ER Overnights

Just started week 2 of the small animal emergency rotation. I would have written sooner, except for a couple of reasons - the first being that my school computer is dead. HP and I are in a fight over the warranty right now.

Let me take a moment to vent: Last year my powercord broke, which is covered by the warranty. So I call and ask them to ship me a new one. I confirm the shipping address twice since I can't use my computer and I need it ASAP, and end the call. Two days later, I track the shipment - it was on its way to parents house - i.e. the reason that I confirmed the shipping address in first place. I call, pissed off, and place a new order. Three days later, I attempt to track the shipment - no tracking number listed online for the order. I call HP again - turns out no order was placed the second time - even though I went through the whole process, confirmed the shipping address, etc. I place a THIRD order for the powercord - and they have the gall to ask me to send the other one back. Um, no I won't be doing that.

Present day - My computer screen shattered right before finals and I now need to start studying for boards, so I would like it fixed. It turns out my warranty doesn't cover accidental damage - which I SPECIFICALLY ordered when I bought the computer three years ago. I called HP, verified that I was ordering the correct warranty, and placed my order. Three years later when I need to cash in on that warranty, I am told that I was given an incorrect item number for the warranty. I spend two hours on the phone with HP, talking to six different people - one of which was the supervisor of the tech support guy who told me he has no boss and is at the top of the chain of command of HP.

Are you kidding me? I was so livid at that point that I congratulated him for owning HP and running such a successful, customer friendly business.

I finally got routed around to the tech support supervisor's man's SUPERVISOR (weird, the first guy really doesn't own HP?) who at least made an attempt to help me. He said he'd ship me the box to send my computer in and that I'd be recieving it within the next two days. I verified my address and politely told him that I had had issues in the past with things being sent to the wrong address, so I just wanted to confirm the correct one. He read me my address and said nothing else was listed. The next day, I track the package... sent to my parent's house. I mean, come on, is this for real? It's almost funny how terrible they are.

Moral of the story - whatever happens, stay away from Hewlett Packard.

Besides the computer debacle, I'm really just exhausted. Working 70+ hour work weeks is starting to get to me. I am so excited for my next rotation - 9 to 4ish, Monday through Friday. How glorious. ER has been interesting - I've had a lot of cases, I've gotten better at drawing blood, taking blood pressures, pulse ox, ECGs, etc. Just basic, good skills to have for the rest of the my life.

Last night was one of the toughest - a few very critical patients, but we were able to leave at 2:45am. At 4:15am, I got called back in and stayed until 7am. The one I got called back in for was a panting dog. It wasn't heatstroke or hyperthermia, but just a dog that had been lying under the owner's covers, woke up panting because it was warm and was brought in immediately. It stopped panting for us, the rest of the physical exam was completely normal. When the intern talked to the owners, the owner freaked and insisted the dog had hip dysplasia.

... what kind of monkey leap takes you from minor panting to hip dysplasia? She then literally pleaded and begged the intern to tell her the truth - that her little cocker spaniel must have hip dysplasia. Her previous dog - a chocolate lab - had hip dysplasia 15 years ago, so she assumed this dog must have it too. I was so tired at this point that the whole conversation was hilarious to me. That sounds mean, and I'm very sorry, but we never mentioned ANYTHING about her hips or any orthopedic issues. I have no idea how her mind just went there! I know the owner was upset and tired herself, but this conversation got very weird very quickly.

Anyway, today is my day off and I slept until 1:30 - which is only 6 hours of total sleep, but I feel better. I went to the pool and read a book, got ice cream, took the dogs for a walk, and am now relaxing with wine. I blew off P90x today because I was exhausted, but I'll definitely get back on it tomorrow :)

Unexpected Praise

I successfully made it through RAHMS (I think it stands for something like Rural Animal Health, Medicine, and Surgery). I have one phone duty shift tomorrow from 2-8pm, which sort of sucks because it is the fourth of July and I'd rather be hanging outside than inside the phone room... I'm also on-call from 8pm to 8am the following morning - I guess when that is over, I'll officially have survived my one and only RAHMS rotation.

Friday morning started off very strange. I arrived at school around 6:45am, ready for my first call of the day. The appointment was for "killing pigs"... i.e. euthanizing 7 pigs at the swine research farm. These guys were part of a research project and the study had ended, so they needed to be euthanized and sent out. They wanted it done via captive bolt, which essentially looks like a handgun. It stuns the animal, rendering them unconscious by damaging the skull and cerebrum. You can then choose to immediately exsanguinate, or allow them to die on their own. We watched Dr. CS do one of them, but we had been taught in class the proper location to use the captive bolt (or gun for that matter) - you draw an "X" from left ear to right eye, and right ear to left eye - and you shoot at the cross-section of the "X". Each of us did two pigs - there ended up being an extra pig that need to be euthanized after her cannula was pulled out (cannulas were placed in these pigs in order to sample GI contents). It was an experience - it was my first time using the captive bolt and I'm glad that I now know how to load it, use it, and clean it. If I am ever in the situation where an animal needs to be euthanized in this way, I'm glad that I know how to do it. These guys were my first real euthanasia and, to tell you the truth, it was pretty tough for all of us, especially beginning our day with that.

Our next call was at a house belonging to one of the doctors at my school. I LOVE her and she has the cutest house and barn - she has one horse, a Paso Fino, and a cute little donkey. They needed Coggin's tests, vaccines, and their teeth floated - I've never actually seen teeth floated on a live animal (I've done it on horse cadaver heads) - so that was cool to see.

We got back to school around 12:30pm and were hanging around the rounds room doing paperwork and enjoying Food Friday (the last day of each rotation, everyone brings food to share). Dr. CS walked through the room on the way to the office and looked at me and beckoned with his finger, without saying a word, and continued walking to the office. I followed him, a little uneasy that I had done something wrong, and he shut the door. He gently grabbed my arm and looked at me and said, "I just wanted you to know that I really enjoyed working with you and that you did a great job. I really hope that you'll come back and see us again." I stumbled through something like, "I had a great time, thank you for teaching me so much" and walked back to the rounds room, basically floating on air. He is an older guy that doesn't offer outward praise all that often. Plus, he is my favorite doctor. It meant so much to me that he personally took me aside to tell me that he enjoyed working with me - I actually started to feel more like a colleague, rather than a student, which is an incredible feeling.

The rest of the day was pretty uneventful - I ended up going out on a call with another doctor that I like and another student (who is a large animal girl and really knows her stuff) - we were going to two different pig farms for health papers, a really boring, super quick visit. The only problem was these farms were two hours apart and in completely opposite directions from each other in relation to the school. We ended up in the car for over 4 hours, just chatting about the rotation, but mostly about one of the students on the rotation who has been an incredible headache for everyone that has had to interact with her. I'm pretty sure she must have some sort of psychological issue, and for that, I feel sorry for her. However, it doesn't erase the fact that she is a nightmare to work with, antagonistic, and rude. By the end of the rotation, I had to stop talking to her completely because every conversation left me wanted to blow out my brains. KJ told me not to feed into the craziness, which was the best advice he could have given me - I know that he must have been sick of me coming home and complaining about every encounter with her each day!

Later that night, a bunch of us went out for drinks at my favorite bar downtown. KJ had gone to dinner earlier with some high school friends, one of which works as a tech at my school. At the end of each week of RAHMS, the clinicians and techs get together and evaluate each of the students on the rotation. After the first week, my evaluation went well - I was told that I was great to work with and enthusiastic about getting things done efficiently. She told KJ that after this past week, I had the best evaluation of the group - I was totally shocked, but super pleased. I was scared going into this rotation, since I don't know large animal medicine very well. But I learn pretty quickly and love learning how to do new things - I'm a very hands on learner, has which seemed to pay off for the rotations that I have been on so far. Anyway, I'm not tooting my own horn - it was just really surprising to hear that the clinicians thought I did well - and super flattering!

I'm off to ER next - I work a few days shifts and then switch to a week and a half of night shifts - it should be very interesting and I hope that Iearn a lot!

"Aw, you got some on your face..."

This morning, we headed out to the dairy farm to dry off a couple of cows and pretreat a handful of heifers. For those not in with the dairy lingo (i.e. me) - that means that they are pregnant and will be expected to calve in the next 60 days or so. They stop getting milked and will slowly stop lactating and "dry off" while waiting to give birth. This allows them to take a break from working, manage any subclinical mastitis issues that may be going on, and prepare for the next lactation. They will then start producing milk again right before they calve.

The way this dairy farm does it may be different from other practices, but this is the only place I've seen it done. First, a separate milk sample from each of the four teats is collected. This will later be plated on 4 separate agar plates (typically blood agar) to see if any bacteria grow. The teats are then disinfected and intramammary antibiotics are injected into each of the four teats. The teats are disinfected again and the internal teat sealant is injected which will form a plug, preventing bacteria from getting into the teat sphincter and setting up a potentially nasty mastitis infection.

Drying off cows is pretty simple - they are used to being in the milking parlor and are used to having their teats handled daily. The heifers on the other hand, have never been in the parlor before and have no idea what to do. When I attempted to inject the antibiotics, they flipped out and started kicking. That is all well and good - I can handle that. What I couldn't handle was when I was about to go into the teat and she flipped out... but instead of kicking, she defecated all over my arms, neck... and face. Thank you GOD that my mouth was closed. It was not ideal, but it was pretty funny!

Slaughterhouses

** Disclaimer: This will most likely not be completely politically correct, but it is my point of view, opinion, and observations, not the point of view or opinion of the university that I attend or the point of view or opinion of the university's meat plant. If you don't wish to read about the slaughter process, please don't read and please don't send me hate emails or comments because you were warned... thank you!**

That being said, I had the opportunity to visit the meat plant at my university yesterday, which is a disassembly house. Most (if not all) of the animals that go through the doors are killed on site and the carcass is broken down completely. They operate a market out of the same building where you can go in and buy steaks, processed meats, etc - that was news to me and I plan on buying steaks tomorrow and grilling!

The reason for our visit yesterday was for an ongoing research study on 2 different drugs on a group of pigs. Groups of 50 or so pigs were slaughtered yesterday and their tissues were examined for pathology (just for a basic health check). The drugs should have no side effects and I'm not entirely sure on the set-up of the study itself (sorry about being fuzzy on those details).

Our plan going in was to analyze different tissues for basic, quick pathology: snout (atrophic rhinitis), lungs (pneumonia), liver (ascarid scars), ileum (ileitis), skin (dermatitis), heart (endocarditis, pericarditis). We donned hard hats, XXXXXXXL sized white coats (they were HUGE), and our boots and coveralls and headed into the main slaughter area. The state inspector was also on site, who examined the tissues first (mostly lymph nodes, quick check of the viscera, etc). He was a cool guy to talk to and he was more than happy to show us what normal tissues looked like.

We also had the opportunity to watch the entire process from start to finish. The pigs, one at a time, walked into a small holding stall and were initially stunned at a really high voltage right behind the ears. This renders the animals unconscious and after they go down, they are stunned again at the level of the heart. They got shackled and raised up, where they were exsanguinated. They then got lowered into the hot bath (about 140+ degrees) so that the hair softened and fell out. After the hot bath, they go into the epillator (?) which sloughs the hair off. The carcasses are then hand prepared by a group of people, where the hooves are removed, excess hair is removed, etc. When ready, the pigs are shackled up again and raised up (the same idea that you've probably seen on tv or in movies) and eviscerated. At that point, the head is removed and that is when we stepped in. We were responsible for removing the snout (with a hand saw) at the level of the first molar so that we could check the nasal conchae for atrophic rhinitis. We graded the degrees of rhinitis on a scale of 0-5 and after the first few, our clinician called us "trained" and let us grade them ourselves. But if there was a question, he was quick to help :) We also were trusted to examine the organs ourselves - we got good at pathology very quickly! Since these were research animals, every single organ was weighed and saved - the reproductive tracts (all males in this case) were photographed as well.

All in all, it was a pretty cool experience. In my opinion, everyone (at least in the veterinary field, but really, everyone) should take an opportunity to see a slaughterhouse and the entire disassembly process. I don't believe the animals were handled inhumanely at all - the voltage is high enough to render them completely unconscious and stop their hearts - the reason they twitch and react to stimulation after being stunned is purely due to muscle reflexes.

Afterwards, the rest of the afternoon was pretty laid back. We rounded on LDAs (left displaced abomasums) and an equine case and called it a day. This morning, I got the chance to palpate about 15-20 dairy cows at the school's dairy farm. Although the 4:45 wake up call was way early, it was peaceful hanging out with the cows while the sun came up and trying to figure out exactly what I was touching. I realized I majorly suck at palpation. I sucked before and I suck still... but I probably will not do it much (if ever) in the future, so it was cool to go out and give it another try. I palpated another mare this morning as well that was about to ovulate. I felt nothing, but apparently she had a 51 mm follicle on her right ovary... oh well!

I also tried my hand at bleeding pigs this morning (taking blood, not killing them!). There were two large boars in isolation at the beef farm that tested PRRS positive and Mycoplasma positive, so we were re-submitting blood and hoping for some negative results. I tried a couple of times with no luck, so I ended up holding the snare for the clinician to give it a go. He isn't totally comfortable with pigs, so I think he was frightened that we would get hurt... these guys were a bit too young to know the extent of their strength so luckily it was a pretty easy process to get blood on them.

Not a truly dull moment on this rotation, and I have enjoyed immensely (other than not knowing ANYTHING about food animal medicine). I think I've learned a lot, but I think I'm ready to be back in the small animal world :)

Making Animal Babies

My first call on ambulatory was the horse farm on campus. There was a group of 8 or 9 mares in various stages of pregnancy/ovulation, so we checked out the pretty ladies all morning. Most had already been bred, so we fetal sexed a few of them. The first one was an obvious colt... after that it got shady because Standardbreds are big. We are not. No amount of trying was going to make our arms longer and able to get the ultrasound probe far enough to be able to check out the babies!

Another mare that we examined was 60 days pregnant - I got to palpate and feel the right uterine horn for the fetus - pretty awesome.

Most of them had foals still with them - little fuzzballs just following Mom wherever she went. Most stood patiently while mom got palpated, but one just couldn't resist nipping at us when we were getting some of mom's blood... it didn't hurt, and it was sort of cute.

Went to the meat plant/disassembly plant today - more on that exciting morning another time. I am exhausted and have a 4:45 am wake up call to palpate cows at 5:15 tomorrow morning... it should be fun, although I'm not very good at palpating... I think I'll be happy when I start ER, even though most of my rotation is on night shifts!

Why Vet Med?

Someone asked me the other day when I decided I wanted to be a vet. I started thinking about the whens and whys of going to vet school and realized that I'm not really like most vet students. Veterinary medicine was never my life's dream. Sure, I wanted to "be an animal doctor" when I was a kid, but then I liked the idea of being an architect (I like to draw, but I'm terrible), and for a little while I considered pediatric oncology (which must be the most depressing career in the world) because my friend's little sister has cancer and I wanted to save little kid's lives.

I think I always knew that I loved science and would eventually have some sort of science or medical related career, but I never knew what. Once I started undergrad, I started aiming toward ecology and environmental science. I took a tutorial on marine mammal conservation because I thought I'd like to become a marine biologist... but there aren't a whole lot of those around the midwest. I eventually got interested in aquaculture and thought for a minute that I could save world hunger by building stable, healthy fish farms and feeding the world. I'm not entirely sure what the turning point was, but sometime during Junior year I decided that I didn't want to graduate. It was only my third year at Lawrence, but fourth of college and I could have graduated on time... but I kind of didn't want to leave... and since I got a scholarship that would pay for my fourth year at Lawrence, I talked to my advisor and convinced her it was a great idea for me to stay and that I was going to apply to vet school.

She nicely told me there was no way I would get in with my grades.

My response was f*ck this, no one is telling me that I can't do something. Unfortunately this ridiculously self involved mindset has gotten me into quite a lot of trouble and pain over the years (my recent marathon, the broken finger... the list goes on...). I ended up rearranging my schedule for the second and third trimesters of junior year and tearfully telling my favorite professor that I could no longer go on marine term (trip to cayman islands for research - the trimester revolves around the 2 week trip). I then registered for organic chem 1 and 2 and a handful of equally exciting classes. Talk about a huge let down to follow my new life dream.

It all ended up fine. I got to stay at school for another year and enjoy the undergrad life before going out into the big scary world. I took the following year off and took my last vet school prereq (biochem) while working full time for an animal hospital and living the high life with my parents. My parents are awesome, but having no friends around really sucked, so I took a lot of trips up north to Minnesota to visit the boyfriend and the friends that lived in the twin cities. Good thing I worked full time because that got expensive... but hey, I was really freaking lonely.

I applied to 7 schools that summer after undergrad and ended up with 4 interviews. They were all quite the experience, but my favorite was my first interview - Iowa state. If you live in northern Illinois or Iowa, maybe you'll remember the crazy ice storm from January 2008. It. Was. Horrible. Dad and I left super early in the morning to get there four hours before my interview to participate in all the fun stuff like tours of the school and learning about computers. I'm sort of happy I missed that part, but getting there 30 minutes before the interview was stressful. Especially when I still needed panty hose and an umbrella so my pretty new business suit didn't get soaked. The normally 5 hour trip took 8+ hours and Dad took away my driving privileged because I apparently don't do well driving on 200 miles of black ice. I knew it was getting bad when I glanced in the rearview mirror and saw a pickup swerving EVERYWHERE across the road. I pointed at the mirror in shock, but Dad thought I was pointing at the sky and that got super confusing... Anyway. We saw more than 30 semi trucks flipped over on the side of the road and some moving vans with some poor families belonging strewn over the road and shoulder. I'm surprised we didn't die.

Interview went fine, but when I was talking fingerprint-unlocking-computer-hardware with a student (yea, its super cool, don't judge), I saw my dad on the phone looking concerned. Apparently my new beagle pup was allergic to metal. She chewed her tag off of her collar and blew up like a balloon, so Mom had to take care of that since Dad and I still had to trek back home. At that point, the first snow of 2008 began when we walked out of the school, so the trip home was as equally fun as the trip to Iowa.

Ohio State was fun too because we forgot about the time change. We successfully made it going 85 mph with 15 minutes to spare. That was my suckiest interview because one of the interviewers was terrible! He asked about my going to school near Door County and asked what was significant about Door County. I don't even know what I said to that ridiculously open ended question. When I asked what he was looking for he said, "I wanted you to say that there were a lot of cows." Word for word, dead serious, that is how he answered my question. The rest of the interview was similar to that question.

I got wait listed.

As fate would have it, at symposium at OSU during my first year, I went to a lecture and the guy that walked in was my interviewer. He ended up being pretty funny, but funny in the pompous asshole sort of way.

I ended up getting into Kansas State and Illinois, so for money's sake, I chose Illinois. I sort of regret that decision based on the downward spiral my school has taken in the past few years, but at this point I just want my degree and D.V.M. after my name!

I guess that is the story of how I became a vet student... but not why.

Simply put, I love animals. Who doesn't? But, more importantly, I believe in the strength of the human-animal bond. I believe that we coexist in this world to enrich each others lives. I hope I'll make a good doctor. My bleeding heart wants to save them all, but my science mind knows I can't and as I've progressed through the years, I hope that combination will make me good at my job.

I lost my very first patient recently. Her name was Lillian and she was the most beautiful chocolate lab I have ever seen, 2 years old, FS. Gorgeous, caramel eyes and a happy, happy tail. She presented with a history of massive right hindlimb swelling, but was also cachexic. She was taken in by a sweet older couple the week before and the swelling had been minimal. They were told she had been "kicked by a horse" the day before they picked her up. With that history in mind, we leaned toward hematoma. We ended up doing a CT, which showed 2 soft tissue masses. We also lanced the medial aspect of the thigh, and only clotted venous congested blood was seen. Two days later, the biopsy results indicated aggressive hemangiosarcoma.

I was incredibly upset, but only let myself cry for a minute alone. Life is cruel, but until the very end, she wagged her tail and ate her treats. I spoiled her with turkey baby food and peanut butter that last day and she went peacefully that afternoon. I learned that I like the effect of using propofol before fatal plus, especially on a young, active dog like herself, it lets them go very peacefully and gives owners peace of mind. Lillian taught me that it is okay to get attached to your patients and okay to be sad when they die. Because of Lillian and all the other animals out there waiting for me in the future, I'm getting excited to graduate and get out into the world be a veterinarian. It may not have been my life's dream originally, but I'm so happy to be doing something I love.

Things I learned today...

... about running. Backstory: So, I've been on this self-imposed running hiatus since the marathon at the beginning of May. I was nursing a strained butt muscle from the marathon and decided I needed a little break with clinics starting and what not. Well, I'm back and I'm not taking it slowly like I should. Case in point - today was my first real run since the marathon. The temperature was a cool 70ish degrees, the sky was cloudy and gray, it was sort of lovely running weather. I got home around 5:30ish and immediately put running clothes on and headed out.

Things I learned today about running:
1. Do NOT start your first run in almost 2 months with the goal of beating your world record time for your favorite out-and-back route.
2. Do NOT continue running AWAY from your house when it starts raining and the sky turns black just because you are on pace to break your world record time.
3. Do NOT smile because running in the pouring rain is hilarious to you. People will judge you and think you are weird.
4. Do NOT wear your super awesome hot pink Illinois marathon running shirt when you are obviously out of shape. You will look like an asshole.
5. DO go home and cool down by walking your dogs since it will stop raining as soon as you get near the house. They need the exercise as much as you do and you can't keep avoiding the two pairs of beautiful brown eyes that are begging you for quality time on leashes.
6. DO let the neighborhood kids play with your incredibly handsome black and white pittie. It is way too adorable when they ask if he is really a Steelers fan because he sports the matching collar.

Overall, really glad to be running again. I'd almost forgotten what a huge stress reliever it is. I can't wait to start training and build up my mileage again.

Anyway, in vet life, I learned how to dry off dairy cows this morning. It was really neat to do and I realized that I really do like working with cows and large animals. In fact, my surgery from Tuesday (my steer calf) and I have finally come to an agreement. He is one of the laziest animals I have ever met and spends more time laying down than any other steer in the ward. So instead of putting him in the headgate (which he hates), I just let him stay laying down and he lets me do what I want. Today, he nuzzled me. It was freaking adorable.