. And in a strategic move, I added a fourth reference to my usual three to provide additional depth and breadth. Pros: good salary, low cost of living, great work-life balance, interesting work. Cons: it would be picking nits to find some. Even better, that particular position can be eligible for a loan repayment program. Not guaranteed, I have to apply to the program, but there is a decent chance of getting at least some loan relief.

I gave all three offers a reasonable evaluation (more in depth than I have done here, of course). Then I accepted the Arkansas offer as I already knew in my head and my heart that I would.

And it should not be a surprise to anyone that I am now pre-approved for a home loan (that literally took only 20 minutes, the result of extremely clean financial living for the past few years--the banker guy and I laughed when he pulled my credit scores) and am working with a realtor to find a house. I may even fly out next weekend to look at some properties.

I'll be in Little Rock by the end of June, and I'll start my new job (more on that to come) in July. Exciting times.

Diary of a Fourth-Year Vet Student: Catching My Breath

I just completed the third of my "big four" clinical rotations: large animal medicine. I finished large animal surgery and small animal surgery back-to-back (that was it's own special kind of hell in a year of hell) in November-December. I've still got small animal medicine to get through, and start it in three weeks.

Large animal medicine, the clinical rotation, trips up just as many people as large animal medicine, the third-year lecture series. Two classmates failed at least one term of third-year lecture and will have to repeat that. And at least two of my classmates will have to repeat the rotation. All four weeks of it, not just a makeup day or two. I was holding 'bated breath all morning waiting for my evaluation to roll in. It was fair, quite fair, and I got a score of 86 out of 100. I am not perfect in my skills but I tried really hard. I also had some challenging patients.

Large animal medicine is for the most part an emergency service and that means we see lots of very sick animals. During my first two weeks, I euthanized 75% of my patients. During the second week, I (and my patients) had better luck, and my overall death rate for the four weeks ended up being 38%. And before you get hasty and wonder what kind of janky care we are providing, know that it's often not our care that makes the difference. Sometimes animals come in that are just too sick to save. The best option is euthanasia.

One of the interesting aspects of large animal medicine is the sheer variety of species we see: goats, sheep, pigs (lots and lots of pigs), camelids, horses, bovines, mini donkeys...and they have an amazing array of ailments that range from the mundane (bacterial ear infection in a goat) to the dire (chronic liver failure in a horse, prognosis of days to live). The diagnostic tools and the pharmacopia used in large animal medicine are quite diverse as well. Dogs and cats will look pretty boring after this past month!

The other thing about the large animal medicine rotation is the hours. I put in around 63 to 78 hours per week at the hospital (I know, I had to track it). It is exhausting.

We had a bit of a scare two weeks ago when a calf one of my classmates was treating came up positive for the protozoa cryptosporidium. Very infectious, very contagious, very zoonotic. The rate of handwashing jumped up exponentially as soon as we got the news! This week is about the time when we will start showing symptoms if we got infected so there's been a bit of texting amongst the group to make sure everyone is still okay.

I now have a bit of time off from clinical rotations. I'd like to spend it sleeping but tomorrow I get on a plane and head off for three job interviews. I had yet another phone interview just this morning that was encouraging so there may be more site visits in the future. I'd really just like to settle the matter, get an offer and a contract, think about it for a few days, then sign it and be done. Knowing where I will end up when June rolls around would reduce my stress significantly.

Diary of a Fourth-Year Vet Student: The Last Hoop

I am in Atlanta at one of the largest food expos in the world: IPPE, the International Production and Processing Expo. Over 30,000 people involved in all aspects of food production attended last year. That's a really huge meeting! People involved in production of poultry, beef, and pork are here. People involved in growing grain and other feed ingredients are here. People who make machines that process meat parts are here. People who make feed supplements (for health and growth promotion) are here. Animal pharma is here. The exhibit halls (yes, halls plural; there are three of them) are jaw dropping. Entire semi-trucks, enormous machines that pellet feed, robots shifting egg crates around a knot of conveyer belts, even functional devices that bread and cook real meat. There's a lot of fake meat parts used in the displays too, which never fail to attract my attention. I just have to give them a poke to see what they feel like.

So what am I doing here? I am working my butt off looking for a job. I don't like cold contacts but I absolutely can walk up to someone, introduce myself, chat them up a bit, then say, so, are you hiring veterinarians? It's quite surprising how few companies advertise open positions. Some exclusively staff their professional positions via recruiters. Others rely on personal recommendations. I've gotten some good leads (and some good advice) and will be sending out a lot of follow-up emails when I get home later this week.

I completed a fourth preceptorship last week and have been traveling for two weeks. Two weeks of rental cars and public transport and hotels--it's exhausting and expensive. I will be very happy to get back home. I'll be even happier if I can get a job! That's the last piece of this long journey. I passed the national board exams. I'll shortly be licensed to practice in Georgia (that story is another blog post). I have more rotations to complete although the end of my time at OSU is in sight. The last step, the biggest one in fact, is to get a good job and start putting all my new skills to work.

Diary of a Fourth-Year Vet Student: That'll Do, Pig, That'll Do

I have spent this week in a preceptorship that really put me on the spot in a lot of ways. I was constantly grilled with thought problems based on real-life scenarios that this person had experienced. I had to use a leg hook to catch feisty chickens--much harder than it looks, you have to be committed once you grab one. I had to get blood from many different types of chicken, and under time pressure. Sure, the basic anatomy is the same but some were so small I could barely tuck them under my arm (in this world, you hold your own bird to collect blood). Apparently I was only the second student in 10 years who had managed to bleed one particular strain, and even better, I pulled about 40% of the needed samples in that barn, which was not shabby at all.

And today, I got to do postings (the word used in the poultry world for field necropsies) on guinea fowl. They were not reaching target weight. Based on observation in the house and discussions with Clemente, the farm manager (who spoke only Spanish), we suspected coccidia, a type of intestinal parasite. It is such a problem in chickens that we vaccinate for coccidia, but guinea fowl do not get this vaccine. So the farm manager grabbed a transport crate and turned it on end, and we euthanized five birds who were not doing well. And I did the necropsies right there. I like to talk when I necropsy, probably annoying to some, but it is helpful if people who have never seen a necropsy before are watching you: "Hmm, the trachea and larynx are clean. Look, there is no feed in the crop. The liver looks great, smooth, no lesions. Oh, look at that gall bladder--a bit bigger than it should be, but then the bird hasn't been eating for a few days." And so on.

When I was done, the guy I am working with this week suggested a picture. There is only one commercial guinea fowl producer in the US and we were not only standing in one of his barns, we were doing field necropsies on the birds. Not many vet students get that opportunity. A picture! Great idea! Suddenly, the farm manager jumped over and put his arm around me.

And that photo is priceless to me. It says a lot that I could walk in and get the confidence of that guy in a couple of hours. Those are his birds in the sense that he takes care of them every single day. He wants to do what it takes to help them get better.

My mentor told me in the car afterwards that I had done an excellent job with the necropsies, and with Clemente.

Diary of a Fourth-Year Vet Student: A Weight Is Lifted

I passed the NAVLE, the national licensing exam for veterinarians. I took it back in mid-November. Everyone had to wait for their score until the testing period closed in late December.

There are some incredibly arcane statistics that go into calculating an individual score for the NAVLE. The specific questions are randomly selected for each test taker--I got around 8 questions on sensitivity and specificity while one of my classmates got none on that topic--and questions are assigned different weighting values based on how hard they are. The minimum number of points that are needed to pass varies a bit from year to year, but they usually equate to a 70-75% score.

You get an idea of how your performance compares to others who took the test during the same window as you (November to December, 2018) in specific categories such as dog, food animal (essentially sheep, goats, and cattle), pig, etc. Compared to my peers, I totally killed it in the pig and equine categories. My large animal medicine instructors will be very pleased. But I did well in all of the categories and passed the exam with plenty of points to spare above the minimum.

Everyone, every single person, leaves the exam feeling like they failed it. It is hours of grueling concentration and knowledge retrieval and application. And it is a huge weight lifted to know that it is now behind me.

Nutrition, Disease, and Mimi

For years, Mimi has exhibited symptoms of "generalized tremor syndrome." She has nearly continuous tremors of parts or all of her body. The tremors get worse when she is excited or stressed. They are also present when she is sitting quietly and thus relatively relaxed and continue even when she is falling asleep. They disappear only when she is fully in REM sleep. This particular tremor syndrome is usually observed in smaller dogs like the small terrier breeds. The tremors showed up when Mimi was just a few years old, and have been slowly progressive since then. They are not painful and they do not affect her ability to run, eat, play, defecate, or engage in any other normal dog activities. All of these are typical characteristics for this disease.

This tremor syndrome has been fairly well studied. It can't be linked to any infectious agent or toxin. Some dogs have a mild increase of white blood cells in their cerebrospinal fluid, but that isn't observed in all cases. Thus it isn't strictly speaking an inflammatory disease, although it has been described as a type of meningoencephalitis (the -itis is used to describe inflammatory diseases). Instead, the syndrome is thought to be immune-mediated. That means that the immune system got its signals crossed at some point and began to attack a specific part of the body because the immune system thinks it is foreign.

When most dogs with this syndrome are given immune-suppressive doses of corticosteroids, they begin to improve, often within a few days. The tremors may be completely eliminated in some dogs and they can taper off the steroids. Sometimes the tremors return and then the dog has to begin the course of steroids all over again.

Steroids like prednisone are a powerful component of the vet med pharmacopia. But when they are given at immune-suppressive doses, they can have some unpleasant side effects. Heck, they can have unpleasant side effects at the lower anti-inflammatory doses. They are not to be prescribed lightly. Suppressing the immune system is not to be done lightly.

For some months now, I have been reading up on this generalized tremor syndrome and wondering if I should put Mimi on an immunosuppressive course of prednisone. She is much older than the typical dog that is treated for this syndrome, mainly because the tremors don't affect her life and I chose not to treat it earlier. Not all dogs who take prednisone achieve resolution of the tremors. I've been on the fence about this since I can't predict Mimi's response to treatment.

And because Mimi is an old girl (13 years now), I have also been thinking about age-related cognitive decline. Harry experienced a significant cognitive decline during his last two years. So when I ran across Purina's new prescription diet aimed specifically at slowing this kind of cognitive decline in dogs, I was quite interested. To be clear, once neurological damage and cognitive decline are present, they are not reversible. Purina intends for this diet to be fed prophylactically to dogs before they begin to show clinical signs. The diet, called Purina Proplan Neurocare, is only available by prescription. Purina, like Hills and a couple of other food companies, does actual feeding trials for their diets. This makes their claims for their diets much more compelling. They have published some good papers on the diet and it certainly seems to work as they claim it should.

What makes their Neurocare diet different? They increase the levels of omega-3 fatty acids, the vitamin B complex, and the antioxidants Vitamin E and Vitamin C. They also include medium-chain fatty acids (vegetable sourced). These fatty acids are processed by the body using slightly different metabolic pathways than longer chain fatty acids. It's not that long-chain fatty acids are bad. Quite the contrary, the long-chain fatty acids in the omega-3 family are extremely useful and are valuable additions to any diet, including yours. But the normal human and dog diet doesn't include much in the way of medium-chain fatty acids and far too much saturated fatty acids.

Purina, like Hills and Royal Canin and other companies that made veterinary diets, also make similar diets that you can buy without a prescription. In the case of Purina, the grocery-store version of their Neurocare diet is called Purina One Vibrant Maturity. Of course, it is not quite the same formulation as the prescription diet. It lacks the extra omega-3 fatty acids. But it has extra zinc, selenium, and Vitamin E. All three of these are important players in anti-oxidant metabolic pathways. And Vibrant Maturity includes those same medium-chain fatty acids and most of the Vitamin B complex. So there is considerable overlap between the diets.

Since I started working towards this new vet med career, I have been interested in how diet can be used to decrease incidence or susceptibility to disease, to decrease the use of drugs, and to improve performance. These concepts apply to old fox terriers as much as they apply to poultry houses with 120,000 broiler chicks.

On a bit of a whim, I decided to feed Mimi the Purina One Vibrant Maturity kibble just to see what would happen. I have now been feeding it for four weeks, which is generally the length of time we know we have to feed a new diet before we can expect to see changes in whatever clinical sign we are monitoring. I made no other changes to her diet or activities.

With respect to her cognition, all I can say is that she is no worse than she was four weeks ago, although that is a really subjective interpretation that has a high risk of owner confirmation bias. She wasn't exhibiting signs of cognitive decline before I started feeding her Vibrant Maturity, and Purina's claim is that their diet will delay these kinds of changes. So this part of my little experiment is a bit moot at this time.

But here is the amazing part: after four weeks, Mimi's tremors are notably reduced. Her head tremors have almost completely disappeared. Her body tremors are still present, although they are somewhat positional now (her hind legs will tremor more if she stands just so, and will tremor less if she stands another way). To make sure I wasn't seeing changes that I wanted to see, I had two other people look at her who have seen her tremors in the past. They saw the same changes that I saw.

This is the take-home lesson: I was apparently able to alter the course of her tremor syndrome using diet alone. I suspect that Purina is not aware that their diet could have this effect since their focus has been on the cognitive benefits.

These kinds of serendipitous observations are what drive me as a scientist and as a soon-to-be newly minted veterinarian. My mind is swirling with ideas for project designs and funding sources. I'm not likely to follow through with any of them, but you never know what future opportunities might appear!

Diary of a Fourth-Year Vet Student: You Know You Are One If...

How do you know you are a fourth-year vet student?

1. You don't have time to eat the lunch you packed for the day, and after 15 hours on your feet in the hospital, you are too tired to eat it for dinner when you get home that night. You are in fact too tired to eat anything for dinner and choose to fall into bed instead. So you take that same lunch back to school the next day.

2. You are offered a half-sandwich by your clinician and your first thought is, there must be strings attached to this, it can't be free. Then your second thought is, don't be stupid, never turn down free food. You grab it, say thanks, and shove it under your white coat because you are in a treatment area and shouldn't have food in that space. Well, you will definitely get yelled at for having food there, the clinician won't. You scurry out into a hallway, find a quiet corner, and began to literally cram the sandwich into your mouth. A classmate walks by and sees you tucked into the corner and says, hey, how's it going. You slowly look over your shoulder, your mouth full of sweet, sweet calories, and you mumble, "...small animal surgery". She nods knowingly, and leaves you to your two minutes of peace and food.

3. You have 50 competing priorities and you are literally running to another part of the hospital to try to take care of at least one or two of them when you round a corner and bump into a crying classmate. You immediately stop--because at that moment, her problems are far, far larger than whatever your problems are, and because tomorrow that could very likely be you sobbing into a bowl of canned dog food--and you give her a hug and say, tell me what's up. You listen, you give advice if you can, you listen some more, you hug her again then look her in the eyes and say, you can do this thing. Then you rush off again.

My classmate was crying because she thought her patient wasn't getting appropriate pain medications and that he was painful, and the clinician and resident weren't listening to her suggestions. I told her to go back and keep advocating for her patient. I told her that she was a good vet and what she was suggesting seemed appropriate. She told me later that day that she did go back and make her argument again, and they listened and changed the dog's pain meds. She was so happy with her patient's changed demeanor now that he wasn't so painful.

4. You get fired by a client.

This is a fairly common thing across the board in vet med, but it is more surreal in this particular tertiary teaching hospital in which all of the small animal patients are referrals only. You can't just call and make an appointment. Your vet has to contact us. The firings I've witnessed have all involved students so it seems like somebody isn't thinking these things through very well. Here is my own story.

The woman brought in a pitbull mix who, like ever so many pitbulls and their cousins, had horrible joints and terrible skin. Elbows, wrists, knees, hips--all degenerating, all arthritic and painful. We had performed an operation on one of his knees earlier in the year and she was returning so we could perform the same operation on his other knee. The dog was obese and he was so painful that he could barely walk. The problem was that this dog also had horrible dermatitis. In his inguinal area (his crotch area) and the area of his belly in front of his prepuce, the skin had open, weeping sores. The skin between his toes was so darkly stained with saliva from licking that it was not the usual red-brown but nearly black. Overall his skin was thickened and scaly. Pretty much a normal Tuesday for a pitbull. She tried to blow smoke up our ass about how he just had a reaction to being bathed at PetsMart two days before (yep, she was trying to throw some minimum wage worker at PetsMart under the bus). It actually took much longer than that for his skin to get this bad. I called the regular veterinarian and discovered that the dog had a multi-year history of chronic bacterial dermatitis that would respond to a short course of antibiotics then come raging back again. (Don't get me started on how fucked up that is--they are creating drug-resistant bacteria by treating this problem in this manner.) This was most certainly not in his history. I relayed all this to the clinician, and showed her the dog's skin. She agreed with my assessment--doing surgery on an animal with an obvious skin infection greatly increases the risk of post-surgical infection, and doing joint surgery in that case could potentially lead to a septic joint and even loss of the limb. Joint infections are not to be trifled with. So we decided to send the dog back home to see if his dermatitis could be cleared up with our recommendation of chlorhex baths and a better diet. The clinician and I went over every line in the discharge instructions before she sent me into the room with the client to talk to her about this plan.

When I told the client that we weren't going to do surgery at this time, she got quite angry. She continued to trot out the PetsMart bath nonsense. I told her that the dog's skin had been that bad for days, even weeks, and she got even more angry. True, that was a mistake on my part because if my tone was even a little bit off, that would make it sound like it was her fault, and in fact that is how I think she was taking it, but jesus, the dog's skin was frighteningly nasty. She interrupted me and said, "I am tired of this middleman business. I am tired of this. I am tired of talking to students."

I paused and said, "You do know that this is a teaching hospital?" (I am already going to hell, so in for a penny, in for a pound, right?)

She looked at me and said, "I am tired of talking to students and I am tired of talking to YOU!"

I dropped the discharge instructions on the empty chair next to her and walked out of the room without another word. Honestly, I was a bit hurt in that brief moment but it quickly turned to hilarity when a teammate asked me what was wrong (my face must have had one of those priceless expressions), and I relayed what had happened. I contacted the clinician, told her that I was really sorry but that I made a mess that only she could sort out. NINETY MINUTES later she emerged from the exam room shaking her head. She looked at me and said, "That woman is insane. You did nothing wrong."

5. You get told by a client whose pet is a frequent flyer with multiple, inches-thick folders containing his medical history, that you are the best student she has ever worked with.

I have been told that by three different clients in the past two weeks.

6. You spend four weeks working with two other students on the same very difficult rotation. You become such a smoothly functioning team that, by the fourth week, clinicians and techs can't tell which student has which patient because the three of you begin to work like Borgs, speaking with one voice and one purpose. That might sound creepy but it actually results in excellent patient care.

Nothing gets overlooked when you reach this kind of teamwork. If I was scrubbed in for a surgery, I didn't even have to ask, I just knew that Lani would be setting up my ICU treatment sheets and Sushil would be in the OR taking notes for my surgery report. If they were in surgery, I would be doing the treatments for their other patients or trotting tissue samples down to the diagnostic lab. I was lucky to be part of such a strong team.

Diary of a Fourth-Year Vet Student: Absurd

So we are standing around a stall, looking at a horse we performed surgery on two days earlier. He had dozens of stones in his bladder that we removed. There are several procedures that can be used on horses to remove these kinds of stones, and none of them are all that great. The surgeon presented these options to the horse's owner and she opted for a perineal urethrotomy. In short, we got into his urethra via an incision that we made just below his anus.

Back to the five of us standing around the stall. The burning question was, how do we know which hole the horse was peeing from? There was indirect evidence that he was urinating (areas of wet bedding) but that wasn't sufficient. The surgeon was not willing to clear this horse to go home until we were sure he was peeing from his penis, not the hole we made in his urethra way upstream.

Even though the student had asked that techs look in on the horse every hour since the day before, nobody had actually seen the horse pee. Our discussion was lively but we had no solution to our problem.

Until the horse suddenly started peeing right in front of us! From his penis!

We (four men, one woman, three different countries of origin, mostly areligious) exclaimed as one "Praise Jesus!" Then we collapsed in a heap of laughter.

You know you are in fourth-year vet med clinical rotations when....the absurd becomes normal.

Here is a picture of all the food I made this afternoon. No matter how tired you are, if you come home from the hospital and sleep, you are wasting precious minutes and seconds. You need to prep meals for days in advance whenever you have a chance. And have plenty of pocket-friendly snacks on hand because you might not have the five minutes you need to heat up then eat that nice food during the 14 hours you are in the hospital every day.

Diary of a Fourth-Year Vet Student: Choices

You know you are a fourth-year vet student deep into your clinical rotations and lost to human norms of behavior when you take your pellas off to pee and your pen falls out of your pocket and into the toilet, and you think, "eh, it's been dropped into worse things three times already this morning and I kind of like that pen"... so you fish it out.

I had a dozen exam gloves stuffed into another pocket. No, I didn't use one. Yes, I washed my pen when I washed my hands. I'm not that far gone yet.

This cute goat, my patient for four days, says "hi!" 

Diary of a Fourth-Year Vet Student: Dealing With the Bodies

All vet students at my school, regardless of their chosen track, spend two weeks with pathologists and pathology residents in the necropsy unit. I just finished this rotation during which I performed necropsies on barn owls, rabbits, dogs, a cat, a sheep, a goat, horses, cows, and a sea lion. We had three sea lions last week and another one this week. I spent two weeks cutting up dead animals, handling their entrails in a modern version of augury.

Necropsies are a systematic examination of the tissues of a dead animal. We are looking for changes in the tissues that might be associated with disease, that might give us a hint as to the cause of death. Sometimes there are no gross lesions (gross meaning we can see them with our naked eye). Sometimes the problems are impossible to miss. But you can't just find the obvious things and call it a day--you have to carefully and systematically examine (look at and often finely dissect) all the tissues to make sure there isn't something else going on that is even more important but less spectacularly obvious. You also have to collect tissue samples for different purposes (bacterial culture, or tissue placed in fixative that will be used to make slides for histopathology).

I did a solo necropsy on a 6-week-old Angus calf this week. Poor thing had severe suppurative pneumonia--his lungs were nearly completely replaced with abscesses filled with thick, greenish pus. After systematically examining all of his tissues and collecting the necessary samples (took me about 45 minutes but I didn't have to collect his brain), I had to dismember him to make it easier to move his remains. And I am here to tell you that even with minimal training and working alone with a single sharp knife, removing the calf's head and four legs completely from his body took me maybe 15 minutes. Someone with slaughter plant experience could have done it in 5 minutes.

Why am I sharing this gruesome information? You may have heard about the terrible ending of the Saudi journalist Jamal Khashoggi in the Saudi embassy in Istanbul, Turkey. You may have heard he was tortured and dismembered by a large group of Saudis, recordings of which events the Turks likely have, and which they likely have shared with our morally corrupt government officials. It is entirely in the realm of possibility for a single man, let alone 15 men, to kill a man and cut him into smaller pieces in a matter of minutes.

The politics of Jamal's horrific story are beyond my ability or desire to write about in this particular venue. Instead, I want to underscore the physical brutality of what happened to a man who dared to criticize his own morally corrupt government.

I am required to cut up animals as part of my training and practice of the veterinary profession. Every day in necropsy, it was just as difficult to make the first cut as it was to make the last one. Think how morally empty a person has to be to think it is okay to do this to a human being, not done for any justifiable purpose but to remove a political problem.

The house is burning down around us--all we have to do is raise our heads up and look.