i have to be up in 4.5 hours

and i'm blogging. oh well. i usually start a post with some direction in mind, generally something that is either interesting or that is niggling at me. or maybe just to update my 3 readers on my grades and current veterinary student status. such is not the case this morning. i'm just blogging because i'm not quite ready to go to bed. i've spent the last 9 hours reviewing oncology (with an hour break for dinner). i didn't realize how much material we'd covered since school started. but considering we've been in school for almost 2 months, and this is our first oncology test, i should have realized it would be a lot of information. ah well. it took me 2 hours longer to finish than i thought. i was aiming for midnight...

in exciting gastrointestinal news, i think i have an ulcer. i'm self-diagnosing, of course. who needs a doctor? i even know the modality of therapy that is commonly used (in animals AND people), so i can treat myself empirically, if i so choose. except for prescribing drugs, i can't do that yet. i have to wait another year and 2 months. if anyone is interested, ulcers are generally related to the helicobacter bacteria that colonizes the stomach. thus, treatment is three-pronged - an antibiotic (generally amoxicillin - a gram positive, cheapo beta-lactam) for the bacterial component, a bismuth type drug to coat the stomach, and an h2 (histamine) blocker like ranitidine or famotidine. fascinating, eh? if you ever think you have an ulcer, now you know how treat it.

of course, given the rocky and generally poor medical history of our class, i probably have something much worse - like gastric adenocarcinoma or diffuse inflammatory bowel disease of some sort...but i'm trying to be optimistic. that and i'm avoiding the doctor assiduously.

see how random blogs are? i had no intent to discuss my GI issues. but oh well. that's what happens...

my new theory

is that it doesn't matter how much or how little i study. my grades will remain about the same. i was woefully under-prepared for my large animal ortho exam about a week ago (relative to my normal - read - last semester/2nd and 1st year - preparedness). granted, i went to the majority of the lectures and actually listened. yes, yours truly attended lecture and paid attention. i prepared for the test only 3 days beforehand (as opposed to last semesters minimum of 5 days with at least 2 complete passes through the material) - and i made a 94. same with the first derm exam. 3 days max prep with class attendance and attentiveness. maybe i should blow off studying all together - see what happens??

i'm up to my ears in extracurricular crap. running AWE and spearheading the exotics committee for open house hasn't been as much fun as i thought it would be. but it's significantly more work. for instance, this week i have a meeting every day except friday, it seems (including tonight). and of course class is 8-4 or 5 everday. so i'm not getting home till 6ish. why why why why do i volunteer my services for these things?? **Sigh** that's right, i'm a masochistic idiot. i tend to forget.
add to this stuff my soft tissue surgery paper (which i have finished the first draft of and submitted to dr T as of today) and my advanced imaging paper (which i haven't started)....and you can see why my 'to-do list' is several post-its long.

taking a moment to blog

about something not embarrassing. epi is eating on her own, by the way. strictly soft foods, but i'm just thankful i don't have to tube feed her. i think she thinks she's died and gone to birdie heaven. she gets applesauce, peanut butter, scrambled eggs, and softened raisin bran or cheerios. she's probably having a little birdie-gasm over the smorgasbord as we speak.

i finished the first draft of my surgery paper. it will be published in veterinary medicine, provided it doesn't suck horribly. i think i did a good job. it's hard to tell, considering i've never actually performed the surgery i profess to know so much about (that will change after tomorrow, when i actually get to do it). i'm a little apprehensive of dr t's critique. i'm normally quite confident in my writing skills. however, writing a 'how to' on scrotal urethrostomy is a bit of a new venture for me. i guess we'll see. now to studying surgical techniques for tomorrow's lab.

i'm almost too embarrassed to post this

but i guess i will. i came down with some strange bug yesterday. thursday night, i went out to dinner with a friend. i had a glass of wine - but that's all. i felt vaguely queasy after dinner, but i chalked it up to the decadent italian food we ate. at any rate, i got up to go to class yesterday - but i actually left in the middle of oncology because i felt so nauseated. i came home and crashed in bed. and i stayed there until 9:30 this morning. i slept from 3:00pm to 9:30 the next morning. i feel icky today. my head is clouded, my stomach is still overly sensitive, i have a headache, etc. so i can say this mistake is totally due to my illness. i dragged myself out of bed to do my obligatory saturday clean. i was cleaning bird cages when my phone rang. it was the army recruiter with some additional information for me. now before ya'll start fretting and think i signed my life over to the army - fear not. i wasn't out of the room for 15 secs before i remembered that i had left epi out of her cage. as i ran toward the bird room, i heard a birdie screech - which i knew to be bad. i didn't know how bad until i scooped epi up and looked at her. last time, it was a small crack across the top of her beak, one that looked moderately bad but wasn't. this time - BAD. she has 3 beak fractures - full thickness through the beak in the case of 2. the other is a mandibular (jaw) fracture under the skin. at any rate, there was a big piece of loosely flapping beak. she didn't even scream when titus did it - the bird screech i'd heard was titus (she'd gotten him a bit on the chin). i'd never seen a beak fracture like this, so i had to speed over to school.

dr greenacre came in (after JUST having left for the morning) and put her under anesthesia. she then used a needle to bore two holes in the beak - one on either side of the fracture line. she threaded the holes with wire to close the beak back together. unfortunately, epi is tiny - and dr g couldn't find small enough wire, so the wire ripped through the holes and through the beak. then epi started to wake up from the gas, so we had to put her back under. she let out a little scream as she woke up, which made me feel terrible. at any rate, there wasn't any wire small enough, so - in the end - dr g used 2.0 PDS suture to close the fracture line. there is nothing to be done about the fracture under the skin. epi is too small for an IM pin or an external skeletal fixator. so, she's back home now - nestled up against her favorite toy - looking pathetic. the suture will have to stay in for at least 6 weeks until the beak heals, as well as the mandibular fracture. she has to eat soft food for the duration of that, until her beak is strong enough to take hard food. she also has to have daily metacam orally (an NSAID) to help with the pain. on the bright side, she attacked the peanut butter and applesauce that i put in her cage, so i know it hasn't put a dint in her appetite.

do i need to mention how absolutely STUPID i feel for this? it was completely and totally avoidable. but i was sick and tired and i wasn't thinking clearly...yada yada yada. it's just that epi has gotten really excessively aggressive lately. she wasn't always this territorial. but lately, she even bites me - which is unusual. i gave in when i got home and moved her cage into a different room. she now has her own window and a little bit of space. maybe that will calm her down some. i guess we'll see. if i have to take her in one more time, i'm going to SCREAM. plus, it was really scary having to put her under anesthesia. she was so pitiful...

it's almost a full moon.

today was unreal. at least i know i can be a decent ER doctor - although i don't think i want the enormous responsibility of managing all of these horrible traumas/illnesses at one time. i'm just not good enough. is anyone??

today, i had the following cases present to me (all within 4 hours): 1) dog kicked in the head by a horse resulting in head trauma + broken jaw 2) different dog/same horse - kicked in the chest with horrible pulmonary contusions, hemothorax, rib fractures, and pneumothorax 3) different dog/same horse kicked in face - leaving large laceration that i had to sew up 4) dog that drank antifreeze an hour before and whose owners didn't have $$ for antidote 5) chocolate toxicity that ate 50mg/kg or some ridiculous dose AND THEN THE PIECE DE RESISTANCE: a DOG THAT WAS HIT BY A TRAIN. yes, you read that right - hit by a fucking train. his back leg was torn off at the knee, his tail was torn off, his head was degloved, and he had schiff-sherrington posture on presentation. 2 spinal fractures were found on xrays (after we bandaged him, placed an IV cath, and gave him his fluids and pain meds). the spine was actually broken completely in half and one fragment was underneath the other by about 6 inches. it was terrible. needless to say - euthanized. the owners saw the whole terrible thing unfold before them as they tried desperately to get him off the tracks.

i had to place a chest tube in the kicked dog (ALL BY MYSELF FOR THE FIRST TIME) and auto-transfuse all the blood right back into him, i cared for him all day, until he succumbed to internal thoracic bleeding - despite autotransfusion, packed RBCs, and heavy duty intensive care. thoracotomy/surgery wasn't really an option, so we tried to manage him (to no avail, obviously). i admitted him at 3:00pm, stabilized him, he crashed and burned at midnight. my antifreeze dog wound up being treated with PGA due to owner financial constraints and is currently doing well, my chocolate toxicity was stable and then suddenly (totally out of nowhere) FELL OVER FUCKING DEAD at around midnight too. no one has ANY clue why. he received the standard treatment for toxin - apomorphine, activated charcoal/sorbitol, IV fluid bolus. one moment, he was up and vocal, then he literally fell over and died. he couldn't be resuscitated. even the great sallye gregg is stumped as to why.

if i'd had 30 seconds to stop and think about what i had to do today - all the treatments i had to administer and the decisions i had to make, i think i would have been completely paralyzed by fear. luckily, i didn't stop to think. and i lived. not all of my patients did.

i was there 5 hours past the end of my shift at 8pm (it's 1:15am, and i just got home). i have to be back at work in 6.5 hours, so i think i should sleep now.

matters of finance (aka in defense of ourselves)

i'm a little reluctant to discuss this on my blog, because it's a very sensitive subject for me. money, that is. it always has been, ever since i was little. further, talking about financial matters in such a public forum opens me up to the criticism of friends and family, who - even though probably meaning well - don't realize how sensitive i am about the whole issue. despite all of this, i'm going to take a gamble and put it out there. how nouveau of me (sarcasm).

going to vet school cost a great deal of money. tuition alone is in the range of $15,000 a year. couple that with the fact that i couldn't work while in vet school (as i hope my blog of the last 3.5 years evidences), and you'll see that my choice of education rapidly becomes a huge financial strain. that's actually one of the reasons i opted to not go into veterinary medicine in the first place, way back during my junior year of college. i actually had some foresight. amazing, i know.

however, almost 4 years ago, jim and i decided to take the plunge together. he for his phd, me for my dvm. and now, almost on the other side of that four years, we are in a somewhat bloodless turnip stage of our lives.

now, i've heard mumblings and mutterings about jim and i not saving money. i won't name names, but i know people think jim and i are bad with money. and i won't argue that we have been great. well, let me restate that. jim is fine with money. he doesn't buy stuff for himself, doesn't want to go to concerts, cooks dinner to help keep our eating out (which is a frequent event, given our schedules) to a minimum. so really, the problem has mostly lain with me. i used to have a shopping addiction - it was like heroin for me. but i got that under control completely. in fact, i can't remember the last time i went shopping for clothes. we don't have new computers, we don't have internet on our cell phones, we don't have 3000 cable channels, we don't have brand new furniture, we don't have cars we can't afford, and we don't have expensive pets (cat food is all free from school, as are my vaccines, which i don't give my cats anyway - and the bird food costs about $40 every 2 months or so). despite all this, we find ourselves scraping by for money quite often. but, for those of you who would so criticize this, i will offer this information: jim and i have been together 11 years, as of january 18th. in those 11 years, we have been students almost the entire time - with a few SHORT hiatuses. we paid for our wedding ourselves - with contributing financial gifts from our parents. we paid for my education - both undergraduate and vet school. despite being tight for money, we both have health insurance and no credit card debt.

this all sounds terribly defensive, and that isn't my point. what i'm trying to get at is that one of the biggest reasons i'm seriously considering foregoing an internship is that we can't afford it. the pay is dismal, relocation costs are not reimbursed or even offset in the slightest. it's going to be very expensive to do one. financial problems obviously put strain on any relationship. couple that with the fact that i'm going to be working an incredibly demanding, rigorous schedule for a year, and i can see why our marriage might really suffer for yet another year. i'm just not sure i'm willing to put jim and i through any more seemingly unnecessary strain. it weighs heavily on me. i feel like i haven't put enough into our marriage during vet school. honestly, we've both neglected each other - our educations have been rather all consuming. we've both been selfish. now i feel like it's time for me to be unselfish a little. i can still be a good doctor without an internship. i'm a hard worker, i'm motivated, i love to learn. i can continually challenge myself. i can find fulfillment in whatever i do, right?

so for those of you who think that jim and i are irresponsible and bad with money - rest assured that besides our school debt, we don't have any credit card debt, we don't have car debt, we've never bounced a check, missed a rent payment, missed a phone bill payment, or even come close to being delinquent on anything. and we're getting along fine - if a bit tightly.

laxity unresolved

(Sigh)
i think derm is gonna be bad. but only because i could care less about:

fleas.

pyoderma.

mites.

scabies.

folliculitis.

furunculosis (though i do dig the word).

etc
etc
etc

signing off now for more studying (snicker)