The End of Veterinary School...

It has been quite some time since I posted here, as I have been quite busy this year. My last post was in November and I had just finished my rotation on equine medicine. This past Friday was my last day of veterinary school ever! I can't believe how fast these last 4 years have gone by! This has been a tough 4 years, although I must say that it has been an enjoyable 4 years. Kristen and I have been apart for a while now and communicating via skype, which is hard and I am ready to finally be with her in person! Over these last two weeks I was on small animal internal medicine. I felt that I would greatly benefit from two weeks of seeing cases not only for the final examinations but for when I begin working in practice. I've learned so much in the last two weeks and knowing that much more has made me much more confident in my decision making for cases. For the next two weeks, I will be studying at home and out at the university in preparation for final exams. We have 8 oral examination stations (3 large animal, 1 anesthesia, 1 communications and 3 small animal). The communications station is 20 min long but divided into two scenarios that are 10 min each. There will be a difficult situation that we have to confront and a routine chat with a client scenario. The anesthesia station is basically us chatting with an anesthesiologist about what sedation / induction agents we would use in various patients, how to safety check an anesthesia machine and explaining all of the different breathing circuits that are available for use. All of the other stations for small and large animal are basically on history taking, physical examination and diagnostic interpretation. I am excited to sit for these oral exams and also nervous! They are going to be a wee bit scary! Following the oral examinations, we have a 3 hour multiple choice question exam on Friday. I am SOOOO ready for this to be over! Once I am finished here, I then have to sit for the Arizona Veterinary Medical Examining Board's exam! Does the testing ever end?????? Seems like one test after the other. I realize that the rest of my career will be constantly testing me, but I am ready for these stressful university exams to be over already! In three weeks, I will be free and then Kristen will be coming shortly after followed by some AZ family that will be coming to see me graduate. My grandpa will be coming all the way to Scotland!!! It will be the longest trip he has ever taken in his entire life and I am looking forward to having him here to see me graduate. Soon I will be back in AZ and it will feel oh so good to be back where the weather is warm and sunny! Looking forward to seeing you all soon! I will try and post again before finals. If not, I will definitely post after to say how I did! I did manage to pass the ridiculous NAVLE exam...I've never been bombarded by so many random questions in my entire life until I sat for that exam! Will post again soon!

End of equine rotation...and now for anesthesia!

Last week I finished my very last week on equine rotation. It was a good end to the 4 week module and we had the final MCQ examination last Friday, which was not too difficult fortunately! After a long 4 weeks on equine, I decided to head down to the city centre last weekend since I had not been down that way in quite some time. It was nice to get out and see something other than my room and the vet school! The rest of the weekend I studied for the NAVLE. I began the anesthesia rotation this week and so far it has been so much fun! Prior to this rotation, I had never seen a surgical procedure done under a general anesthetic. On Monday, we were fortunate enough to have 2 procedures to do. The first case was a horse that fractured its mandible and needed fixation via wires and screws. Unfortunately, the endotracheal tube could not be placed due to the requirement for access to the oral cavity for the procedure. So, they had to place a nasotracheal tube instead and the resident that placed it ended up hitting some of the ethmoid turbinates and caused a massage nasal hemorrhage! Once we had the ET tube in place, we attached the horse to the crane and moved it to the surgery table. About 5 minutes later, the head anesthetist noticed that the ET tube cuff was deflating and we had to place a new nasotracheal tube in. This took about 10 minutes before the anesthetist was able to get it in place, so it was quite stressful and we had to top up the injectable anesthetic so that the horse would not begin to recover. Once the tube was placed, the surgical repair of the mandible was smooth and the horse had a smooth recovery. The second horse had a surgical procedure done in the larynx so we were unable to use an ET tube at all. We had to resort to Total Intravenous Anesthesia (TIVA), which was a mix of Romifidine, Diazepam and Ketamine. TIVA is only meant to be used for about 45 min and after that, there is a ceiling effect which causes the TIVA to become ineffective. The recovery time for TIVA is quite prolonged as well as the tissues become saturated with the drugs. The total time under TIVA in this particular horse ended up being 55min and the recovery time was about 3 hours. We sat in the break room with the TV monitor watching the horse for 2 hours while it was in lateral recumbency and non mobile. The camera has a remote control, so when the horse moves, you can follow it easily. Today, we had a septic tarsal joint case that was coming in for GA to have arthroscopy and joint lavage. All in all, this week has been an extremely good week and I have learned loads on anesthesia so far. I've learned quite a bit about breathing systems and calculating O2 flow rates and interpreting CO2, etc. Has been a very good learning experience. We have some dental cases coming in tomorrow, but they are just coming in for routine rasping so that the students on Soft Tissue rotation can rasp the teeth for practice. We did this 2 weeks ago and now it is our rotation to do the anesthesia for the cases. Should be a good day tomorrow. Anyway, I should head back to study land. Happy Thanksgiving to all and I will see most of you very soon!

Equine Rotation

So I am currently on my equine rotation and just finished my ICU rotation at the equine cottage and have another ICU rotation to go, which I start next Monday. The weekend ICU shift was not bad, there were 21 horses to be treated all through the night. There were loads of grass sickness cases and several colic cases that were on 2 hourly colic checks. There are two at the hospital at the moment which resent anything you do to them. Something as simple as listening to right ventral gut sounds will cause them to hop and kick! Very frustrating and a bit scary as well, especially since I am not used to working with horses! We had a horse yesterday that has been at the hospital for several weeks now. It ran into an electrical fence and managed to catch its lower lip in the fence. The lower lip became necrotic and we removed it yesterday. Whilst we were cleaning the lower lip, the horse decided to rear and leap towards everyone in the room. Was a bit stressful but the horse managed to calm down a bit afterwards. Today we did a sinoscopy today in a case that I have been leading all week. It was presented for bilateral mucopurulent nasal discharge and had previous history of choke episodes that had since been resolved. On sinoscopy yesterday, there was quite a bit of purulent material in all of the sinuses. We placed a lavage tube and sutured it in place. Today we did the same to the opposite side and the horse loves to sneeze during sinus lavage. I was standing in front of the head today scoping the sinuses and he blew the saline we were lavaging with all over the front of me, with the majority of it going in my face...at least he was nice and did it after we removed most of the purulent material and blood clots! I begin orthopedics next week, so that should be quite fun. I am flying back on December 2nd and will be in AZ until January 18th. Will be taking the NAVLE on December 6th! Looking forward to that 7.5 hour exam! Will be very happy to be done with it at 3.30pm that day! Well, I will try and update when I can but no promises. I have been extremely busy since the last posting. Hoping everyone is well and I will talk to you all soon!

I am still here!

Yes yes, it is true! I am still here but busy as ever! Where to begin? Well, I finished 8 weeks of small animal rotations and am currently on Equine. After I completed the cardiopulmonary rotation in small animals, I then began my dermatology rotation. Dermatology consisted of atopic dermatitis...EVERY CASE! There was one case of pemphigus foliaceous that was there for a recheck. After dermatology, I then was on Oncology for 1 week. Oncology was not terribly busy and I had quite a bit of time to study for the NAVLE. Wednesdays and Thursdays were chemotherapy days, so we treated a lot of patients with mainly CHOP protocol and some with COP. All in all, it was a good rotation and I received great feedback from the senior clinician. Everyone in my rotation group received very negative feedback. Out of the five of us, I was the only one to receive excellent feedback! Was quite happy about that! So, I am now on equine rotation. This entire week has been the Dick Vet Equine Practice rotation. The calls that we go on are first opinion and mainly consists of floating teeth, lameness checks, vaccinations, etc. It is quite slow and in the slow times I have been doing fecal worm egg counts for horses and studying for the NAVLE. There was a pony that came in yesterday with seedy toe that had a dorsal hoof wall resection and was at the vet practice to have the farrier fill the defect in with acrylic. Next week I begin equine medicine and next weekend I will be on ICU nights doing colic and grass sickness checks every 2 hours. Have equine soft tissue and then orthopedic following that. After the equine rotation, I come home until January 18th! I am looking forward to working at the clinic over the summer and seeing everyone! Kristen will be coming in December as well so I am extremely excited to see her! This is going to be a great Christmas break! Well, back to NAVLE studying I go...unfortunately. Hope everyone has a great rest of their week! The weekend is near! I am going to go see Skyfall 007 tomorrow! Woohoo!

Week 2 on Internal Medicine / Cardiopulmonary Medicine

Tomorrow is the start of week two on rotation with Internal Medicine / Cardiopulmonary. Last week was extremely busy and I loved every minute of it! Each day we had to take a case that had either come in overnight or was due to come in for that particular day. I had taken on a case that was a cat with chronic neutropenia and lymphadenopathy. It had developed pleural effusion and came in for dyspnea and severe respiratory distress. It was sent home mid-week but was re-admitted, as it had collapsed at home and required thoracocentesis to drain 175ml from its pleural cavity! Lots of fluid for a little kitty! It was due to go home on Saturday but on my Friday 4pm check just before I had to be at a special seminar, I noticed the breathing pattern had changed slightly. There seemed to be more of an abdominal component with each breath. I called the primary clinician over to double check and she decided to perform a fast echo on the cat. Sure enough, the pleural effusion had returned. So much for the seminar! I spent the next 1.5 hours sedating the cat and draining the fluid from its chest. Needless to say, the cat did not go home on Saturday. Not sure if the cat will be there tomorrow or if other decisions were made over the weekend... I had another 2 cases I followed all week. I had an 18 month old cocker spaniel puppy that came in with hypoalbuminemia, peripheral edema and generalized erythematous lesions. It stayed with us for a day and went home the next day as the albumin levels had risen to within normal reference range. We deemed it a hypersensitivity reaction with severe hypoalbuminemia. We worked it up for liver disease initially as PLN and PLE were both ruled out at the referring vet. Question for the vets reading this, have you seen hypoalbuminemia around 17g/L in hypersensitivity cases? There was an argument as to what level of albumin would cause peripheral edema. The last case I had, was a labrador that was 13 yrs old that came in for a month-long cough. We did abdominal ultrasound as the referring vet was worried about an abdominal mass. Ultrasound was insignificant and we then performed CT scan, which again showed no abnormalities. Bronchoscopy revealed a 4cm long grass blade lodged in the right mainstem bronchi! We removed the foreign object and put the dog on anti-inflammatory and antibiotics. Was a satisfying case to have! I went to Perth on Saturday for hiking and spent the remainder of the weekend studying for NAVLE. I can't wait for the NAVLE to be over and done with! I haven't had much time to study for the NAVLE during the week as I have had to prepare for cardiac tutorials and work up my cases for each morning at rounds. Every morning we have to discuss our cases that each of us has with the clinicians. So I have a lot to go over tomorrow! Surely there will be a lot of treatment that occurred over the weekend with the kitty cat. Hope all is well with everyone and I will update again as soon as I have a spare moment!

My first rabbit spay/castration

So this past Monday was my group's rabbit neutering rotation. We had two spays and one castration to perform. So since there is an odd number of students in my group and only 3 neuters that were available, we had to share each one. So, for the first spay, I was on first with another group member. I opened the abdominal cavity and ligated the first ovarian artery. However, the right uterine horn was DEFINITELY not normal in this rabbit! Everyone thought the rabbit was pregnant until I opened it and pulled out what appeared to be several fist-sized uterine masses. One was grayish in appearance and looked like an abscess. The other masses did not look good. We examined the rest of the abdominal cavity and there were nodules throughout the coelomic cavity. We ended up euthanizing the rabbit while it was still under anesthesia. Sadly, my very first rabbit spay died...but it wasn't my fault, as it was the clinician who administered the euthasol! I did half of the castration as well and that rabbit is doing great, as I checked on him this morning! The clinician on duty said that it was the best post-op incision from a student castration that she's seen in years! Ha! It's quite scary that they give us rabbit neutering for our first surgery, as everything inside of a rabbit seems to fall apart! The fat just crumbles when you touch it and the cecum is as thin as a chewing gum bubble! So I finished the rabbit neutering Monday and am now currently on Professional Skills rotation. We had to role play the other day for difficult situations that we may encounter when in practice. Today I sat at the finance desk in the hospital for small animals for two hours and discussed finances with the lady that works there. I have to prepare a presentation for Friday on what I found. That's about all for now. Nothing too exciting at the moment. Oh, I have begun studying for the NAVLE...do I really have to take this 7 hour exam??? Not looking forward to sitting at a computer in December for 7 hours. However, I would just like to get it out of the way! I am looking forward to starting my career! Finally! Well, I should get back to studying NAVLE material. I will try and post more as the rotations progress. Hope everyone back home is doing well and I will post again soon!

A week on exotics rotation

Today was my 11th day out at the Hospital for Small Animals (HFSA) between last week's ICU and this week's exotics rotation. I have really enjoyed the exotics rotation this week and have gotten a lot of rabbit and lizard handling/treatment experience. This is the most I have ever handled rabbits and I quite like them. They're quite easy to work with and easy to treat. This whole week has been consultations and surgery with exotic animals. Monday and Tuesday I was on for surgery and was responsible for monitoring anesthesia. Monday was easy as we had a dental on a rabbit with overgrown cheek teeth/incisors. The rest of the day was treatment of the hospitalized rabbits and recovering the rabbit that had the dental procedure. Tuesday, we had a Netherland Dwarf rabbit that was in for overgrown cheek teeth/incisors. During the surgery, the nurse was holding the head up for the surgeon working on burring the teeth. As they were working on the mouth, I noticed the heart rate dropped from 220bpm to about 75bpm. The breathing pattern became very shallow and labored and was about 5 breaths per minute. Seconds later, the heart rate had completely disappeared and I brought it to the attention of the surgeon immediately. The rabbit was slowly becoming cyanotic and the surgeon immediately began CPR. After about a minute, the rabbit's heart rate returned to about 68bpm and slowly increased over a period of about 15 min. We recovered the rabbit and placed it in the incubator for a while. Towards the end of the day, the rabbit had fully recovered from the event and was looking great. Vitals were within normal parameters and he was much more alert. Yesterday, we had our dissection practical of entire female rabbits so that we could practice our spaying skills for Monday's live rabbit spay we are required to perform. The rabbits we were given were immature so their uteruses were virtually non-existent! Everything inside the abdomen was so friable and I had to be so gentle with tissue handling! It was a good practical to refresh knowledge of rabbit anatomy and practice suture tying. They use a particular type of knot here in Scotland called the Aberdeen Knot. It is used at the end of the simple continuous intradermal suture pattern. It's a nice knot technique and is extremely fast to do. Today, we had consultations and surgery. It was my turn to take on consultations with one of the clinicians. I went in on a red-footed tortoise consultation, an African Grey Parrot consultation and a Horsefield Tortoise consultation. The African Grey Parrot we saw was extremely friendly and was good to practice restraining with a towel. The owner of the parrot was a 4th year vet student and the bird had the neatest trick. The owner would have the parrot perched on her hand and aim at the bird with her other hand that was in the shape of a gun. She yelled "bang!" and the bird fell backwards and swung upside down as if it had been shot! Was hilarious and awesome! What a neat bird! After the consultations were over, we treated some more rabbits. The clinician in the exotics ward then had to perform a post mortem on an axolotle. This axolotle had been dead for about 7 days and was in cold storage the entire time. When we got it out and placed it on the table for dissection, the tail started curling and uncurling. Every time you touched the tail with an instrument it would curl and uncurl. I got the doppler probe out to ensure it was dead and there was no heartbeat that I could find. I told the clinician that was on duty that she would need to come out and pith the axolotle just to be sure. So she came out and pithed the axolotle and administered euthasol as well. The tail was still moving afterwards! We went ahead with the post mortem examination with the tail moving the entire time. Was a very creepy dissection!