Diary of a Third-Year Vet Student: Boosting My Confidence

Yesterday we did our first sheep surgery. I was the assistant surgeon. My team for the Large Animal Surgery Lab class has been really great at communicating and dividing up tasks, and after a bit of discussion, we decided that I'd try to place the jugular catheter in the sheep.

With one of my teammates holding the sheep securely, I clipped his neck. Then I did a rough prep with betadine and alcohol and injected a line of lidocaine under his skin where the catheter was going to be placed. Then I put on sterile gloves and did a sterile prep. My other teammate opened the package so I could grab the catheter while remaining sterile and he helped me fill it with heparinized saline. I hit the jugular vein right away but passed the catheter all the way through the vein so we had to pull that one and give it a go with a second catheter. It's really important that these be placed in sterile conditions so you don't introduce bacteria into the skin or blood. I was successful with the second catheter and placed two stitches through his skin and tied them around the catheter port to hold it in place.

My arms were shaking from a combination of stress and excitement when I finished. It was a big boost to my confidence to get it done quickly, efficiently, and properly. Even better, that catheter remained patent for the two hours it took to do the surgery. I can't take all the credit, however, because successful catheter placement depends quite a lot on the person holding the animal. Our ram weighs 186 lb and was not sedated. I kept thinking about that as I was kneeling on the ground in front of him, poking him with sharp things, but my teammate did a fabulous job of keeping the ram steady and calm.

Next week is the last week of this winter term, then finals, then a week off. Our lecture and lab schedule drops off a lot in the spring term because we will be doing mini (week-long) clinical rotations to prepare us for the real things that start in June. Our cohort will break up then since the order of the clinical rotations is different for each of us. Plus their length depends on the track that we have chosen. Most vet schools offer tracks along the lines of small animal, large animal, non-traditional, and general. I went with the general track. With my interest in poultry medicine, none of the other tracks were suitable. Finishing my time in vet school with a well-rounded exposure to all facets of vet med seemed to be the most reasonable choice.

Since I can't put up a picture of the sheep, I will leave this here instead.

Freezing fog is typical for western Oregon winters. These ice feathers formed on my car windshield overnight. I took the photo sitting inside the car looking out towards the sun which is just below the horizon.

Diary of a Third-Year Vet Student: But How Is The Hemostasis?

It’s a rule of life that we develop rules of life as we go along. One of my rules is, “Never miss an opportunity to pee.” A new rule that I have added since starting my vet school is, “Whenever you encounter really stinky odors wafting out of Necropsy, make a beeline for the viewing gallery and start asking questions—you are bound to learn something.” Death is a constant and significant element of veterinary medicine. Oftentimes, doing a necropsy is the only way to collect a key tissue or fluid sample for analysis. In the case of some diseases in some species, it may be the only way to make a definitive diagnosis. In vet med, being able to perform a proper necropsy is a learned skill that is just as important as doing surgery. During our fourth year clinical rotations, each of us will do a one- or two-week stint in that part of the hospital. I'm looking forward to it.

Necropsy is not what I decided to write about today. I wanted to write about a related aspect of vet school: using cadavers to learn procedures. It's really great when we get live animals to do surgeries on, but for some invasive procedures and surgeries, it is prudent that we practice on cadavers first. 

Despite my interest in necropsy, I detest our cadaver labs. The animals, or their parts, are either still frozen or are melting into goo after being used for a couple of weeks in other labs. Cadaver labs don't have the alluring stink of necropy. They just smell bad. Sometimes I can hardly bring myself to touch the specimens--they are cold, slick with a film of bacteria and ooze, and the texture is so very wrong. 

But last week in our Large Animal Surgery lab, the instructors threw us an interesting twist. We were to perform two procedures that are commonly done on horses to correct growth abnormalities in their legs. Each team had a horse cadaver leg. Just the front leg from below the elbow to the hoof. Here's the twist: the two people in each team who were to perform the surgeries had to scrub in, gown up, do a sterile prep of the surgical sites, do sterile drapes of the surgical fields, and suture up the incisions as appropriate when we were done.

Having us treat the cadaver lab as if it were a surgery on a living animal completely changed the way we all approached it. I thought it was an excellent review of the sterile techniques we are required to learn and put into practice, and a good way to get us to focus on doing the surgery well and not just mess around in a horse cadaver leg. It felt like a real surgery.

We even had to write surgery reports. That's what the title of this post refers to. Hemostasis means controlling blood loss during surgery. Since cadavers don't bleed, there is no need to monitor and react to that but quite a few of us put the statement "Hemostasis was adequate" in our reports for a little dark vet med humor.

Of course, there was a bit of a disconnect when we began the lab by duct taping the legs to the surgical tables.

The magic was quite gone when the legs showed up again for this week's lab. We practiced the common nerve blocks and joint injections in horses that are used to diagnose and treat lameness, injecting saline mixed with a blue dye. After we completed all of the procedures, we had to dissect the legs to see how close we got to the target nerves and joint capsules. My team struggled mightily with one of the joint injections that should have been really easy. We found out on dissection that the horse had proliferative bony growth covering the joint. No wonder we couldn't get a needle in there! It was also likely the reason he was euthanized. It was a long afternoon with a decaying horse leg. But it was a necessary step along the way to becoming a veterinarian.

CircusK9: File Under "Never A Dull Moment"

Hijinks and hilarity are the rule, not the exception, at CircusK9. I have two stories to illustrate and amuse. 

The first story is about Archie. He loves to play--he plays with the cat, with Azza, with his toys, with me. When I am studying, he brings me toys one by one, hoping that maybe this one will entice me to play since the one he brought me five minutes earlier did not. I've written before about looking up from my books and notes and computer to find myself surrounded by a sea of dog toys, so many that I have to move them out of the way to move my chair. 

Often when he is super stimulated during toy play, he carries his toys into Azza's or Mimi's crate, or to the two dog beds by my study area. He proceeds to ruck up the bedding, vigorously pulling it up and back with his front paws, with the general aim of burying his treasure within. He can completely turn over all of the bedding in the process, and in the case of the dog beds, move them several feet across the room. He will also bury his antlers like this. So every morning, while the dogs are eating breakfast, I go around to all the crates and dog beds to straighten out the bedding and remove all of Archie's stashed toys and antlers. 

The other morning while I was straightening up the dog things, I was completely taken aback to find this:

That is a picture of an antler and a plush toy carefully placed on the cat's scratching box. In case you are thinking, "pfft, carefully placed--that was just an accident", I will tell you that I removed them and a different antler and two different toys were on the scratching box the next morning. Archie deliberately stashed his treasure there.

There are several levels of silliness here. I have no idea why Archie gets so much pleasure out of burying his toys--he never retrieves them so I think it is the act of moving everything around that he likes. He never puts toys in his own crate. The terriers regularly take snoozes in any available crate or bed, but they absolutely know which crate is theirs. While the cat doesn't use a crate, Archie sees him use the scratch box every day. I can only assume that Archie logically translated this as "cat's special place, good for stashing treasure." Makes perfect sense.

The second story is about Archie and the cat. I don't free-feed Beast--every meal is measured out. Thus he is convinced that he will starve and blow away like a bit of fluff, and he is constantly, and loudly, on the lookout for things he can eat. The compost bucket is a regular stop on his rounds although I've learned to put the lid on it when I put things like eggshells in there. He will come to the kitchen and beg just like the dogs when I am preparing dinner, although I have a low tolerance for that behavior and chase them all out after a few minutes. 

Last night, I carved out an hour to make some real food. I sliced up half a sweet onion, peeled and cubed an eggplant, and cleaned, trimmed, and cut up three chicken thighs into thumb-sized chunks (when you are in vet school, you learn that when you manage to find time to cook, you cook big, enough for several meals, because you don't know when you'll have time again). I put all of that deliciousness into a saucepan with olive oil, salt, black pepper, and basil, gave it a bit of a stir, and turned on the burner. Suddenly, and now I can't even remember exactly why, I had to run back to the bedroom for something. It seemed necessary at the time. I was only gone for a few seconds. 

I returned to the kitchen just in time to see the cat leaping off the stove with a piece of raw chicken dangling from his mouth. A piece of raw chicken he pulled directly from the heating saucepan. Little fucker. Archie was waiting below, jaws open like a crocodile--he is a very alert terrier and knows when the cat is up to something. The cat leaped over his head, hit the floor, and the chase was on. The cat was so frantic to take his treasure into the bedroom and under the bed, and Archie was so equally frantic to take the raw chicken from the cat's mouth, that they were bouncing off each other, off walls, off corners, off furniture, like pinballs. Archie was growling, the cat was growling, I was laughing so hard I could barely stand up. 

I grabbed a flashlight, ran to the bedroom (yo, a nod to earthquake preparedness here, I have flashlights stashed all over the place), and dropped to the floor to watch it all play out. I sleep on a platform bed so Archie was not as maneuverable in that low space as the cat was but he sure gave it his all. In the end, the cat managed to choke down the piece of raw chicken before Archie could take it from him. Archie had to console himself with licking up drool and juice from the floor.

Never, ever a dull moment.

Diary of a Third-Year Vet Student: Back in the Saddle Again

Our pony, Thomas O'Malley, is shaping up nicely. He had a bath last Monday and is getting groomed daily. Nobody on my team is all that expert at daily horse care but we make an attempt at keeping him brushed. I've been trying different grooming tools on him. He seems to like a regular plastic hairbrush with knobs on the bristles the best. I can gently brush his face and forelock and he closes his eyes in what I think is pleasure.

My Large Animal Surgery team castrated Thomas on Wednesday. We do three big surgeries this term and each team got to decide who would be surgeon, assistant, and anesthesiologist for each one. I intentionally negotiated with my team members to do anesthesia for this first (and only) surgery on our ponies.

I had a really terrible experience at anesthesia for the third dog spay that my Small Animal Surgery team did last term. The dog survived, but she did all she could to make things difficult. She needed glycopyrrolate twice during surgery to get her heart rate up, she needed more injected pain meds (morphine) during the surgery (she had already received 3x what we had planned before that point), and most of my monitoring devices stopped working or weren't working. I only had a device to measure the oxygenation of her blood and her heart rate, and a crappy little inline device that we added during the procedure to measure how much CO2 she was blowing off. And that's basically it. I was manually breathing for her by squeezing the rebreathing bag 4 to 6 times a minute, every 10 to 15 seconds or so. I had to do that for 1 hour and 45 minutes. ONE HOUR AND 45 MINUTES. I'll leave it to you to figure out how many times I squeezed that bag, but it was a horror show. I stared at the clock for my mark then watched the manometer to make sure I didn't squeeze too hard (easy to do) then turned back to the clock. I was hardly breathing myself. I stopped just twice during that period to manually measure her blood pressure using a cuff and a squeeze bulb--inaccurate but it was the best I could do under those time constraints. She was hyperventilating so she was not inhaling as much inhalant anesthetic as she needed and I had to keep adjusting the rate of flow of that drug. Her belly was rapidly moving up and down for most of the entire procedure from the hyperventilation, making it very difficult for my teammate to place the three layers of suture required.

But she survived, and recovered smoothly and quickly despite being pumped full of all kinds of drugs. And I learned a lot about physiology and anesthesia in one afternoon. A crash course, really. Even so, I felt pretty traumatized by it and I didn't want that experience to hold me back when it was my turn to run anesthesia for my Large Animal teammates. So I decided I needed to tackle the anesthesia role as soon as possible--get right back into the saddle.

No matter what the procedure, the student anesthesiologist has to give peri-op antibiotics, pre-op analgesics, and pre-sedating drugs so we can place the IV catheter. Then we induce with more drugs, intubate, give more induction drugs because we tend to err on the low side, and get the patient hooked up to O2, inhalant anesthetic, and what seems like thousands of monitoring wires and leads. The drugs and doses vary with species but the basic tasks are more or less the same. I did all of those things for our pony without too much trouble or reference to my notes. And when all of the other ponies became hypotensive (blood pressure too low) and had to be put on special IV drips to address that, our pony's blood pressure remained nearly normal, as in waking and walking around normal. His heart rate--same thing. He was absolutely sedated, but he was just not having any problems with it! The only bit of trouble was that he wanted to stop breathing every so often. His average respiration was about 5 to 8 breaths per minute but they weren't evenly spaced and I sometimes had to remind him to breathe by manually giving him a breath. But given that I had spent most of the dog spay doing just that, I had no problem with it.

Besides the castration, which was basically more like a giant dog neuter than a pony castration, we did some additional procedures including hoof care. I had to continue to monitor anesthesia during that as well as help my team.

I am really pleased with how well it all came out. I felt like I had a much better idea of the balance between the drugs and what I was observing and monitoring. Rather than squawk out a panicked "help!", I was instead calmly calling over the clinician or resident and saying, "I see this combination of physical parameters that look great, holding steady for an hour, but this other parameter is trending a little off. I don't believe it is a problem but I wanted to verify that." Such a huge difference between panic and validation of my interpretation of the situation. I am so very glad that I chose to repeat the anesthesia experience right away. It wasn't a perfect walk in the park--I made a couple of rookie but correctable mistakes. I learned from those too. All of my classmates are taking similar tiny steps towards becoming a veterinarian.

Diary of a Third-Year Vet Student: Worms, Eyeballs, and Feral Ponies

Last term was all about the small animal surgery lab: dog and cat spays and neuters. This term will be all about the large animal surgery lab.

For this lab course, we are again working in teams of three or four. Different teams, though. This time we were teamed up based on our relative experience with horses. Each team has been assigned a miniature horse. Over the next 7 weeks, we will perform a variety of diagnostic procedures on the ponies (after labs in which we practice first on cadavers), and we will castrate the ponies in a couple of weeks.

The ponies are feral. Entirely feral, never been handled. Some are quite young (my team's pony is at most six months old), some are several years old. Feral mini ponies are little ninjas, and can strike you with front or rear hooves as they choose. They can also bite. However, we've been pretty lucky this year. Most of the ponies are so shocked at being yanked from a cold, muddy pasture somewhere in Oregon and placed in dry, warm pens with abundant food that they only put up token resistance to being haltered for the first time and being handled and dragged about for the first lab.

The ponies are owned by one individual who is making them available to the vet school for the use of the junior surgery lab. So far, they have been weighed, dewormed, vaccinated for tetanus, and had a physical exam and basic blood work done. Some arrived with conditions that required immediate treatment. About half of them are underweight and the students have to come in twice a day and give them additional rations. Because they are technically patients of the vet hospital, I can't post any pictures of them as that would violate client and patient privacy. But I can post this cool picture of a worm that we found on the floor of our pony's pen this afternoon (horses are social animals so the ponies are penned in groups of four; no telling which one passed it). Better living through deworming, right?

Strongylus vulgaris, a common intestinal worm in horses.

One of my classmates spotted the worm so I made her collect it in an exam glove that I had in my pocket. Everyone was excited and wanted to look at it. I eventually set it up on a paper towel in the female student's locker room so people could get pictures.

In case you hadn't noticed, by this point in our education, vet students are completely unacceptable to be let out into the general population.

Another example. We had an ophthomology lab today. We did some basic procedures on mares from the vet school's teaching herd but we practiced the more invasive procedures on heads from horse cadavers. Just the heads, sitting out on lab tables. The heads were used first by half of the class yesterday so by the time of our lab today, the eyeballs were not in great condition. So the first thing we did was pump a bunch of saline in to them to practice a particular type of injection, which had the beneficial effect of plumping them back up again.

We all openly acknowledge that we have crossed a sort of Rubicon. When non-vet people ask us what we are studying in class, we shrug and say, oh, you know, dogs and cats and horses and things. What we really want to say is, worms, eyeballs, and how to find barely descended testicles in young feral ponies.

Archie and His Tennis Balls, Continued

It's hard not to compare Archie to Harry: male, black and white smooth fox terriers, sweet and loving and astonishingly stubborn. And both utterly obsessed with tennis balls. That's not particularly fair to Archie--he is very much his own personality. But the overlap between them is surprising.

I had to keep all tennis balls picked up when Harry was around because he would guard them rather fiercely. Mine! All mine! I was able to channel his energy into a great career in flyball, but that only fed his obsession with tennis balls. I have no doubt that Archie would also do well in flyball, sailing over the start/finish line shaking his head and growling with the ball in his mouth as he passed the dog coming in, just as Harry did. Mine! But I prefer to keep Archie focused on agility for now.

Even though Archie is not particularly guardy for a fox terrier, I still have to keep tennis balls picked up. Otherwise, he would either bury me in a mound of them while I was studying (he picks the balls up and drops them inches from me, letting them bounce a few times, then repeats this...endlessly) or he would chew on one constantly like a large yellow cud. That's not great for his teeth.

I can't even say "ball" around him--he starts flinging himself around the house with the same energy as if I had said "agility" or "walk". His pupils dilate, his ears come forward. He drools a little. He runs to one of the spots where I store the balls, looking back at me expectantly.

I think there are around 20 or 25 tennis balls in the house. I'm not actually sure of the total count because even though I am vigilant about looking under furniture for them when I clean and picking them up after we play, Archie somehow manages to produce 1 or 2 a week. I have absolutely no idea where he stores them. In fact, I have decided that he makes them. I think Archie has a laboratory somewhere in the house where he conducts his alchemy: turning lead into tennis balls. Retorts bubbling away, flasks of stinky, gem-colored liquids, mortars filled with ashes of newt. 

I have a dog bed in the bathroom because I gave up years ago on peeing and showering alone. Mimi sticks to me like a burr and 99 times out of 100 she will curl up in that bed long before Archie shows up to see what's going on. The other morning, I got out of the shower to find Mimi standing there glaring at Archie who was tightly curled up in the dog bed. Hmm, that's odd, I thought. It wasn't until I finished my routine and was leaving that I found out why he was in the bed--he was curled up on top of TWO tennis balls. Two. Did he lay them like eggs? Did he bring them in from his secret laboratory in anticipation of napping on them during my shower? It is a complete mystery.

Diary of a Third-Year Vet Student: Whew

It was a difficult term for my cohort. Five people failed Large Animal Medicine and at least one person (perhaps some of the five, perhaps different people) failed Small Animal Medicine. That is a dismal attrition rate, at least 8% of the class.

One of my classmates pointed out, quite correctly, that nobody should be failing out in the third year. The ranks should have been thinned in the first year, not this late in the game when people have accrued significant debt and invested years of their life. There is no consolation prize, no interim degree that we can be given then sent on our way. We did in fact lose four or five in the first year and more in the second year. And here we are, in the third year, still losing far too many people.

Failing in vet school is defined as getting a grade of D or worse. What happens to someone who fails a course in vet school? They begin the process of remediation. I don't really understand remediation. My friend M says our ignorance is a good sign. There are lots of "if this, then that" qualifiers, but sometimes people can take another exam; if they pass, they will be allowed to continue. Sometimes people are not allowed to advance and have to wait for an entire year to repeat one or more classes. If that happens, their graduation is delayed by a year. This happened to a woman from the class ahead of us. She just appeared in our Large Animal Medicine lecture this term. She failed it last year and had to repeat only that course. I suspect that she is one of the five I mentioned above. If she failed it a second time, what happens? Honestly, I don't know.

It was a difficult term for me too. I felt like I was on the wrong foot for the entire term. Some good things happened, like the publication of our laying hen ovary paper on the Monday of finals week. Some very bad things related to the still-unresolved issue of the predator happened too. I felt like I spent nearly all my free time doing nothing but studying. But I barely passed Large Animal Medicine myself. That is not like me.

I also found out towards the end of the term that one of the surgery instructors made every single female student cry during surgery. I thought it was just me. I was struck nearly speechless when I found out that he treated all of us that way. Only the women students, not the men. Yeah, that's a problem. I don't go to school with precious snowflakes. My female classmates kick some serious ass. But he was so cruel to all of us that he made us cry. That was just one more burden added to this already overwhelming term.

I had grand plans for the break. With the successful publication of our first manuscript, I wanted to get the draft of the next one ready for my co-authors. Such grand plans. About all that I managed to do was re-take all of the photomicrographs so that I have high resolution images for the next paper. I have 66 histology slides and ended up with a couple of hundred images. They are very nice, to be sure. But I only have the barest outline of text to go with them and dozens of new references to read. That's not likely to be advanced much in the next couple of weeks.

I'm going to view this dismal term as a wake-up call. I need to change my study methods for some of my courses. I need to get more exercise. I'm still in the game.

I'll leave you with this picture of a pre-cancerous lesion associated with chronic inflammation in the surface epithelium of the ovary of a laying hen. I haven't white-balanced the image yet--I do that by hand in Photoshop. Still, it is impressive. I'm describing this lesion as "exuberant epithelium."