Sunday, December 30, 2007

the real world part 1

i just deleted an entire post because it bored me to tears. yes to tears. i'm sitting here crying, i'm so bored.

i've been thinking - as of late - how different my life will be in 4 short months. just 4 months and my day-to-day life will become something entirely new. i'll be a professional, holding a doctorate degree, a real solid person in the world - no longer an ephemeral academic. i'm not good with change. at one time in my life massive changes could easily precipitate all-out panic attacks. this was back before i learned that i could control my panic attacks. or at least have the illusion of controlling them (without medication, thank you very much). i've been so immersed - so totally and completely submerged in my education that i don't know what i'm going to do when school ends. my education will never end, i hope to continue learning till the day i die. but my formal education - at the hands of professors - more than likely ends in may.

what am i going to do? i've decided that i'm going to explore the things i've wanted to do for a long time, but i've kept putting them off because vet school has been so all-consuming. in undergrad - for those of you who don't know this about me - i rode on the equestrian team (i rode english - equitation and jumping). in my spare time, i jaunted around large pastures on a friend's horses. very occasionally, i went foxhunting. now, i can't clearly remember the last time i rode. i sold my beautiful saddle ages ago - why let it gather dust in the closet?

i used to read voraciously. i still read - but not nearly as much now as i once did (my overfull bookcase points to this truth). i love music and going to shows. i've managed to attend concerts sporadically - but due to the drive involved with many, i see far fewer than i would like. (although i got to see the avett brothers again last night and DAMN are they amazing live).

i've always wanted to learn to ballroom dance. my grandparents were professional ballroom dancers, long before i was born. i've also always wanted to learn to play an instrument - the piano or violin. i've decided i will pursue one or both of those things post-graduation.

this smacks of a new years resolution post - but it isn't. this is a post-vet school graduation resolution. i'm going to stop wishing i'd done those things and do them. after all, time grows ever shorter, eh? also on the list: have a family of 2-4 children, finish reading all the "to-read" books on my shelves, own an off the track thoroughbred to take more riding lessons with, spend more time with my other family members and husband.

i'm so ready to have a real life.

Thursday, December 27, 2007

would love some feedback - please!

greetings from sunny, balmy florida. christmas day was lovely but the day after was even more beautiful. blue skies, gentle breeze, a gorgeous early spring (winter?) day all around. if this is global warming - i LOVE it.

so, i'm in a dilemma - and i'm asking for opinions. i have a few regular readers - some in the vet scene, some not - but i want to know what others think. within 20ish days, i have to decide whether to stay in the match or withdraw. if i stay in, i will rank 6 places: 4 academic internships, 2 private. these will be 6-7 day work weeks, long hours, low ($25,000) pay without possibility of a 2nd job as a relief vet elsewhere, and no real vacation. due to lack of funds and my senior year being diabolically busy (boards, matching, plus my rotations) - i haven't visited ANY of these places and thus have no idea how or if i'll fit in or even like the place. BUT these internships will be incredible learning opportunities, i will really develop as a diagnostician - as well as refine my ability to treat and manage diseases in both acute and more long-term situations. i will be able to pursue a residency if i want to do so after one of these internships - but i can also work for a while. doing a competitive, top-notch, structured internship will make me a better doctor right off the bat. all are a 5 hour drive away from home, which means my long-suffering but patient and wonderful husband will have to commute 2 days a week to teach classes so that he can keep his stipend. thus, he will spend tues, wed, and thursday of every week away from me. lastly - and least importantly, i'm competitive and driven as hell and want to prove to myself that i'm good enough to capture one of these positions and excel.

my other opportunity is taking the internship offered to me already (outside of the match). it pays $30,000, i work a week then take a week off which means i can work as a relief vet nearby and make an "extra" $30,000-45,000 per year. it's only an hour and a half drive from our current home - only 3.5 hours from our real home, so husband can keep his stipend and assitanceship, have an easy commute, and come home to me at the end of the day instead of staying away (although mostly, i won't be at home because i'll be slaving away as an intern). i'm also not so far from my family - either of them. i love the place, i love the staff, i felt welcomed - i felt like a part of the team. it was a fantastic place for me - and the clinic is beautiful. it pays well, it's a good fit for me personally, but it's not competitive for residencies and may require that i do another one later if i decide to pursue that course. further, it's not structured at all - so teaching opportunities outside of being a real doctor are few. there are no structured case rounds, no journal club, no rounds of any sort - yet. the organization is a bit lacking at times, but it's something i can live with - i think.

so...i'm opening the floor to my few but faithful readers. what do you think - whether you're a fellow vet student or not?? i'm torn still. my heart seems to know the answer - but my head is trying to be stubborn and pragmatic...i'd like to hear how others feel.

christmas thanks

i didn't do a real thanksgiving post. i think i just bitched about being tired and upcoming boards and being sick. so i'm going to take a moment and actually list the gifts life has given me.

1) my husband - patient, forgiving, loyal, and supportive through 4 years that have sorely taxed us both in many ways (ahem- vet school). after almost 9 years of marriage (yes, nine!) - i am still sad when i'm the first one home. i am still happy when i hear a car door slam and know it's him coming home. i still like to surprise him at school and take him to lunch. he's still my best friend and the person that gets me through the rough patches.

2) my family - flaws yes. outweighed by what they give me? most definitely. without my family, i wouldn't be who i am today - the good and the bad. i feel incredibly lucky to know that if i ever needed anything, if i was ever in trouble - whether of my own making or otherwise - i have not one but TWO families to whom i could turn. not only was i born with an incredibly close family - but i married into one that over the years (11 of them all told!) has become a part of me. they are as much a part of me as the family to which i was born.

3) my friends - those that i would call my close friends are numbered in single digits (family members excluded). but those people that i do call true friends are as dear to me as family. i know - in a moment - they would be with me, should i need them. miles separate me from some of them - but our hearts are never separated.

4) the opportunity to be a veterinarian - i am blessed with enough motivation and intelligence to pursue a rigorous degree in a rigorous program in a country with only 27 vet schools. despite having to take out a massive amount of financial aid to pave the way, in 4.5 short months, i will be walking across a stage to receive my DVM degree. i never imagined i could or would do it, but with the support of my husband and family, i'm almost there.

5) my country - despite its shortcomings, i wouldn't choose to live anywhere else in the world. i'm proud of my country and all that it stands for - i think we are - as someone once said - "like a shining city on a hill."

enough maudlin ramblings for the evening?

i'm going to do it

i'm going to tempt the black fates that mock human arrogance. i'm going to utter a phrase that no one with any common sense would utter for fear of jinxing themselves.

i have not YET been bitten. i've had close calls with animals - dogs and cats that is. i've been gnawed on by plenty of parrots - big and small. it hurts, but it's something to which i'm accustomed. parrot beaks don't frighten me much. but as for dogs and cats - not one has sunk its fangs into me. YET. but i know it' s coming. i try not to worry about it too much. and on a day to day basis, i rarely think about it. i've absentmindedly palpated a large dog's abdomen before while discussing disease processes with an owner - and nearly had my arm removed - but i dodged the bullet. i've examined a painful, glaucomatous eye and pulled my hand back fast enough to evade the quick, sharp teeth of an annoyed blue heeler. i've yanked my hand back just barely fast enough to avoid needle sharp cat teeth on more than one occasion - though the teeth skimmed me and ripped my glove open. yet, the actual teeth sinking into flesh hasn't happened.

it's not something i'm thinking about and worrying about daily - it certainly doesn't prevent me from doing thorough physical exams or being hand's on with my patients - but every now and then, i suddenly think - "hey, i'm gonna get bitten. probably more than once in my life. and it's gonna hurt like hell."

that scares me a little.

Saturday, December 22, 2007

goings on and what-have-you

i'm at the in-laws for "christmas" - since all but 1 of husband's four siblings are married - getting together all on one day becomes more and more difficult. this year we elected to all get together on dec 22nd and have christmas. my MIL decided that since it wasn't really christmas then no traditional christmas dinner (turkey, stuffing, etc). instead, she made filet mignon, twice baked potatoes, hot rolls, and all the rest. i can't say i missed the turkey too terribly much. but then again, i am having it on tuesday when we head down to florida to see my side o'the family. my filet mignon was sooooo delicious.

in other, definitely not-christmasy news, i ran my new 3-legged pal (norman) by school to have him looked at by my favorite professor so that she could prescribe him some pain meds. she did a brief physical on him (something i had never done, apparently) and pointed out that he had a raging heart murmur (4/6). chyeah. seriously. i slotted him for an echocardiogram and it turns out that norman has early-onset hypertrophic cardiomyopathy with systolic anterior motion of the mitral valve. i know, i know - you're thinking -- WHA?!

hypertrophic CM is a fancy way of saying that his heart, for some obscure reason, has decided to asymmetrically thicken (no, it had nothing to do with the trauma that broke his leg). no one knows what causes this disease, but it's much more common in older cats. the thickening causes the valves in the heart to stretch apart and open so that regurgitation through the valves occurs. on top of that, for some reason, the valves that separate his left atria from his left ventricle get sucked into the aorta when his heart contracts. so yeah, he's on heart medication now and will live a truncated life that will probably end 1 of 2 ways : with heart failure or with a thromboemoblism that will paralyze his rear legs. oops. i meant rear leg. luckily, atenolol is cheap. not great news. but he's happy and healthy now and going to live with my BF, her husband (my brother in law), and their other 2 animals.

i suppose that it's for now.

angels of death

angels of death
as my friend over at all but 1 has noted, veterinary medicine can be a bit sad sometimes. you fight hard for your patients. sometimes you win those battles, but in emergency medicine (and oncology) - often you lose those battles. yet in that inevitable truth lies a great beauty. veterinarians can offer dignified, painless death to our patients. human doctors can (legally) not. this post is not meant to be an argument for or against human euthanasia. (sidenote: when i was young, i remember hearing my parents talking about the big debate over euthanasia and the elderly. and all i could wonder was why did people care about youth in asia? end of sidenote). to discuss human euthanasia would require navigating tricky emotional and political waters - and i don't dare tread there (mainly because i believe there are multiple "right" answers to that debate - kevorkian NOT being one of them). anyhoo, as i was saying...

one thing i got to do multiple times on my externships was offer the merciful sleep of euthanasia. i also performed quite a few - considering i've only done 1 that i can remember as a vet student that actually involved an owned animal. it was a new experience for me - being the only person present as the owners said goodbye to a beloved family member. and while it was heartwrenching, it also made me profoundly thankful that i don't have to navigate the channels and trenches of human euthanasia. few people question the job that so often falls to us as animal doctors. animal euthanasia is an accepted - dare i say - embraced tradition with which few disagree (although there are dissenters). and i'm grateful for that.

there is nothing (in the animal world, that is) quite as sad as seeing a 17 year old cat with multiple diseases stop eating or drinking but still drag on and on, somehow clinging to a shred of life. or worse, to see a young, otherwise healthy animal in agony with a broken spine . it is sad to have to end the lives of these loved ones, but it is a gift too - however much (as vets and as pet owners) - we struggle with it.

i euthanized one of my patients while on externship, and i cried with the owners as if he was my own. he was a 15 year old cat - a big, black ex-tom cat, previously healthy, with sudden onset of diabetes. it was secondary to some other disease - possibly pancreatitis, portal triad syndrome, hepatic lipidosis, or all 3. he was a very, very sick kitty. despite insulin therapy, antibiotics, and fluids, he did not get better. his owners made the difficult decision after 2 days to stop treatment. i cried when i carried his lifeless body back to make him a little coffin. but the owners thanked me for my obvious caring, my involvement with them, my calm and confident nature...and in the end, they thanked me for ending their kitty's suffering.

as much as it sucks to lose one, i'm so thankful that i have the option -that owners have the option - to stop the suffering of a their animal. so while we sometimes (especially in emergency medicine) feel like the black hooded figure with the scythe - i prefer to think of us as the benevolent angels of death - guiding animals to the afterlife (whatever that may be).

Wednesday, December 19, 2007

it's the end of the world as we know it...
apropos of nothing - i've lost 10 pounds. i now weigh about what i did in high school (124lbs). i think i've either picked up a worm of some sort from my patients or i've just been working so much, i haven't had time to eat. still, it's odd. the weight has just kind of dropped off of me. i'm not complaining, i'm always pleased when i randomly lose weight...

i just read nevil shute's book 'on the beach'. i was supposed to read it my freshman year of high school, so i'm roughly 15 years late on that. i can't remember how i passed the test in freshman english without actually reading the book - i was never one for cliff notes. passed it i did, though. maybe i skimmed the book - but honestly, it didn't even seem vaguely familiar on this reading. it was a good book, if a bit subdued. i liked how it dealt with the subject of the apocalypse so deftly and with so little melodrama. on the other hand, it might have been a little too low-key - in some ways, it lacked emotional punch.

in the theme of end of the world, the husband and i saw 'i am legend' tonight. i'm not sure what prompted me to choose it. perhaps the lack of the other remotely interesting movie-going fare - even in the independent movie scene (which is sorely lacking here in kvegas). some advice: save your money. it really wasn't worth the $7. the first 2/3rds of the movie was actually rather worthy - tense, clausterphobic, interesting. the scenes of empty, desolate, shelled out New York were arresting and spooky - if you could ignore the laughably bad - and i mean out loud laughing - CGI effects. i mean - christ - with all the money that was poured into this movie, you think they could have at least had scary monsters. these CGI fakes were so transparent and ephemeral as to be amusing. not frightening in the slightest. i was surprised at how good will smith's acting was - i've always kind of seen him as the fresh prince of bel-air. ultimately though, he couldn't hold up the slapdashed ending. really - the ending seemed so phony and so out of nowhere that i have to wonder if it wasn't tacked on after bad test audience reaction to the real ending - as depicted in matheson's novella (which, despite having a fascinating premise, sucked).

so...tomorrow heralds a day of christmas shopping, cleaning, and preparing for the holidays away from home. i wonder when my nuclear family (brothers, girlfriends) and i will start celebrating here at home and stop driving to florida. seems like a long way off - but it's getting harder every year to get away 650 miles for a week...

what else, what else? i can't believe i'm saying this - given my constant awareness of my mortality/the brevity and weight of life/etc - but i want the next 4.5 months to FLY by me. and i mean fly. i want to wake up and find out that it's may 6th - and i'm graduating vet school the next day. i am so ready to be a doctor, to be working, to be out of school for a while and doing something different. it seems a ways off to me now but only because i so urgently want it to be over so that i can move on with the next phase of my life. but i know - in my heart of hearts - it will be here all too soon. isn't that how life works? days last forever yet pass like a sigh...

Tuesday, December 18, 2007

answers come when i'm not looking for them...

i'm home again and restless. it's 1:20am - and i'm not used to being this awake and having nothing to do. i'm officially on break until january 2nd. boards are over. the matching/internship application deadline is past - everything is turned in - finished. i'm free. for the time being, that is. and what to do - what to do? well, other than shop for christmas presents, clean, pack, and get ready to frolic off for a jaunt to home, then florida...

i think i neglected to mention that the cat whose leg i amputated on my externship is now residing in my household (temporarily, i hope). the owner didn't want to pay for surgery so he relinquished the kitty. he was named grayson, but i changed it to norman (after norman bates). this kitty is a hair on the psychotic side - bipolar, at the very least. he goes from loving to be petted to growling. of course, his stump probably i'm going to wait a bit before i make any judgements about true temperament. pictures will be forthcoming, once i've charged the camera battery.

i might have raved about how much i enjoyed my externship. seems like i did, eh? i had my exit interview today - and i think, if i so desire, i could return to that clinic for an internship. and it just might be the answer to all of my concerns. the ALMOST perfect answer. it pays $30,000 (compared to $20,000 - 27,000 at any of my other choices). i love the city - the little i saw of it during my time there. you work a week, then you have a week off - during which you can do relief vet work at local clinics and earn an extra $35-40,000 a year (relief work pays very well). it's a mere hour and 45 minutes away - allowing the husband easy commute time should he need to see his advisor for dissertation consultation, also allowing him to keep his stipend/assistanceship and teach 2 days a week (=$20,000 extra a year). imagine - we could be making $90,000 a year in just 5 months time. on top of all this, i loved the clinic and staff. i had access to excellent diagnostics - we had ultrasound, digital radiography (with access to the radiologists at my school for review/collaboration), 2 surgery suites, monitoring equipment for anesthesia, and excellent technicians. furthermore, specialists in ophthalmology, internal medicine, orthopedics, etc are present or available much of the time. and i LOVED emergency work. i found it (despite the odd bad case - see the post below) to be very rewarding. even though i lost some of my most difficult cases - the owners of these animals were so wonderful and so grateful - it made the sadness easier to bear.

there is a downside to all this upside, though - the organization was a little lacking and the clinic tended to run out of important stuff- like heartworm tests and green blood tubes and diff-kwik stain for blood smears. but those things - eh. you find stuff like that anywhere. my only real concern is that this internship wouldn't be super-competitive if i decided that - after all - i did want to pursue further training and do a residency. i might have to do another internship later on - at an academic institution or a more well-known referral center.

what i keep coming back to is this - i loved it there. i relished what i was doing. i felt challenged and excited and fulfilled. isn't that what's most important? i could see myself being very happy in that environment. it would be a good decision for not just myself but for my husband - which is very important, too.

yes, it might just be the answer after all...

sometimes i wonder...

this externship ends in a couple of days. it has been an exhausting and emotional 2 weeks. i've worked anywhere from 14-24 hour days. i've managed intensive cases - including a diabetic cat with pancreatitis/liver failure/portal triad syndrome and an old dog with vestibular disease - all on my own. it's been terrifying and exhilirating at the same time. i'm so afraid of making mistakes, of missing something, of not saving an animal because i wasn't fast enough or smart enough. but i loved it. LOVED IT.

but...i digress. i came here to talk about the fact that sometimes i wonder if i'll be able to do this. veterinary medicine. why? you might ask - since i so obviously love what i'm doing. i'll tell you a story then - to illustrate what makes this job so hard.

yesterday, a husband and wife came in with a 6 month old miniature pinscher. it was sunday - which = crazy around here. and i mean CRAZY. the pinscher presented for ADR (ain't doin' right) for a couple of days. i was swamped and overwhelmed, but i took the case because the otehr 2 doctors were equally busy. the puppy was obviously ill. i could hear seriously increased lung sounds, wheezes, a heart murmur, the skin would not return to its normal place when i pinched it because the dog was so dehydrated, and the mucus membranes were BLUE. that means its gums - which should be pink - were BLUE. it was obviously extremely ill. it also developed blow-out bloody diarrhea while it waited for me to examine it.

when i finally got to the puppy, i realized how sick it was. and i told the owners - who were belligerent already because they'd had to wait (in an emergency hospital, no less). they also informed me that they had 20 other dogs at home and just couldn't afford to do anything about this puppy. i told them that we needed to do bloodwork and chest radiographs to find out what was causing the sounds in the lungs (fluid, i guessed). i talked to the owners about the murmur, i talked to them about heart failure. i TOLD them that the dog - with blue mucus membranes - would not make it through the night. they declined every test in the book - they even declined fluids. we did a snap parvo test and a fecal exam in the hopes that we would find something. the owners absolutely and totally refused any sort of diagnostics or treatment, despite me practically begging them to allow me to conduct radiographs. they asked me if the dog would make it through the night again - and i said that i doubted it. i even went so far as to call them at home and beg them to come back for a lasix injection to help the supposed pulmonary edema.

they left, and i heard nothing. tonight, when i came on for the night shift, i called the owner to ask how the puppy was doing. the owner proceeded to yell at me - the puppy had died - as predicted by myself and my mentor. he called me a greedy asshole - saying that my recommendations were strictly for me to make money. AS IF. i'm getting paid $500 for this externship. he took the puppy to the vet the next day and allowed bloodwork to be conducted. at which point the vet "diagnosed" rat poisoning. just in case you're wondering - there is no definitive diagnosis for rat poisoning. you can do a clotting profile - which can increase your index of suspicion. but you cannot say for sure that the dog got into rat poison (barring finding it in the stomach on post-mortem). regardless - at least i was right about the lung sounds and heart murmur. hemothorax (blood in the chest) and increased blood turbulence due to the fact that the dog was bleeding out ... (rat poison causes decreased coagulation).

still, it hurts. it hurts that the little dog died because its owners were negligent. it hurts me that i couldn't really do anything about it. i wish i could. i offered, they declined. i couldn't do it for free. and still, i feel like the bad guy. veterinary medicine (and human medicine) is a sticky area. you want to give away health care for free - but you can't. it's a hard fact of life. still...

sometimes i wonder if i can do this the rest of my life and not become embittered...

Wednesday, December 12, 2007

they call me doc

the technicians at my externship - that is. i'm having so much fun and doing so much that i never, ever want to go back to vet school. for the first time, i see it - i see what it's like to be a doctor - to have people look to you for answers and to trust that you know the answers. this last week has been amazing. the overseeing doctors have turned me loose to take cases and treat as i see fit. and i'm confident. and i love it. i really really really love it.

i did an emergency spay on a pregnant dog (1 fetus was dead, 1 alive) in renal failure, tomorrow i'm amputating a cat's leg, i've sutured up lacerations, diagnosed and correctly managed blastomycosis (on my own, no less!), diagnosed a cat with severe anemia and given a life-saving blood tranfusion, repaired a proptosed (popped-out eye) and sutured the eye closed to let it heal...and so many other things.

i've been working anywhere from 14-24 hour shifts (one notable day started at 9am and ended at 9am the next day) - and i cannot get enough. it's rewarding and it's sad and it's hard and it's everything i thought it would be and nothing like i thought.

i don't want to go back to finish my senior year. especially since our boards are over now, and i've been out and called doctor. i just want to stay out...

only 4 more rotations to go...

Tuesday, December 4, 2007

and another one goes ... and another one goes by

meh. i went - i saw - i thought until my brains came squirting out of my ears and disgusted the person unfortunate enough to be sitting next to me. it was a test - like any other. granted, it was a looooooooooooooooot longer and a looooooooooooooooooooot harder. but it was still a test.

rather anti-climactic, i have to say. i didn't ace it/knock it out of the park/pass with flying colors, but overall, i'm happy with my performance. god, it was long. and exhausting. and now i have to pack and get up at the rear-end crack of dawn to drive an hour and a half to start my oh so fun externship. i love veterinary medicine (seriously, i do).

it's over. i have cleared the hurdle (unless of course, i failed).

Monday, December 3, 2007

T minus 14 hours and counting

till i take the biggest exam of my life.

i'm suffering an immense amount of anxiety lately - even more than usual.

i am paralyzed by indecision, as of late. i went to blocksbuster last night to choose a movie, and it took me over half an hour. i roamed the aisles, and the more i looked and tried to decide, the more stressed i became. i was actually uneasy and anxious about selecting a movie. rather indicative of my mental state lately, i must admit.

last night, lying in bed, waiting for sleep to come - i tossed and turned - filled with a nervous, coiled energy. it felt like worms were wiggling beneath my skin, i kept changing sides, sighing, and doing that thing with my hair that i recently acquired. or have i not mentioned this yet? i sucked my thumb for a way longer time than normal people. WAY longer. till i was about 12, i think. and it wasn't just thumbsucking, i would always twist my hair around my index finger while doing it. i'm not sure what made me break the habit, but at some point, i decided i was too old to be doing it, so i gave it up. however, in the last 7 months or so, i've picked up the habit of taking a chunk of hair and lightly pressing the ends against my upper lip. i haven't the faintest idea what brought it on (other than stress, of course), but it's become rather annoying in that i do it all the time. i read somewhere that gentle hair pulling/follicle stimulation releases serotonin and generates a sense of well-being. i've always had an uber-sensitive head, in that i scream if someone else brushes my hair and i can be put into a hypnotic state by having my head rubbed. but still, this habit is just getting out of hand.

ANYWAY, none of that was the point. as i laid in bed last night, i kept running through all that is going on in my life currently and it pushed me to the brink of panic.

first, i can't decide about the internship vs job thing. i feel totally paralyzed. i'm torn because of money, time commitment, further damage to my marriage, all the things i've already talked about. further, as i said 3 posts ago, vet school cost a lot of money - and i need to start paying some of that back. the burden of our student debt adds a whole other dimension to my worries. couple that with the fact that whatever happens - job or internship - i am going to be moving soon, to a new city, with new opportunities...and i'm a basket case. i don't deal well with big changes - and a few of them are coming my way in the next few months. i've been in vet school for the last 4 years. it's consumed me. i don't know who i am without it. i spent a couple of hours last night surfing the AAVMC job site for veterinarians. i saved about 20 jobs to which i'm interested in applying. and then i realized what all this really meant. i'm about to be an adult. not just an adult but finally and truly a professional in a professional field. people are going to expect me to know things, to tell them what to do - to make firm decisions and be accountable for them. real life is scary. and it's getting scarier by the minute.

i wish i could just relax but this nervous energy is radiating from me constantly. it's also making me unbelievably grouchy.

anesthesia ended on friday. it was a great rotation while it lasted, but i was happy to see it end. i didn't lose any animals under anesthesia, unless you count my last surgery on friday - which had to be euthanized on the table. after it's all said and done, i feel much, much more comfortable with anesthetizing patients now. i actually kind of know what's going on with the machines, and i'm not scared anymore. so it was a good rotation.

now, i'm officially on vacation. unless you count the fact that i have to start my externship wednesday morning. but i'm looking forward to it. i'm going to a large emergency/referral hospital in a nearby town. i expect it will be exciting. hopefully also a great learning experience. and hopefully, once my board exam is over and done with, i can shed some of this nebulous anxiety.

Wednesday, November 28, 2007

can i get a hell yeah?

i've come here again to ruminate. not in the fore-stomached ruminant sort of way, mind you. that would be far too literal for my tastes. at any rate, as everyone in the entire universe probably knows, i have been struggling for a good long while with a career decision. by january 18th, i have to decide whether or not to pursue further veterinary training as an intern or stop the madness and actually practice veterinary medicine.

of course, opinions on this subject are numerous and varied. i can't complain that i haven't had a good sampling of opinions from everyone i know. in fact, i was involved in a very heated debate amidst orthopedic surgery just yesterday. i was informed, in no uncertain terms, that without an internship, i would probably not be a good doctor. i - obviously - took huge offense to this assumption and argued quite aggressively with my antagonizer (a person i actually rather like and respect). but that's not why i came here to think aloud...

suffice to say that i have heard many, many negative remarks about private practice. granted, my population pool is skewed. i'm currently in an ivory tower of sorts - where "cutting edge" medicine is practiced (i use the term loosely). everyone in this bastion of intellect has obviously gone the route of further education. most have done it because they became disillusioned with private practice. many of my professors have worked with older doctors - out of vet school for 20 years or more, stuck in their ways, disinterested in continuing education or betterment of their practice, totally apathetic and/or burnt-out. indeed, that was my first experience with a veterinarian (at the tender age of 18). i worked for an embittered middle-aged man - stagnating - obviously - as evidenced by his rage any time an animal behaved in any way other than perfectly meekly. i watched him choke a 7 lb chihuahua once out of pure rage. he was obviously an unhappy person - someone who didn't really like animals anymore (who maybe never had). he didn't do any continuing education, didn't seem interested in improving the level of care he offered his patients, had no desire to upgrade his equipment or standard of care. in short, he was miserable at what he did - but he kept doing it - for whatever reason.

so, on the subject of disillusionment i come to discourse. my grandfather is one of my favorite people in the world. however, he is a self-professed cynic. it runs in the family, i must admit. over dinner with my family last week, he launched into a story of how his naivete with the world and the system of higher education was shattered within his first few years as a college professor. he was amazed and disgusted when grades were changed for athletes, cheaters caught and let off scott-free, and disheartened in general to see that the world, after all, isn't a very fair place. and i understand the feeling. i once sat in on a class my husband teaches. next to me and in front of me were 2 very well-known university athletes. before lecture, jim gave a quiz. i sat and watched as these 2 "students" cheated, brazenly. jim didn't see it until i indicated the problem with some not so subtle head nodding and pointing and coughing and such. and what happened? nothing. jim discussed it with his supervisor. and what it boils down to is that it doesn't matter. failing a student is much more hassle than its worth. besides they just need to pass so that they can become NFL or NBA stars. who cares anyway?

i used to get righteously angry about this sort of thing. hell, i've seen it happen in the vet school. it happens every day in every profession - just read the newspaper: drunk doctors killing patients, drunk pilots being kicked off planes, it happens everywhere.

i'm getting off track here, so i'll try to tie this up into one grand thought. actually, it's two separate thoughts that kind of come together. in regards to the cheaters, liars, thieves, and generally lazy in the world that get away with this - hell that will hold the same degree i hold -after 4 years of dedication, incredible sacrifice, and hard-work - and so what? life isn't fair. some who deserve nothing have everything and some who deserve everything have nothing. that's the way it is. life was never made to be fair. nature isn't fair. it just is. so instead of focusing on what everyone else is doing wrong and how i am working much harder, being much more dedicated, blah blah, and how we/i am getting gypped in the meantime, i can focus on myself - my career - my marriage - my situation - making it the best it can possibly be and leaving those cutting corners and practicing poor medicine to their own devices. self-righteous anger is really only detrimental to those with the feelings of anger, after all.

the real thoughts i wanted to express were on disillusionment. my grandfather thinks that when i venture out into the real world of veterinary medicine, i am going to realize that it sucks and that people suck. that every job i ever hold will end up being about the money, that i will lose the love and joy i find in veterinary medicine, because - in the end - it boils down to the money. i have thought about this a great deal - especially as of late, hearing so much unhappiness from my professors and colleagues in regards to the "real world" - and this is what i have surmised: you're going to be disappointed and disillusioned no matter where you go. no matter who you're friends with, no matter who you love, what you love, everything disappoints you. yeah, i'm going to see stuff done by colleagues and doctors that disgusts me, that i don't agree with, that i wouldn't do myself. i'm going to have to sacrifice some of my own stances on subjects because that's what happens. you can't be an idealist in an un-ideal world. what staves off the inevitable cynicism then? some would say nothing - that in the end, i will wind up exactly as my professors and colleagues and grandfather already are - cynical. but this is my staunch (and perhaps naive) attempt to take a stand. disillusionment and disappointment come if you allow them to do so - but you can make a choice. you can let the garbage flow by you - accepting that nothing is perfect, everything has its flaws - and focus on becoming the best you can be at what you do - not just your job but your marriage, your relationships, your hobbies - everything. forget the rest of the world and its imperfections. love what you have, love what you do, keep a keen and open mind, and let the rest go its way. if you can do that, i think cynicism can be kept at bay.

if i choose to go into private practice right away, i can let the things i see and disagree with embitter me. i can decide that veterinary medicine is all about money and that i will have to completely compromise myself to be successful. or i can do what i already plan to do no matter what - strive to be the best i can be at what i do. offer the highest quality medicine i am capable of offering and continue to be the person i am - someone who loves animals and loves vet med. i can accept those things that i can't change about the world - its essential unfairness namely - and not let it drag me down when i witness this. after all, it's not fair that people cheat and get by, people cut corners and never get caught. but what's really not fair is that people are murdered, raped, starve to death - every day - and the world moves on. it's life. get over it, cynics.

if i go into an internship, i'll bitch and moan (as i always do) about how hard it is. but i'll love it too. if i stay in academia, i'll love it, i'm sure. but just like anything and everything, i'll be disappointed in some way - and yes, probably disillusioned. but...i've already said it all. accept life as it comes to you, keep an open mind to it, advance yourself, your knowledge, your relationships and loves, and the rest...well to hell with it.

then again, maybe i am terribly naive.

Monday, November 26, 2007

second verse, same as the first.

the nex week is going to be fantastic. and by fantastic, i mean AWFUL.

the wedding this past weekend was fabulous. everything was gorgeous, it went off with only a minor hitch or two (AWOL hair dresser, last minute hair scramble, etc). we had a great time, and i got to see my family - both of them. a little anyway. there was much to do and a very short time in which to do it all. schlepping back and forth between the families proved difficult, and i didn't get to see much of my blood relatives. hopefully that will be remedied over christmas...but we'll see. money money money - always money.

and our football team won - in a spectacular 4 OT game - and they're off to the division championship! whoo. i didn't get to watch the game - as it coincided with the wedding, however - i did have a handheld radio which i kept at close hand throughout (including the reception) so that i might hear the results of the game. since pretty much every native in our state is a football fan, it was no surprise that when we erupted into cheers during the reception over our precarious win that the DJ broke into our rousing and well-known (and despised) fight song.

the 2 black furballs went to live with my parents. mom and dad lost their 8 year old cat to acute renal failure a few months ago and have been lonely ever since. i had planned on giving them the male kitten, but when they saw the mittens together - they couldn't resist. so both kittens are now gone. i'm a little sad, i'd gotten used to my little shadows.

anesthesia ends in a week. i also take my board exam in 1 week. between now and then, i have 2 ICU duty nights. that means i arrive at school around 7:30am and stay till midnight. i hate ICU duty (as i might have previously mentioned). and i'm stressing a bit about my licensing exam - since i was at school very late this evening and will be again tomorrow and thursday. this month has been jam-packed - and i haven't prepared as much as i'd like. fortunately, i'm coming up on my 2 week "vacation." most of you will recall that i elected to end my externship early and come home from florida. so i'm making up those 2 weeks over vacation. however, i don't start until next tuesday, after i take my board exam. so i have a three day weekend during which to cram cram cram cram.

i'm excited about my externship. it's at a critical care/emergency/referral hospital about an hour and a half away. i think it's going to be a great experience. it's close enough that i can come home, if the need arises. after it's over, i have 2 weeks of christmas vacation. then it's january - and i have a mere four rotations left!

as for the internship vs. job front - i go back and forth every single day. i'm still officially in the matching program - as i've finished all of the application materials, had letters of rec sent, and have finally finished and sent my CV and letter of intent. now all that's left to do is determine if i actually want to go through with it or not. can i still be a good doctor without it? i cannot decide how much of my desire to do an internship is based on an actual need to do it versus an insane drive/competitiveness to prove that i can. argh. every single day brings a new twist and a new consideration and a new lack of decision-making. oh well. i have until jan 18.

i'm breaking the rule of my blog and posting pictures of the wedding. they'll come down in fairly short order, but in the meantime - enjoy.

Wednesday, November 21, 2007

here i am again

studying for a test. as per usual. it's a urinary exam this time, my 2nd test of 3 (the final being...well - the final). today was pretty mellow at school - only 2 lectures - and a lab. i'm feeling pretty good in general. we found a place to live, once school gets out. our previous landlord just bought a new house for a rental property - and it's about as perfect as you can get (for us). it's 2 bedrooms with a real dining room/breakfast nook. it also has a 'spare' room that's too oddly shaped to be a bedroom - but is perfect for bird cages. it has hardwood floors and plenty of space. only one bathroom, but i couldn't care less at this point. it's reasonably priced - and it's near enough to school. it's fairly close to rhiannon too (about a 5 min drive). it's also RIGHT NEXT to the farmer's market - so no more kroger for birdie veggies. i'm thrilled that the weight of finding a place to live that would accept all of our pets has so unexpectedly and expediantly been taken care of. it's more of a relief than even i realized it would be.

in other news...i can't believe how fast this semester has flown by. we only have 9 more days of class - and then finals are upon us. kind of a scary thought. but i'm cavalier right now. my grades are good - i've been able to relax a little lately - because i've worked so diligently throughout the semester. and i'm just generally in a good mood. my social neuroses seem to be calming themselves. i am realizing anew the value of my family and the friends i already have. i can get along with people at school - hang out with them and enjoy their company. but it doesn't have to extend beyond that. i don't feel so socially obvious, i guess. it's weird - i know. but i'm realizing that i enjoy my own company and that of my family and old friends. i think i expect too much - loads of friends and constant social activity. when i step back - i realize it's because i have a driving need to be accepted and fit in, not because i feel any personal lack of companionship and love in my life. i think i always felt like a misfit in high school - and to some extent - undergrad. and that feeling has carried over and created a need to feel liked by everyone i know. but in the end, is that really all that important?

in sad news, we won't be congregating at granny russells this year for thanksgiving. i had just finished telling my friends today about the amazing food and family togetherness that always goes on at the russells - and how much i was looking forward to it. but granny is getting older and the strain of feeding and entertaining 20 or 30 people has finally become too much. it makes me sad because i realize that all things - no matter how good and important - must come to an end. it makes me sad for jim, and it makes me sad for the day when it happens in my family too. it also makes me want to cherish the time and family i have all the more. we will still be gathering -but at a buffet instead of granny's house. time does pass too rapidly.

life is good.

Tuesday, November 20, 2007

busy turkey day

since i'm about to run off for a weekend, i thought i would go ahead and do my thanksgiving post.

i still feel like crapola. oh wait. i'm not giving thanks for that. i don't believe it's flu anymore. i'm not sick enough. yet. i feel like i need to say yet...just in case i jinx myself. vet school has made me superstitious.

so my sister-in-law is getting married on saturday. this happens to coincide with the few and hallowed days of fall - football saturdays. we're playing our last game of the season, which will determine if we get into the championship game. and i don't get to watch it. i'm so, so sad. don't get me wrong, i love weddings. especially when i get to wear a beautiful dress, have my hair done, dance, and look pretty. but saturday during the fall is a sacred time dammit. it's going to be hard to be discreet with a radio plugged into my ear from 1:30 until 5. especially since the wedding starts at 4:30. maybe i can just wear the earpiece in my left ear, that way the guests won't notice.

so, the wedding is an all day affair - bridesmaid breakfast in the morning, hair in the late morning, other stuff up until 4:30. and it's a baptist wedding. we all know what that means - lots of SOBER people NOT dancing. actually, there is dancing. just no alcohol. and all white people. *sigh* i'm not a drunk (despite my kitten/vomit story), but i really do enjoy alcohol at a wedding. it makes them all the more fun. sooooo....friday evening will be spent doing the traditional rehearsal dinner stuff. it leaves me some time on the actual turkey day to see my other, blood, extended family. most of the relatives from florida are coming up to visit. i can't complain about having actual time off from school and not being on call for emergency anesthesia, especially since i was on call july 4th when the family was here (for surgery). but...i won't have too much spare time to spend.

it's going to be a very, very busy 4 days. and i only have 1 week left on anesthesia. hard to believe that another rotation is almost finished. i have the following left: equine and farm animal med (1 month), radiology/pathology part II (1 month), avian/exotics and externship (1 month), small animal med/oncology (1 month), and equine surgery/overnight critical care (1 month). that means i have 5 months of my senior year left. it's going by really, really fast. as i might have mentioned.

Monday, November 19, 2007

my last exciting day in the neuro ward

this is how NOT to hold a canine speculum.

i spent my last night on emergency duty. i arrived at 7:30 in the morning and left shortly after 11:30pm. it was a loooooong day. and not a very good one. as usual, i spent most of it feeling like i was in the way. i tried to volunteer myself for jobs - and to be helpful. but to no real avail. this whole week was a disappointment. i worked as a vet tech essentially - cleaning cages, giving meds. other than 1 exciting activity, i did nothing 'vet-like' this entire week.

the final night was what got to me. on emergency duty, we received a very elderly dog in acute renal failure. we stabilized the dog (gave it fluids, some minor pain meds, etc). the emergency doctor decided to catheterize the dog. a good decision, as when the kidneys are failing - it's crucial to monitor urine output. i held an oxygen mask on the dog's face while the doctor prepared a sterile catheter and set to work. catheterizing a female dog is not easy. of male and female dogs and cats, female dogs are the hardest. this dog was elderly. it was very, very ill and dyspneic (in extreme respiratory distress). it was also evidently in some pain. at any rate, the best thing for this patient (in my humble opinion) would be to stabilize her with fluids, catheterize her quickly and painlessly and get her into an oxygen cage. that was not to be. the doctor spent over AN HOUR trying to insert the catheter. at one point, blood was on the tip of the catheter and he jokingly said, 'if this dog didn't have a urinary tract infection to begin with, it does now!' an hour and 10 minutes into trying to catheterize this poor, poor dog that was struggling to stay alive and breathe, i gently suggested that he turn the speculum right side up. he was holding it upside down. i did not say it was upside down but tried to tactfully offer a better solution for visualizing the urethral tubercle. after all, we're all 'colleagues' here, right? i also offered to try the catheterization- because my fingers are tiny compared to his (this was a 12 pound dog). he couldn't get his pinkie all the way into the vulva to expose the urethral opening. he ignored me. at some point (an hour and 20 mins?), he gave up - and we were able to put the dog in an oxygen cage.

at that point, the evening was more or less done. it was 10:30. we were scheduled to be on till 11pm, but seeing as how we're 2nd years - and apparently fairly useless - i asked our overseeing students (4th years) if we might call it a night. they all readily agreed. however, the doctor looked at me - and in a snide voice informed me that we needed to stay until the students left. to get the whole experience of 4th year. i knew - without a doubt - that his frustration at his inability to catheterize the dog was bearing down on me. i turned around and walked out of ICU and went to find the other students (to see if there was something i could do to burn the next 30 mins). when i left, he turned to the 4th year overseeing me - and said "i didn't appreciate her smart-ass comments. if she'd been more helpful, i would have let her go home." this -- after all week -- i have been everywhere - offering to do ANYTHING i could to help the students - even bringing them lunch or running stupid, un-vet related errands. this doctor worked with me for 2 hours and said this about me.

now, i understand completely that he was frustrated and felt embarrassed about the catheter thing. i would too. and i understand completely that sometimes there are things that have to be done that are extremely difficult - for whatever reason. and i understand that everyone makes mistakes - and that sometimes people can't do something that should be relatively accomplishable. i understood all that. what i don't understand is how some people can be so petty. i was truly interested in the health and well-being of this dog. yes, i was impatient after standing still holding an oxygen mask for an hour on a dog's face. but seeing the dog struggle to breathe - and seeing the obvious distress (though mildly sedated, she was still conscious) that this procedure was putting her through - made me impatient to help her. i was under the false notion that our first concern was the patient's health, followed by learning (as this is a teaching hospital). i was also operating under the assumption that we're all colleagues. and - despite the fact that i'm just a vet student - i could maybe offer some thoughts on the subject. ESPECIALLY considering the fact that we had our catheterization lab in renal systems a mere 3 weeks ago. doing this exact thing (albeit on cadavers - which are MUCH harder to work with). i'm a silly girl.

i'm not angry with the doctor that was on emergency that night, though he didn't exactly ingratiate himself to me. i'm just frustrated about school in general. the whole week was more or less a waste. i didn't learn much or get any hand's on experience. i spent most of the week trying to help out and stay out of the way of the doctors and 4th years. i'm also frustrated at my inability to keep my mouth shut when it seems that i should. i shouldn't give advice to my superiors. or should i? the procedure wasn't going to kill the dog (though the stress might've) - and whether he held the speculum right-side up or not seemed to make no difference in the end. why couldn't i have just kept my mouth shut?? what prompts me to say the things that other people wisely choose not to? it's a rather frustrating trait.

at any rate, the week is over- and i go back to classes. we have a test in urinary coming up on wednesday, which i need to be preparing more for. i tried to study over this past week. i often got home at 7 or so - and wound up sleeping really early. it was a hard week. i'm actually glad to be going back to class. where i can learn more stuff that i'll promptly forget and have to relearn when i'm actually a fourth year student.

Thursday, November 15, 2007

can you say hemilaminectomy?

today was my 2nd day in the neuro ward. it was a longish day, starting at 6:45 and ending at around 6:00p. i got to see 2 surgeries today - a dorsal laminectomy and a hemilaminectomy. i hope i'm spelling those right! these surgeries exist to treat herniated discs in what we like to call 'back dogs.' back dogs are dogs that become paraplegic, quadriplegic, ataxic, or otherwise severely incoordinated in their limbs due to a neurological problem. it usually happens because the little 'disc' inside the vertebrae starts to bulge out of its snug little spot and press upwards on the spinal cord. this causes pain and pressure, as well as a loss of function. so - a laminectomy is when the surgeon goes into the back from above, cuts open everything, exposing the vertebral spines. they then cut a little window into the bone (in a hemi, this is done on one half the vertebrae, in a dorsal -the window penetrates both sides of the vertebrae) and pull the disc out. this fixes the pressure - effectively decompressing the nerves.

i observed both a dorsal and a hemi today. the dorsal went as expected. the hemi was much more exciting. the doctor opened up the dog, cauterized vessels, etc - and got to the offending vertebrae. BUT - there was no bulging disc. instead - there was a purplish streak ascending the spinal cord, under the dura mater (protective covering of spinal cord). this was utterly baffling to the resident surgeon, as well as the surgeon on staff. ther were many hmmms...and ahhhs...and ... WTFs? they then performed a durotomy, which is opening up the dura. the purple material was removed and sent off to pathology. at this point, they (i should capitalize the they) suspect either trauma leading to a hematoma or a mass of some sort. apparently the dog tried to fly from the front porch- and failed. it was really neat to watch (the surgery, not the dog flying off the porch). i was also relatively useless. the only function i served was to run out of the surgery suite looking for vet techs to retrieve important instruments - like the oddly named Gelpi. the other thing i did was push the doctor's magnifying/microscope lenses back up everytime they slid down his nose. he was in a rush and forgot to screw the thing on tight. i almost offered to get the screwdriver and do it myself - but when the words "i can screw" almost came out of my mouth, i recanted of the notion. probably a good thing.

standing for 2-3 hours is hard on the knees and legs. i'm always amazed by surgeons and the stamina it takes to do these kinds of things. the technology at school seemed impressive to me as well - but then - i have no real exposure to this sort of thing. i do know that i saw 2 surgeries today, both costing the owners in excess of $2500. and these are fairly common at school.

i feel like i asked too many questions today though. i was extremely inquisitive. i feel - on the one hand - that it was annoying. but on the other hand i figure - i'm paying a lot to get this DVM/education. i sure as hell better be able to ask questions. i feel like i'm learning a lot in some ways. i also feel like a big fat nuisance that's in the way of all the 4th years, residents, and attendings. it's making me feel excited about being a 4th year - and less apprehensive about it then i thought. but interacting with so many people all day is also making me slightly neurotic about my personality, mannerisms, and social skills. i'll either have to just get over that or start medicating myself. does everyone have this kind of social anxiety? or only freaks like me?

my vocabulary seems to be degenerating. i used the word feel in that paragraph 4 times. as if vet school is making me more feel-y. i feel things very deeply. yes...

i question everything i say, every joke i make, every facial expression. and i know that's excessive. i realized that i asked some things i shouldn't have today - but that's good, because i won't ask them tomorrow. but it seems that i'm more prone to making verbal mistakes than most. why couldn't i have just kept my mouth shut in the first place? i feel like god should have given me a verbal delay so that my brain has time to think it through before my mouth falls open and a question plops out (did i use the word FEEL again?) ahh, the neuroses.

my final grade in anesthesiology was a B+.

Friday, September 21, 2007

it's over

my first trip through necropsy has come to a close. i wish i had something wise to say, but really - i'm just grateful to be moving on to something else. even if that something else is radiology.

things i'm excited about in late september and october:

the avett brothers concert next weekend
the football game tomorrow night and having seats on the 50 yard line
my next block (after radiology) has med I = small animal medicine = YAY
band of horses has a new album out in october
my favorite chinese restaurant reopens oct 3rd after being bought out

my life is full of small excitements. i did a cheetah today in necropsy, by the way. it came in from the zoo. raging carcinomatosis. that means raging diffuse malignant cancer. this cat was filled from diaphragm to colon with hard white nodules of cancer. the liver was obscured by bumps. the spleen had undergone osseous metaplasia - which means that the cancer cells, for whatever odd reasons cancer cells have, decided to become bone. the spleen was so hard you could bang it on the table. it was quite dramatic. unfortunately, said cheetah showed up at 5pm, when we were finished with all the day's work. so we had to stay and do the cheetah. i didn't get home till 7ish. ah well. that's vet school, eh?

Wednesday, September 19, 2007

theme of the week

today was a vast improvement over both monday and tuesday. despite the fact that since i missed parasit, i have to make up ALL eight of the cases, instead of the one i would otherwise have been responsible for, i'm pretty mellow and happy right now. i had a chat with the pathologist - she said she knew i was being flippant when i said 'i hate necropsy' - and she wasn't aiming her comments at me...not really. also, her cat was euthanized yesterday, so she was in a rough place...and i - AS PER USUAL - took her comments totally personally. i'm such a freak.

i'm actually acclimated to the stench and gore now. i did a big horse today, with the help of a rotation-mate (usually takes 2-3 people per large animal). it was freshly dead but by no means pleasantly aromatic. no problems. no vomiting in my mouth. i'm finally ok. and i think i'll be ok next time i get down to path (which isn't till january or so). everything else is going smoothly too. i did a bearded dragon yesterday, which was interesting because it was very different than what i've been accustomed to doing.

i wish i could be a little more equilibrated...generally. i hit a small rough patch, and i just lost my cool. i felt so bad on monday and tuesday. but, it all turned out fine. and no one (besides ms bitchy) really seems to care about that patch. or even really noticed it. i always take everything too hard and too personally. even constructive criticism makes me feel like a failure. ah well. at least i've learned to pick myself up and move on, right?

i started this post with a point, but i've long since forgotten what it was. i have to give a presentation tomorrow for parasitology. i decided to do canine heartworm infection in people. yes, you can catch heartworms from dogs. well, really - you catch them from mosquitoes that caught them from dogs. but you catch my drift. it's really rather interesting. i'll spare you the gross details and pictures of my case report - which was a man with a filarial worm in his EYE. floating around in his vitreous humor (the jelly in the back of your eye). i kid you not. i know. repulsive.

but isn't repulsive the theme of the week?
today was a vast improvement over both monday and tuesday. despite the fact that since i missed parasit, i have to make up ALL eight of the cases, instead of the one i would otherwise have been responsible for, i'm pretty mellow and happy right now. i had a chat with the pathologist - she said she knew i was being flippant when i said 'i hate necropsy' - and she wasn't aiming her comments at me...not really. also, her cat was euthanized yesterday, so she was in a rough place...and i - AS PER USUAL - took her comments totally personally. i'm such a freak.

i'm actually acclimated to the stench and gore now. i did a big horse today, with the help of a rotation-mate (usually takes 2-3 people per large animal). it was freshly dead but by no means pleasantly aromatic. no problems. no vomiting in my mouth. i'm finally ok. and i think i'll be ok next time i get down to path (which isn't till january or so). everything else is going smoothly too. i did a bearded dragon yesterday, which was interesting because it was very different than what i've been accustomed to doing.

i wish i could be a little more equilibrated...generally. i hit a small rough patch, and i just lost my cool. i felt so bad on monday and tuesday. but, it all turned out fine. and no one (besides ms bitchy) really seems to care about that patch. or even really noticed it. i always take everything too hard and too personally. even constructive criticism makes me feel like a failure. ah well. at least i've learned to pick myself up and move on, right?

i started this post with a point, but i've long since forgotten what it was. i have to give a presentation tomorrow for parasitology. i decided to do canine heartworm infection in people. yes, you can catch heartworms from dogs. well, really - you catch them from mosquitoes that caught them from dogs. but you catch my drift. it's really rather interesting. i'll spare you the gross details and pictures of my case report - which was a man with a filarial worm in his EYE. floating around in his vitreous humor (the jelly in the back of your eye). i kid you not. i know. repulsive.

but isn't repulsive the theme of the week?

Monday, September 17, 2007

bad monday. bad, BAD monday.

you probably think i'm referring to some rotting carcass - deer, cow, horse, pig, whatever. but actually, necropsy itself was very low-key today. we only had a puppy (another acute death - but this time with actual history of disease) and a 7 year old cat. no, necropsy wasn't what made this monday absolute shite.

so, friday - our parasit professor says that he won't be here on monday. i think - yay, no parasit lab! then he says that the lab tech will teach. only i either didn't hear that remark or it was something i heard and mentally discarded - for whatever obscure reason my brain had. so, i woke up this morning, refreshed, relaxed. i didn't have to be at school until necropsy at 1pm. when i was ready to go, i went to grab my keys. but said keys were absent. i looked and looked. and looked. then i called jim, frantic to get to school for necropsy. luckily, he came home and got me, though the keys were not and have not been located. so, not a great start to the day. however, i still arrived early for necropsy and seated myself in the conference room, where we round every day before starting. in walks a classmate. **EDITED** looks at me, and says ''re just not going to join us for parasitology lab anymore?' and i'm completely dumbfounded. so i stammered out, 'well, we didn't have parasit lab today.' she looks at me and say (and i quote) 'oh we had lab today' - again, i still wasn't catching on, so i repeated my stupid statement, only to receive the same answer. finally, one of my other rotation mates gently reminded me that the lab tech was teaching. a little light flickered on dimly in the back of my brain, and i thought ... 'shit!' so, obviously i felt BRILLIANT. i felt like absolute pond scum for letting my rotation mates down, they probably had to do extra work due to my absence.

oh but wait, it gets better. i might have mentioned before (here in my blog, mind you) that i hate necropsy. however, i've been keeping the whining about the smell and hard work to an absolute minimum on the necropsy floor. in fact, i've tried - while i'm there and working - to have a positive attitude and keep making jokes - even when the gore and stench is getting to me. but i slipped ONCE and said that 'i hate necropsy' in front of one of the pathologists. it was the day of the rotting pig, i was cramping badly and my back ached with that slow burn that only a menstrual cycle can inflict. this pathologist, i wasn't on with her last week, but she's on with us this week. and i love her. i think she's great. she's smart, funny, and her classes were some of my favorites throughout vet school. furthermore, she's always been super-friendly to me, even once bringing me into her office to ask my opinion about some slides she was using for the 2nd year's test. i thought she liked me. but she sits down at the conference table, centers me in her sites, and says 'to start with, i'd like to say that i don't want to hear anyone say that they hate necropsy. whining about it won't change anything, and we all don't want to hear it.' she says that while staring at me. i was humiliated and near tears at this point.

anyone who has read my blog knows how seriously i take clinics, how hard i work at it, how much i've been studying and trying to be diligent about whatever i'm doing, no matter how much i dislike it. i haven't been late or missed a single day of my clinical year. and then, all at once, i seem to make as many mistakes as possible in one day.

after that, necropsy was fine. the professor was fun, as usual - sunny and helpful, showing us the way she likes her necropsies done (which is different than last week's pathologist - by a lot!), making jokes, and offering constructive advice and praise. she was super-nice. it was just such a rough start to the week - when already i am struggling with what i'm doing. and i hate, hate, hate appearing irresponsible. i carry around a lot of guilt with me because i feel like i've always been irresponsible, to some degree. sure, in high school, i always worked - starting when i was 15. but i never took any of these jobs seriously. they were minimum wage - small points in my life marked merely by their unimportance. later, during college, i was the same way. i'd wait tables for a while, then just quit. and post-undergrad, i worked in a medical office. now, the circumstances were extenuating, it was a terrible place to work, but i walked out one day and just never went back. so i've always felt bad. that i don't have a good firm work ethic. that i've never learned to stick to something, if for nothing else than to be responsible. so i've taken clinics very, very seriously - always being early, always having everything completed on time, or well-ahead, being diligent about studying nightly, even when i'm exhausted. i've worked hard. i am working hard, every single day. but days like today make me feel irresponsible and childish all over again.

*sigh* i'm just glad today is over and i can refocus and actually get my head in the right place for tomorrow

Sunday, September 16, 2007

welcome back to alice's adventures in wonderland

and by that i mean welcome back to my 2 weeks in hell traipsing through the corpses of the dead and sometimes rotting.

i must hate necropsy more than even i realize. i've been uncharacteristically depressed all day, weeping for reasons that are a little obscure, even to me. i have been reading 'the memory keeper's daughter' - which, while beautifully written and amazingly vivid, is almost stunningly depressing. i also have been so busy with this rotation that i've seen very little of my close vet school buddy - who generally helps to keep me somewhat centered in all the madness. on top of that, my other closest friend in the world is in a deep state of depression and has pretty much isolated herself. so i'm feeling melancholy and lonely. couple that with dreams of losing my intestines through my body wall, and well...i'm not quite sane these days.

anyway, it probably doesn't help that tomorrow, i plunge back into (pun totally intended) necropsy for week 2. despite the fact that parasit rounds for tomorrow were cancelled, and i don't have to be at school until the late hour of 1pm, i am still dreading it. but it IS getting better, just so ya'll know. there's a certain rhythm one develops when dealing with something as dreadful as necropsy every day. and while i by no means like it, i can face the thought of next week without nearly the trepidation that last week brought upon me.

friday wasn't as bad as i thought. we were busy - we had an elk that was hit by a semi. why, you might ask, do we need to determine cause of death in an elk that was smeared by an 18 wheeler? shouldn't cause of death be fairly easy to identify? actually, we're looking for chronic wasting disease - which is found in elk and deer. it's caused by a prion, the same type of agent that causes mad cow disease (bovine spongiform encephalopathy). we're also looking for meningeal worms...
besides the splattered elk (who actually looked pretty good for having come out on the losing end of the elk vs. semi encounter), we had a 10 week old female boxer puppy that was found inexplicably dead when the owners came home, and an 8 year old golden retriever with hypothyroidism that mysteriously died. we were actually all finished up at 3:59pm. 4pm is the cut-off for bringing new necropsies to us. guess what showed up at 3:59?? yeah, a recently deceased llama. so, we had to do it, too. but since we were all finished, it only took about 30 mins for all 6 of us to collect samples. i still got home by around 5:45.

now, i'm sitting here faced with the difficulty of writing a necropsy report on the previously mentioned boxer puppy. we opened her up with the expectation of finding a huge, obvious cause of death - ruptured stomach, electrocution, choking to death, something - anything - but it would be obvious. yeah, right. not happening. the pup was the picture of health. beautiful to cut up (although sad). so now, i'm sitting here trying to come up with differentials for an acutely dead but previously active, healthy appearing boxer puppy that doesn't involve the 10 roundworms i found in her small intestine. any ideas???

by the way, if you're ever overwhelmingly annoyed by your parrots you can give them gobstoppers. parrots produce very little saliva, so they don't really get up enough spit to get the sugar off - and none of mine are big enough to break them open and eat them. but man are they quiet for like 30 min spans! course, i wouldn't recommend this for you people with cockatoos and macaws -but for something timneh african grey or smaller, knock yourselves out!

Friday, September 14, 2007

andrew bird, half nelson, metronomes.

andrew bird, in concert, last monday. eclectic. electric.

half nelson, DVD, tonight. excellent.

doctors, metronomes, forever. elegaic.

i dreamt last night that i was disemboweled. in the dream, it was night. a blue, eerie half-light suffused everything. my jejunum and part of my large intestine were exposed. i needed help but was embarrassed, so i kept hiding them under my shirt. i would show them to selected people, but only because i was terrified that i couldn't find someone to fix me. i went to a hospital but was informed that it would be at least an hour before a doctor could treat me. i kept noticing that my intestine seemed to be tearing (although it looked like my pancreas).

i know it sounds funny, but it was exquisitely solitary. i felt so alone and frightened. at one point, i was in stands - at a football field. and there were people everywhere, but i felt so scared and alone. i was trying to avoid everyone and still find help.

trying to explain the intensity of feeling associated with dreams and nightmares to someone else is utterly impossible. it was the most profound feeling of loss - the loss of self (apparently via my jejunum), the loss of other people, the impending loss of life.

i awoke and laid in the darkness, afraid. i'm not sure of what. just afraid.

necropsy is seriously f*cking with my brain.

Thursday, September 13, 2007

i don't hate necropsy anymore

haha. made you look. i still hate it - more than i did last time i posted in a semi-hysterical state. wednesday was actually worse than tuesday. we had 3 cows and a goat to cut up. THREE COWS. do you know how much work cutting up 3 cows is? we can't just cut them up, peek inside, and be done. it involves removing every organ, as i've said before. and then - the cows must be dismembered into chunks that can be disposed of easily. god. it SUCKS. when i got home yesterday, my back ached terribly from sawing the goat's head off. and i couldn't expunge the smell of rotting and death from my mind's nostril (if you have a mind's eye, then why not a mind's nostril? i certainly seem to possess one...)

furthermore, the last 3 nights, i've gotten home at 6:30-7. now, if i were a) on a rotation i liked or b) on any other rotation - like neuro or ophtho or med then i would expect late nights - far in excess of merely 7pm. but necropsy?? keeping us at school till 6pm?? and i've had to write a necropsy report every night and do parasitology homework. when i come home from pathology, all i want to do is fall onto the couch and pass out. but i can't. it takes me - the WRITER - 3 hours or more to properly research and write my necropsy report.

but sometimes i believe in god, and that he is merciful. in the morning hours today, while doing parasitology rounds, we were informed that we had 2 horses, a cow, and a sugar glider to do this afternoon. again, 3 large animals. we were all near tears when we heard the news. the last 3 days have been so rough. and then we got to path rounds before going to the amphitheater, and it turns out that one horse was an optional necropsy and the other a disposal only. and the cow never showed up (it was an outside case). so, we had NOTHING but the sugar glider. you can imagine my intense elation.

i'm sure it will rapidly wane, as tomorrow is friday. and fridays are -- well, fridays. it's gonna be entertaining. to say the least.

Thursday, May 17, 2007

depressing week

i think the emotional weight is starting to burden me already. that's a little bad, right? i guess i'll post more later, it's been too emotional lately to talk about it now. i need to get through this week and to my next rotation, then i can post ...

Saturday, May 12, 2007

week 1 of neuro over and done with

week 1 of neuro over and done with
i thought neuro would be a scary rotation - just because it is -- well, brain surgery and all. at any rate, it's been a busy week. i had 2 interesting patients - one was really sad, the other has a good prognosis. i guess i'll talk about the sad one first.

on thursday, a lady came in with her 12 year old dog. big guy - oddly light for his substantial size. only weighed 60lbs, but he came up to my hip. some sort of chow/greyhound mix. he was a really, really nice dog - sweet-natured. at any rate, she came to see us because the dog recently had 2 seizures. no other clinical signs, just the seizures. the bad news was evident as soon as i heard the dog's history. 12 years old, no previous history of illness, sudden onset of seizures. no metabolic issues like hypoglycemia that could be causing seizures. there's 1 thing you think of immediately and that's brain tumor. typically a meningioma - as that's the most common brain tumor in older dogs. the woman was crying from the minute she started to explain the dog's problems to me - she barely got through 'he's been having seizures' before the tears started. she's really been struggling with this.

so a seizure is caused by a single neuron or a group of neurons in the forebrain that - for whatever reason - become overstimulated and start to fire. there are different types of seizures, ranging from brief absence spells, in which an animal or person just spaces out, to what used to be called grand mal seizures - but are actually tonic-clonic seizures. those are the biggies in which the animals are rigid, unresponsive, cry out, lose bowel and bladder control, and usually have post-ictal symptoms like disorientation, ravenous appetite, and maybe transient blindness.

so with that said, our biggest recommendation for diagnosis was first what's called a met check - 3 radiographs of the chest to look for metastatic cancer. for some reason, cancer in dogs loves to go to the lungs. if we suspect cancer, any type, we always look in the chest first. so we did our rads - and they were normal - yay! the next step in this case was CT scan of the brain. i was sure what we'd find. and sure enough - there it was - a big tumor, sitting in the olfactory lobe of the brain. probably a meningioma- although without doing histology, there's no way to be 100% sure that's the type. but it's definitely a tumor, and it's definitely big.

the owner was distraught, but i think she was prepared for it. the options for treatment are multiple - surgery followed by radiation, surgery alone, radiation alone, or palliative treatment (treating the symptoms without treating the tumor - steroids and phenobarb for the seizures). the owner is mulling over the options, but i don't think she has decided yet what to do. it's been an emotional couple of days for her. she came down from about 2 hours away and stayed in a hotel here while her dog was with us for 2 days. she was alone - and it made me feel bad. i can see why veterinarians get compassion fatigue. i felt so bad for her that i wanted to do something to help her - but there wasn't anything i could really do - except try to recommend a good hotel for her. it made me really sad for her.

i wasn't there when her dog was discharged and went home today. i had to be at school from 6:30-12pm, taking care of my patients. that patient wasn't going home till 3pm. i actually came back to be there, but the owner was running an hour late. i wound up going home and crashing into bed for 6 hours...wasn't the plan, but that's how it happened. it sucked, but i have to get away from that place sometime - as jim says, i'll burn myself out if i don't. i have to be back tomorrow at 7am to take care of my one patient left in ICU. that's my happy story - but i'll save that for later...

i had multiple other cases throughout the week - but my brain tumor patient and my little back dog have been the most interesting.

Friday, May 11, 2007

still kickin'

and tons to talk about - but it's 12:18 am. i got to school yesterday at 6:30am. now, 17.5 hours later, i am finally home. i have to go BACK to school in 6 hours. i was on my feet for 17 hours straight with cases - and i only have 5 hours to sleep before i have to return and care for my 2 high maintenance ICU cases...and 1 non-ICU non-high maintenance case...

hold tight, interesting stuff to come tomorrow - on my honor...

( i just realized how many numbers there were in that short short's another number -- 54, no - 36 - no 48...OK BEDTIME FOR ME)....

Sunday, May 6, 2007

i'm suffering from acute idiopathic polyradiculoneuritis

not really, else i'd be paralyzed and very unhappy. that syndrome is also known as coonhound paralysis. it's a disease of dogs (particularly coonhounds - surprising i know) that is caused by some unknown toxin in raccoon saliva. it causes a rapid ascending motor paralysis. the end result of this is that the animal is totally paralyzed - respiratory muscles included. if supported on a ventilator through the crisis, they can recover. it takes a while, though. i'm just hoping one doesn't come in this week, because i'm on neuro emergency duty from 12am-8am on friday night, and if there is a ventilator case, i get to sit with it and monitor everything for 8 hours straight. yeah. i'm serious.

i'm totally serious.

my final grades:
LA ortho: A
SA ortho: B
SA ultrasound: A
Adv Imaging: A
Derm: A
SA Soft Tissue Sx: A

still left to find out is oncology... not that it matters, but if it weren't for SA ortho, i would have made straight As. i was a little surprised, i thought i did poorly on LA ortho and went down to a B. i was never concerned about small animal ortho. oh well...

Saturday, May 5, 2007

anisocoria (that's pronounced 'gawd, aren't i stupid?')

we had an emergency surgery come in yesterday at 4:15pm. sucks, eh? on a friday afternoon. i didn't leave school until 7pm (and i got there at 8am, of course). at any rate, it was a dog with an iris perforation (or prolapse). this occurs usually when the dog has a really bad ulcer that eats all the way down through the cornea. the iris muscle can then pop out of the ulcer and hang around. not good, obviously. we went to surgery immediately to fix it. after it was over, dr m asked me to place some atropine in the dog's eye. atropine is a mydriatic/parasympatholytic. see, your pupils are under sympathetic nervous system and parasympathetic nervous system control both. when your sympathetic nervous system (from now on SNS) kicks in you have a fight or flight response. your heart rate skyrockets, you start to breathe fast, your muscles get more blood flow, and your pupils maximally dilate to let in more light for better vision. when you're relaxed, your PNS is running, and your pupils are constricted and small. well, atropine is a parasympatho-lytic drug, which means that it 'lyses' the PNS response. one result of this is that your pupil dilates. anyway, i put drops in the dog's bad eye, and went about my business. when i came home, jim and i had dinner, watched a movie. then i went to take my contacts out and was given quite a start. my left pupil was huge. my right was small and normal. it took me a minute, but it occurred to me almost immediately that i must have inadvertently touched my own eye after giving the drops.

i feel stupid because they warned us that this might happen and to be careful. and yeah, i wasn't obviously. last year, a student did the same thing. only she didn't come to the realization of what must've happened. instead, she saw a doctor and went through a score of tests before - midway through the testing, she realized what had happened. she was so embarrassed that she let the doctors finish the tests rather than tell them.

oh yes, unequal pupil size is anisocoria.

so i promised to talk about the dog with diaphragmatic hernia. but i'll start another post because alison has complained that mine are currently too long.

can we all say OW?

diaphragmatic hernia (can anyone say ow?)
so, 2 wednesdays ago - i was on emergency duty from 5pm-11pm. this entails hanging around the vet school, fielding calls from concerned owners, and taking emergency cases as they present. around 8pm, we were informed that a dog was coming in that the owner said was hit by a car (HBC, as vets refer to it). the owner said that the dog was stable.

when he came in, the dog was panting heavily but otherwise ok. no obvious trauma, broken bones, hemorrhage, the like. we took it back to ICU, and the panting steadily got worse. the dog was obviously in shock. it was pale, breathing rapidly, and weak. the internist tapped the chest for fear that the dog had a pneumothorax (breach of the chest cavity leading to air in the chest, loss of negative pressure, and lung collapse - called atelectasis). the chest taps were negative. we were exceedingly puzzled, as the dog was obviously in respiratory distress. pneumothorax is quite common after HBC. we tapped again, and the chest tap was still negative - on both sides. we should have known what was wrong immediately after listening to the heart. in a dog, the heart sounds are loudest on the left side and much more muted on the right. when we ausculted, the heart was on the right side, and nothing was heard on the left at all. we stabilized him as best we could and prepared to take him to radiology. as we were wheeling him down there a tech suggested diaphragmatic hernia. it was like a light went on - duh! of course.

xrays confirmed it, there was indeed a DH - and a bad one. DH is exactly what it sounds like. the sudden increased pressure in the abdomen (as a result of the car hitting the dog) leads to an explosive rupture of the diaphragm. this hole in the diaphragm allows things that should stay in the abdomen to rush into the chest like there's a party goin' on and hang out there. and that's what had happened. the stomach was all the way up to the heart and had displaced it to the right side of the chest. the spleen was up there too - whoopin' it up with the stomach. the xrays were impressive, to say the least. the stomach was filled with gas and bloated, so it was easy to see.

the dog, meanwhile, was rapidly going into respiratory arrest. he was most comfortable and could breathe most when he was held upright with his front legs in the air. we're guessing that the stomach fell lower when we did that, allowing him to breathe. my rotation mate, thomas, held the dog in this position for 45 minutes, while the owner decided whether to euthanize or precede with surgery. at one point, the dog stopped breathing completely, and we had to intubate him and bag him. very ER, i know.

the emergency surgery team was called in to work on the dog, and the surgery went pretty well. however, DHs have a very high complication rate - the highest mortality is within the first 24 hours after surgery. our dog was still kicking a day later, and we had high hopes for survival. unfortunately, he died 2 days later. the heart and lungs just aren't meant to withstand that kind of trauma. barotrauma and traumatic pericarditis are 2 reasons that DHs have such a piss-poor prognosis. the abdominal contents smash up against the heart and lungs, which are just not meant to handle pressure.

interestingly enough, dogs can be born with a congenital DH, in which intestines and organs slide in and out of not just the chest but the actual sac around the heart (called a peritoneal-pericardial DH). they can live years and years before some other problem necessitates xrays and someone notices the irregular silhouette of the heart and diaphragm. the traumatic ones are the baddies...

ps - avian species lack a diaphragm and rely entirely on their pectoral muscles to breathe. thus, when restraining a bird, it is crucial to not press down on their chests, else they cannot breathe.

so yeah, that's about all here for now. i'm going to look in the mirror at my normal sized pupils and enjoy feeling not weird.

Thursday, May 3, 2007

what i've learned in 2 weeks

as my first 2 week rotation draws to an end, i'd like to take this moment to reflect on what small store of knowledge i've accumulated in that time. so here are my thoughts on the ophthalmology rotation:

1) eyes rock!

2) a properly prepared vet student should ALWAYS have the following on hand at any given moment:
-a pencil - because for SOME reason, clin path likes the order numbers for cytologies written on the slides with pencil only - everybody else looks at you like you're crazy for owning one
-a ball point pen - because you're writing crap down constantly
-a Sharpie - for all those blood tubes for which a pencil OR pen won't suffice
-a calculator for quick drug calculations
-a small reference card with all drug information written on it so that you're actually capable of calculating said drugs
-the small animal nerdbook - which while small - is surprisingly heavy - and if not properly counterbalanced will cause a definite tilt toward the side of the pocket where it is located
-a hemostat, because you just never know when you're going to need to pinch an animal's toes (for deep pain perception, not because pinching animal toes is particularly amusing)
-a leash - or two - which are worth more at the vet school than a million dollars - lay one down, and you will NEVER see it again. EVER. and if you do - around another vet student's neck, you'd better have DNA evidence to prove it was once yours
-a stethoscope - for taking rectal temperatures. doh. i'd hope you'd know what a stethoscope was for without me telling you
-bandage scissors - because what good hospital doesn't bandage it's patients? getting an eye exam? here - have a bandage! and somebody has to cut those bad boys off!
-post-it notes to stick all over everything, including your forehead so that you don't forget the 15,941 things you have to do in the next hour and a half before fluffy's owner shows up 3 hours early to take fluffy home
-your picture vet ID and your student ID so that you don't find yourself on emergency duty at 10pm, banging on the door leading to the courtyard, hoping desperately someone hears you and you DON'T have to scale the chain link fence, walk through the construction site (of the new vet school addition), and climb the other chain link fence to again reach humanity (or alternately, sleep outside for the night until the doors unlock at 7am)
-the mental fortitude of a triathlete. because - my god - you'll be in one treatment area with 15 other vet students, 7 vet techs, 2 vet assistants, 8 doctors, and 43 animal - all exhibiting some sort of neurological and/or dermatological and/or ophthalmological and/or critical emergency type problem (and i'm not just referring to the animals here). and god help you if you can't a) move fast b) think fast and c) locate things when you had no prior knowledge of either their existence or whereabouts. as in 'yes dr vick, i know exactly what an Oppenheimer-Weizelsteffen micrometer is - and i'll get it right to you' - and finally, do all
this with a smile so that you don't piss of a) your classmates b) the techs c) the doctors d) the techs e) the techs f) the techs - and of course, you have to do it while the building shakes because these last few weeks have been the weeks during which pile driving of huge, 100 foot foundation spikes are being driven into the ground, a mere 13 feet from the hospital and further, these weeks have been marked by 2 power outages - one lasting 7 hours (how exactly do we run a hospital without central power? you'd be surprised - you don't really need much light for ophtho exams).

SOOOO. anyway. it's been a great rotation, in all seriousness. and in all seriousness, i do carry all of that stuff with me everywhere i go. i think if i were to weigh myself, i'd be at least 5 lbs heavier with all my gear. it's pretty funny. especially seeing myself in the mirror.

3) i DO NOT like being the 'low-man' on the totem pole, so to speak. the outgoing 4th years (tomorrow is their last day) are still with us currently, helping us adjust to the clinics and learn how to do paperwork. and we have 3 especially nice 4th years with us - who obviously know more than we do about everything - and yet, i have a huge chip on my shoulder about anyone trying to tell me anything. i tend to get short and snippy when i feel like someone is explaining something to me that i already know how to do or find. and it's a really unattractive character trait. even though tomorrow is their last day, i'm going to try really hard to keep that chip hidden for the day. i really don't like it about myself.

4) i feel really comfortable in clinics - but that might change with rotations.
so my week - overall - was fairly interesting. i had 3 great cases, one very sad, one interesting and mystifying (i had a bunch of other cases, too - but none hospitalized - and more run of the mill cataracts and glaucomas and ulcers 0h my!).

on tuesday, we saw a jack russell terrier - 10 years old. his owner complained that he'd had a sudden onset of cloudiness and redness in his right eye. he came in on emergency, and i stayed to help dr m deal with it. interestingly enough, it was another anterior lens luxation -in which the lens in the eye comes forward and hangs out under the cornea. this lens had a mild cataract, so it was much more obvious than smoky's (see previous post). what made this case interesting is that first, the JRT was 10 years old. this is an inherited problem in these dogs, and they often have lens luxations. however, it's typically at a young age - and this dog was pretty old for it. but what made it really exciting was that the owner elected to have surgery to remove the lens. however, when we went to prep the dog the morning - we found a curious thing. the lens was gone from the front of the eye. when we looked in with a transilluminator, it became apparent that the lens had fallen back into the posterior segment of the eye. it wasn't "fixed" - it was just in a different location -one not amenable to surgery. we were quite surprised, as this is a little unusual (though not unheard of). we could see the lens moving around back there. it was pretty nifty to see. it's not the greatest thing, as its presence in the back of the eye could lead to retinal detachment, so the owner is watching the eye and is prepared to come back at a moment's notice so that we can constrict the pupil - in an attempt to keep the lens forward - and do surgery.

my next case that stayed in the hospital was really sad. we saw a young black lab (4.5 years old). he was massively fat and had difficulty breathing because of his weight. but no matter, that's fixable, right? when i did my eye exam on him, i saw a disease called anterior uveitis. this is a really impressive eye disease to see because it can make the eye really pretty and visually appealing. however, it is almost always indicative of systemic disease. around here, blastomycosis (a fungal infection dogs get by inhaling spores) is a known culprit. we were fairly confident that in a dog this age with the signalment (mild fever, feeling ok otherwise, anterior uveitis) that blasto would be our underlying cause. the dog was very sweet natured, but he did NOT like having his eye examined. AU is really painful - it's basically inflammation of 2 structures deep in the eye - called the ciliary body and the iris. all kinds of secondary changes occur in the eye, including something with the flashy name of iris bombe (pronounced bombay) - in which the lens and the iris stick together, making the pupil all funky looking. (See the picture). one of our first diagnostics was chest xrays, as these can locate fungal granulomas - since blasto likes to hang out in the eye and lungs. xrays obviously can find lung metastatic cancer too. but we expected blasto. we also aspirated the two GIANT prescapular lymph nodes that dr m found on palpation (that i missed because the dog was a spaz). guess what this sweet, only 4 year old black lab had? yeah. no blasto. cancer. everywhere. not only was it cancer, but the cytology on those lymph nodes came back saying that it was some kind of crazy cancer that the cytologist, who has been a cytologist for 30 years, did not recognize. they said it much more medical jargon-y than that, but that was the gist...

so that blew. a 4.5 year old dog.

my other case was ANOTHER lab with AU. but i'll fill you in on that one later.... right now, i have to study. as usual.

Monday, April 30, 2007

kickin' ass and takin' names

i'm really super-duper proud of myself today. i diagnosed a sneaky little eye disease. of course, i was nearly bitten in the process (and badly), but i dodged the bullet this time. just a reminder that i REALLY need to get that rabies vaccination, especially considering that this dog had not been vaccinated for rabies recently. but that wasn't the point. this was a little blue heeler dog of indeterminate age and definitely determinate temperment (nasty). he had a history of an acute onset of cloudiness about 3 months ago in his left eye. his right eye was gone, but the current owner wasn't sure of the circumstances under which the eye was lost. they suspected trauma. at any rate, after nearly losing a hand to "chopper" - as i will affectionately refer to him, i muzzled the dog and preceded with my ophthal exam. i was thrilled when, upon examining the eye with a transilluminator, i saw what looked like the lens hanging out in the front of the eye.

now for a brief lesson in eye anatomy. everyone knows what the pupil is, right? the black spot in your eye, surrounded by the colored portion of the eye (the iris). well, the iris is actually a muscle surrounding that pupil, which is nothing more than an opening into the back of the eye that allows light in so that it can be detected by the retina. the lens, a basketball shaped clear object that is responsible for the refraction of light, sits back there. it's kept in place by thousands of tight little - for lack of a better word - pseudo-ligaments - called zonules. sometimes these rupture. there are a variety of causes, the most common being an inherited defect, as seen in jack russell terriers. glaucoma (increased pressure in the eye) can also cause this, as can trauma to the head (less frequently). at any rate, when i first looked in the dog's cornea (the clear part at the front of the eye/where you put your contact lens), i was 100% sure i saw the lens in front of the pupil. this represents a total luxation, where all the zonules are broken, and the lens has floated forward into the anterior chamber of the eye. i was SO excited. for my diagnosis, not so much for the dog. when the lens comes forward into the eye, it blocks a crucial angle that exists more or less solely for the purpose of draining aqueous humor (the fluid in your eye - NOT tears). when that angle is blocked, the aqueous can't get out and pressures in the eye begin to rise, leading to glaucoma. when i measured this dog's pressure, it was definitely elevated (normal is 15-25mmHg, this dog had 33mmHg). the 2nd time i looked, i had a harder time seeing the lens. after all, in a normal, cataract-free eye, the lens is crystal clear - and really hard to see, even when it's misplaced.

the doctor came and examined the dog and confirmed my diagnosis. i swelled up like a japanese blowfish, i swear to god. i was so happy to make such a definitive (and to me) difficult diagnosis. so our recommendation for this poor dog (already blind on the right side due to -- well -- not having an eye and all) was that the owner take him home, try to bring down the pressure in that eye with glaucoma medications, and that the eye be dilated with mydriatic drugs (tropicamide) to encourage the lens to fall back into the posterior chamber behind the lens (it poses less of a threat there to vision, although it still ain't good). the other option was surgery to remove the lens, but with the problem lasting 3 months already, and the pressure in the eye elevated, and the dog already experiencing visual deficits in that eye, it is unlikely that the dog will have restoration of vision (10-15% chance). he's already lost some, so the probability of ever being even 50% visual in that eye is very, very poor. those are not great odds for a surgery that costs $1000.

the owner elected medical therapy, and we sent "chopper" - the first dog to nearly take my hand off, home. he was quite the patient. we had to muzzle him to do a proper ophtho exam. it was not fun. well, the part about being right was. the rest wasn't. a cat also tried to bite me today. i must taste particularly yummy...