You would think that spaying something big would be a lot easier than spaying something small. With something big, you can visualize everything more easily, right? It turns out to be the exact opposite, actually. The smallest thing I've spayed is a two pound kitten, and oh boy is that uterus easy to find and manage. The biggest thing I have spayed is a hundred something pound Great Dane, and wow was that uterus deep in a deep abdomen and so covered in fat that it was hard to see where it stopped and the ovaries started. Big things bleed a lot; big things have ligaments that are really hard to break down (as in, you will get out of breath); big things have all kinds of extra fat and tissue and such that get in the way. Little kittens (and cats and puppies) have pristine little uteruses that pop right out at you.
This is something that vet schools don't make clear enough, in my opinion -- at least, not the one I went to and not the one that I work at now. I was supervising some beginning surgeons recently. Day Two was amusing: everyone who had spayed a cat the day before was spaying a dog, and they were all complaining about how hard it was. Everyone who had spayed a dog the day before was spaying a cat, and they were saying things like "I'm so much better at this than I thought I was!" No, you're just spaying a much smaller animal.
Given all of that, it bewilders me that vet schools seem to tend to start students off on dog spays. Why not cat spays? They are so much easier. Why start a beginning student on the hardest possible case? This is yet another brick in the wall that stands between me and understanding how veterinary education makes any sense at all.
Showing posts with label veterinary education. Show all posts
Showing posts with label veterinary education. Show all posts
Thursday, March 21, 2013
Wednesday, December 19, 2012
Diary of a shelter medicine veterinary intern: late fall
I seem to have spent two months with no time to blog. What in the world was I doing?
The last you heard from me, dear readers, I was in the first week of our month-long shelter consult. The first week we digested a lot (a LOT) of data from the shelter. The second week we wrote up what we thought about that data. How many dogs did this shelter take in over the last few years? Cats? Are there changes in intake? How many of each species were euthanized? Why? What is the average length of stay for each species? Are pit bull type dogs treated differently? Etc.
The week after that, we were on site, crawling all over that poor shelter. That was a very busy week; in the evenings we were scrambling to write up everything we had seen and photographed during the day. On the last night of the consult, we generated our exit report, which was an overview of our findings. What did we think were this shelter’s greatest strengths? Its greatest challenges? What did we think they should address first? How? What was our five year plan for them?
The week after that, we were back on campus, writing, writing, writing. The complete consult report is traditionally quite a long document; in previous years it has been hundreds of pages long. The shelter medicine residents (the veterinarians who are specializing in shelter medicine) worked on the report for another week after that, but we interns were released after just one writing week.
After that, I spent two weeks at a truly lovely limited admission, adoption guarantee shelter about an hour and a half from home. I shadowed the shelter vet some of the time, and worked on my own some of the time. I did a lot of physical exams and surgeries! I also helped one day to select animals from the local municipal shelter (lots more animals, lots more euthanasias) for transfer to the adoption guarantee shelter. Our truck was almost full of animals when shelter staff pointed out an ancient, arthritic collie mix and asked if we might consider taking her. I argued against it, saying she was too old and decrepit to be adoptable. But in the end we felt sorry for her and took her (another dog had to ride on my lap on the way home to make room). Then I felt too bad for her to put her in the shelter kennels — her arthritis was so bad and she seemed so depressed. So I took her back to my room for the night. And the next night. And home over the weekend. And hung on to her my second week in the shelter. I officially adopted her on the last day. Her name is Rosie.
In mid November, I spent two weeks on campus, working with veterinary students as they learned how to spay and neuter animals. I am getting more and more confident in my own spay/neuter skills, but teaching still feels scary. Will I be able to tell ahead of time before someone does something wrong? I also got to amputate a badly broken leg off of a kitten. My first amputation! Terrifying. There are big arteries in there.
After Thanksgiving, I was on campus again for our shelter behavior course. This was a blast. A lot of reading about behavior (one of my favorite things to do), and a surprising amount of hands on work. We learned about different temperament tests for dogs and tried them out, both on shelter dogs and on our own dogs. We visited some different shelters in the area and talked about how they handled their dogs, and at the end of the two weeks we spent two days at one shelter, getting hands-on helping some of their dogs: setting up play groups, putting up cage barriers for those dogs who were over-stimulated by their surroundings, hanging treat buckets, etc.
Now I am in the hospital on the dermatology service. Skin problems are really, really common in shelter animals, particularly in the South. Flea allergies! Pollen allergies! Allergies allergies allergies! Also mites.
And that brings me to today. I finish up my dermatology rotation next week and head on to another week in the emergency room. And that is what I have been up to. I have been quiet, but I have not forgotten you guys.
The last you heard from me, dear readers, I was in the first week of our month-long shelter consult. The first week we digested a lot (a LOT) of data from the shelter. The second week we wrote up what we thought about that data. How many dogs did this shelter take in over the last few years? Cats? Are there changes in intake? How many of each species were euthanized? Why? What is the average length of stay for each species? Are pit bull type dogs treated differently? Etc.
The week after that, we were on site, crawling all over that poor shelter. That was a very busy week; in the evenings we were scrambling to write up everything we had seen and photographed during the day. On the last night of the consult, we generated our exit report, which was an overview of our findings. What did we think were this shelter’s greatest strengths? Its greatest challenges? What did we think they should address first? How? What was our five year plan for them?
The week after that, we were back on campus, writing, writing, writing. The complete consult report is traditionally quite a long document; in previous years it has been hundreds of pages long. The shelter medicine residents (the veterinarians who are specializing in shelter medicine) worked on the report for another week after that, but we interns were released after just one writing week.
After that, I spent two weeks at a truly lovely limited admission, adoption guarantee shelter about an hour and a half from home. I shadowed the shelter vet some of the time, and worked on my own some of the time. I did a lot of physical exams and surgeries! I also helped one day to select animals from the local municipal shelter (lots more animals, lots more euthanasias) for transfer to the adoption guarantee shelter. Our truck was almost full of animals when shelter staff pointed out an ancient, arthritic collie mix and asked if we might consider taking her. I argued against it, saying she was too old and decrepit to be adoptable. But in the end we felt sorry for her and took her (another dog had to ride on my lap on the way home to make room). Then I felt too bad for her to put her in the shelter kennels — her arthritis was so bad and she seemed so depressed. So I took her back to my room for the night. And the next night. And home over the weekend. And hung on to her my second week in the shelter. I officially adopted her on the last day. Her name is Rosie.
In mid November, I spent two weeks on campus, working with veterinary students as they learned how to spay and neuter animals. I am getting more and more confident in my own spay/neuter skills, but teaching still feels scary. Will I be able to tell ahead of time before someone does something wrong? I also got to amputate a badly broken leg off of a kitten. My first amputation! Terrifying. There are big arteries in there.
After Thanksgiving, I was on campus again for our shelter behavior course. This was a blast. A lot of reading about behavior (one of my favorite things to do), and a surprising amount of hands on work. We learned about different temperament tests for dogs and tried them out, both on shelter dogs and on our own dogs. We visited some different shelters in the area and talked about how they handled their dogs, and at the end of the two weeks we spent two days at one shelter, getting hands-on helping some of their dogs: setting up play groups, putting up cage barriers for those dogs who were over-stimulated by their surroundings, hanging treat buckets, etc.
Now I am in the hospital on the dermatology service. Skin problems are really, really common in shelter animals, particularly in the South. Flea allergies! Pollen allergies! Allergies allergies allergies! Also mites.
And that brings me to today. I finish up my dermatology rotation next week and head on to another week in the emergency room. And that is what I have been up to. I have been quiet, but I have not forgotten you guys.
Saturday, September 1, 2012
Diary of a shelter medicine intern: August
Oh my god do I miss blogging. But I have been flat out all month. Let’s see, what have I been doing?
When last I wrote, dear diary, I was finishing up the course on how to handle community (feral/outdoor) cats. My team did trap a handful of cats (if I remember right, it was around five), and won the Best Dressed Trappers award for the t-shirts that one team member put together saying “Team Dog Zombie” on them. I am pretty sure that I wasn’t the one to inspire the team spirit (I have always been a little deficient in the team spirit category), but they were awesome people to work with and the t-shirts really amused me.
The next week I was on an emergency room/intensive care unit rotation. The hours were very long, but I really love emergency medicine, so I didn’t mind. I got a puppy with parvovirus midway through the week. Parvo is a highly contagious disease, associated with (but not unique to) the shelter environment, so I was extremely pleased to get to work on this case. The puppy lived in the isolation unit for five days, and I was essentially barred from the rest of the ER in case I carried germs back, so it was just him and me for the duration. Oh, and a bunch of very competent technicians and very hard-working students, of course. I learned a lot about parvo. How to get a parvo puppy who still feels nauseated to eat: buy him a roast chicken from Publix! Mmm.
The last two weeks have been didactic, a strange throwback to veterinary school. I am not in shape for sitting on butt for hours a day anymore! We would read frantically, then go in to listen to lectures about the readings. The class was small (the handful of shelter medicine interns and residents, plus a few more distance learners), so it wasn’t like your traditional large lecture course, but it was still an odd experience to spend four hours a day sitting in front of PowerPoint slides again. How did I manage it for eight hours a day, back in school? But I learned a lot about shelter medicine: do microchips cause cancer? How likely is it that an unchipped animal will find its way home again? How do you wash your hands? (Yes, really.) What kind of animal are you most likely to get rabies from (and how likely are you to get rabies)? How do you calculate how many animals you might expect to have in a shelter on a given day, and what are your best methods to reduce that population? And, of course, our favorite, what color is this cat?
For these first few months I have felt my brain being gradually remolded to fit the perspectives of the faculty members in this school’s shelter medicine department. I can almost no longer remember how it felt to have different beliefs about how to approach cat overpopulation than I do now. Here’s hoping I find the time to blog it all out!
When last I wrote, dear diary, I was finishing up the course on how to handle community (feral/outdoor) cats. My team did trap a handful of cats (if I remember right, it was around five), and won the Best Dressed Trappers award for the t-shirts that one team member put together saying “Team Dog Zombie” on them. I am pretty sure that I wasn’t the one to inspire the team spirit (I have always been a little deficient in the team spirit category), but they were awesome people to work with and the t-shirts really amused me.
The next week I was on an emergency room/intensive care unit rotation. The hours were very long, but I really love emergency medicine, so I didn’t mind. I got a puppy with parvovirus midway through the week. Parvo is a highly contagious disease, associated with (but not unique to) the shelter environment, so I was extremely pleased to get to work on this case. The puppy lived in the isolation unit for five days, and I was essentially barred from the rest of the ER in case I carried germs back, so it was just him and me for the duration. Oh, and a bunch of very competent technicians and very hard-working students, of course. I learned a lot about parvo. How to get a parvo puppy who still feels nauseated to eat: buy him a roast chicken from Publix! Mmm.
The last two weeks have been didactic, a strange throwback to veterinary school. I am not in shape for sitting on butt for hours a day anymore! We would read frantically, then go in to listen to lectures about the readings. The class was small (the handful of shelter medicine interns and residents, plus a few more distance learners), so it wasn’t like your traditional large lecture course, but it was still an odd experience to spend four hours a day sitting in front of PowerPoint slides again. How did I manage it for eight hours a day, back in school? But I learned a lot about shelter medicine: do microchips cause cancer? How likely is it that an unchipped animal will find its way home again? How do you wash your hands? (Yes, really.) What kind of animal are you most likely to get rabies from (and how likely are you to get rabies)? How do you calculate how many animals you might expect to have in a shelter on a given day, and what are your best methods to reduce that population? And, of course, our favorite, what color is this cat?
For these first few months I have felt my brain being gradually remolded to fit the perspectives of the faculty members in this school’s shelter medicine department. I can almost no longer remember how it felt to have different beliefs about how to approach cat overpopulation than I do now. Here’s hoping I find the time to blog it all out!
Wednesday, July 4, 2012
Day Two
I didn’t really feel like a vet until the second day of my veterinary internship in shelter medicine. I spent the first day being driven from department to department in the blazing heat to get my email address working (it still doesn’t), turn in medical records (not yet successful), and get my ID (the photo isn’t great, but a lot better than what I had managed on my first day of vet school).
The second day was different.
My alarm went off at 4:45 am. In New England this close to the summer solstice it would have been at least dawn if not full light at that time of the morning, but here it was still pitch black out. This may be due to being closer to the equator or to being farther west in the time zone, take your pick. Exercising the dogs was a little scary, because this town is home to the largest (flying) cockroaches you have ever seen, and they come out at night. (I survived.) My intern-mate arrived at my house at 6:15, and just as the sky was lightening we got in the car.
We drove for an hour and a half, getting to know each other on the way. We have known each other for a little less than a week now, but expect to be spending long hours together, so our relationship is sort of on the fast track. We talked about family and vet school. While I drove, she read aloud off her smartphone about a large hoarding case we will be working on in a few days.
We arrived at the shelter/hospital complex a little before 8 am. The senior resident drove up a few minutes later, fresh from the coffee shop. Warm drinks were distributed. I am still amazed that people down here drink hot drinks at this time of the year. At 8 am it was not yet sweltering, but well on its way.
We started the morning in the veterinary clinic, doing surgeries on shelter animals. Dr. Intern-mate and I had both gotten married after graduation from veterinary school but before the beginning of this internship, and we shared a moment of surprise when scrubbing in for surgery at discovering that now we had to deal with what to do with our wedding rings. It is a common problem with surgeons that rings get removed and then lost; neither of us had come up with a good plan yet for dealing with ours, and just stuck them in our pockets.
I neutered a cat and two dogs. I declined to spay a cat who was pregnant; I have spayed pregnant cats before and I will do it again, but it still makes me uncomfortable, and since I was offered a choice of two animals, I took the male. I may regret the decision, as spays are much more difficult than neuters, and I could have gotten some valuable instruction from Dr. Senior Resident on a new technique I’m learning.
While I only participated in sterilization surgeries that day, I observed two tail amputations. Why were so many cats with severe tail trauma coming in that day? (I saw a third get scheduled for an amputation as well.) Just lucky, I guess. I saw a dog get two stones the diameter of quarters pulled out of her bladder. (Ouch.) Then a technician appeared with a tiny kitten in a carrier, and announced that the kitten had some sort of wound in its neck which appeared to be infested with maggots. Dr. Intern-mate and I immediately bailed on surgery observation and went to give the kitten a physical exam.
She was a tiny grey kitten with a head way too big for her body. While an outsized head is somewhat normal for a kitten of this age, four to five weeks, she was clearly undernourished. Most of the fur was gone from the right side of her neck, and the nearby fur on her shoulders and chin was matted. She had a huge swollen mass on her neck, with a hole in her skin maybe 2 cm in diameter, and a dark mouth sticking out. It looked like a curled worm to me at first (though clearly not a maggot), but Dr. Intern-mate had seen this kind of thing before and declared it to be a fly bot. The mouth was pressed up against the hole for it to breathe. We cleaned the skin as best we could, and as we pressed against the bot it retracted deeper into the skin. (Everyone who encountered this bot reacted by exclaiming that it was gross, but after that you can divide the reactions into two camps: Tell me more! and I’m leaving the room now. Which are you?)
Dr. Senior Resident finished up her surgery and came over to see the kitten. We sedated her, then, when her eyes remained wide and her head remained up, put a mask on her to deliver anesthesia gas. When she was out we dripped a little local painkiller on to the area, and Dr. Senior Resident opened the hole up with scissors. She pulled the bot out with forceps. It was huge, almost as long as but much fatter than my thumb, and especially large to have been pulled out of such a tiny kitten. It was very definitely alive, and undulated sluggishly around the table while I filmed it on my smartphone. (Smartphones are the star of today’s story.)
Dr. Intern-mate and I also tried to draw blood from a stone, er, a very dry cat. She was dehydrated and sick but sweet. I felt bad poking her and wished once again that I was better at it. A tech saw how long the draw was taking, came over, and in the way of all techs, slipped the needle in and extracted plenty of blood in very little time. I try hard to get as much experience as I can with blood draws, because I think being able to do them is important, but it’s always hard when I feel that I am hurting an animal with my inexperienced prodding. I did fulfill my doctorly duties by reporting the cat’s dehydrated and flea-infested status to Dr. Senior Resident and making sure that both things would get taken care of, but I felt very much like a student at the moment.
After lunch, we began the medical (rather than surgical) portion of the day. Much of this consisted of checkups on animals who were either healthy (but we didn’t know that yet as they had just arrived at the shelter) or being treated for something previously diagnosed. I did physical exams on two teenage kittens. Both looked great, but one had a little bit of red around her eye. This is a good example of how shelter medicine differs from general practice. In general practice, a slightly red eye is not really worthy of note unless it goes on for a few days or gets worse. In a shelter, it is a sign of impending upper respiratory infection (URI), which about half of cats will come down with while in the shelter environment. URIs don’t kill very many animals, but they do keep animals from being adopted out of shelters while sick, and they of course add expense to managing animals. I recommended just keeping a close eye on this kitten, and Dr. Senior Resident agreed.
As the afternoon got hotter, Dr. Intern-mate and I headed over to the dog kennels to do some physical exams and give some rabies vaccinations. One dog was recovering from kennel cough, so we had to don Personal Protective Equipment (PPE) to go in to his run. This entailed putting on booties, a gown, and gloves over our scrubs. The dog runs were not air conditioned. On an already miserably hot day, it was almost unbearable: welcome to the South. Hopefully I will toughen up as this summer goes on.
Finally, Dr. Intern-mate and I headed over the the kitten house. Kitten house! It is an entire little house, a few blocks from the main shelter, entirely dedicated to housing kittens. It is staffed by volunteers, and the main room has rocking chairs for them to sit in with kittens on their chests. The cuteness was unbearable. Dr. Intern-mate and I were sent in to the Upper Respiratory Infection room (again in PPE, but this time there was A/C) to weigh, feed, and medicate about 40 kittens. They were in a rack of cages against the wall, and as they were mostly feeling pretty good with their medications (yay) they were all bouncing off the walls of their cages. It was hilarious. The next hour or two were populated by the sounds of kitten bodies hitting all possible sides of the cage (including the top), and Dr. Intern-mate saying things like “oh no, you mustn’t bite me in the face” and “it’s not nice to beat up on your sister like that.” My favorite moment was possibly when one kitten escaped from her and got under the rack of cages. I closed the door to the room while she fished him out. As she went to put him back, we realized from the records that he had come out of the wrong cage (which cleared up some confusion as to why there had been only two kittens in the previous cage, when the records suggested there should be three). So far as we could tell he had been in the wrong cage for several days. With the level of chaos in the room, we could easily see how it had happened. We had a good-natured argument about which cage to leave him in. I won with the argument that his original cagemates were on medications which he was supposed to be getting as well.
Finally the day was over. I was exhausted, hot, and hungry; we had been working for eleven hours. We piled back into the car and set off on the hour and a half drive for home. Twenty minutes in, Dr. Intern-mate realized her wedding ring was not in her scrub top any more. It must have fallen out. Yes, we turned around, and it was right were she suspected it would be, but at this point I was not sure I would survive the trek home without food. I pulled the hero of the story out of my pocket, and it told me that an excellent “fit for foodies” restaurant was very near by. We went, and ate the best fried zucchini you can imagine, along with a very good noodle dish which I could barely stuff in after the amazing appetizer. We finally got back on the road, missed a turn, drove for quite a while in the middle of very dark nowhere under a lovely harvest moon, hanging on every word of the smartphone as it guided us back to civilization.
I got home sixteen hours after I had left. I think this day was a sign of good things to come in the internship. I’ll let you know how it goes.
The second day was different.
My alarm went off at 4:45 am. In New England this close to the summer solstice it would have been at least dawn if not full light at that time of the morning, but here it was still pitch black out. This may be due to being closer to the equator or to being farther west in the time zone, take your pick. Exercising the dogs was a little scary, because this town is home to the largest (flying) cockroaches you have ever seen, and they come out at night. (I survived.) My intern-mate arrived at my house at 6:15, and just as the sky was lightening we got in the car.
We drove for an hour and a half, getting to know each other on the way. We have known each other for a little less than a week now, but expect to be spending long hours together, so our relationship is sort of on the fast track. We talked about family and vet school. While I drove, she read aloud off her smartphone about a large hoarding case we will be working on in a few days.
We arrived at the shelter/hospital complex a little before 8 am. The senior resident drove up a few minutes later, fresh from the coffee shop. Warm drinks were distributed. I am still amazed that people down here drink hot drinks at this time of the year. At 8 am it was not yet sweltering, but well on its way.
We started the morning in the veterinary clinic, doing surgeries on shelter animals. Dr. Intern-mate and I had both gotten married after graduation from veterinary school but before the beginning of this internship, and we shared a moment of surprise when scrubbing in for surgery at discovering that now we had to deal with what to do with our wedding rings. It is a common problem with surgeons that rings get removed and then lost; neither of us had come up with a good plan yet for dealing with ours, and just stuck them in our pockets.
I neutered a cat and two dogs. I declined to spay a cat who was pregnant; I have spayed pregnant cats before and I will do it again, but it still makes me uncomfortable, and since I was offered a choice of two animals, I took the male. I may regret the decision, as spays are much more difficult than neuters, and I could have gotten some valuable instruction from Dr. Senior Resident on a new technique I’m learning.
While I only participated in sterilization surgeries that day, I observed two tail amputations. Why were so many cats with severe tail trauma coming in that day? (I saw a third get scheduled for an amputation as well.) Just lucky, I guess. I saw a dog get two stones the diameter of quarters pulled out of her bladder. (Ouch.) Then a technician appeared with a tiny kitten in a carrier, and announced that the kitten had some sort of wound in its neck which appeared to be infested with maggots. Dr. Intern-mate and I immediately bailed on surgery observation and went to give the kitten a physical exam.
She was a tiny grey kitten with a head way too big for her body. While an outsized head is somewhat normal for a kitten of this age, four to five weeks, she was clearly undernourished. Most of the fur was gone from the right side of her neck, and the nearby fur on her shoulders and chin was matted. She had a huge swollen mass on her neck, with a hole in her skin maybe 2 cm in diameter, and a dark mouth sticking out. It looked like a curled worm to me at first (though clearly not a maggot), but Dr. Intern-mate had seen this kind of thing before and declared it to be a fly bot. The mouth was pressed up against the hole for it to breathe. We cleaned the skin as best we could, and as we pressed against the bot it retracted deeper into the skin. (Everyone who encountered this bot reacted by exclaiming that it was gross, but after that you can divide the reactions into two camps: Tell me more! and I’m leaving the room now. Which are you?)
 |
| Image provided by Wikimedia |
Dr. Senior Resident finished up her surgery and came over to see the kitten. We sedated her, then, when her eyes remained wide and her head remained up, put a mask on her to deliver anesthesia gas. When she was out we dripped a little local painkiller on to the area, and Dr. Senior Resident opened the hole up with scissors. She pulled the bot out with forceps. It was huge, almost as long as but much fatter than my thumb, and especially large to have been pulled out of such a tiny kitten. It was very definitely alive, and undulated sluggishly around the table while I filmed it on my smartphone. (Smartphones are the star of today’s story.)
Dr. Intern-mate and I also tried to draw blood from a stone, er, a very dry cat. She was dehydrated and sick but sweet. I felt bad poking her and wished once again that I was better at it. A tech saw how long the draw was taking, came over, and in the way of all techs, slipped the needle in and extracted plenty of blood in very little time. I try hard to get as much experience as I can with blood draws, because I think being able to do them is important, but it’s always hard when I feel that I am hurting an animal with my inexperienced prodding. I did fulfill my doctorly duties by reporting the cat’s dehydrated and flea-infested status to Dr. Senior Resident and making sure that both things would get taken care of, but I felt very much like a student at the moment.
After lunch, we began the medical (rather than surgical) portion of the day. Much of this consisted of checkups on animals who were either healthy (but we didn’t know that yet as they had just arrived at the shelter) or being treated for something previously diagnosed. I did physical exams on two teenage kittens. Both looked great, but one had a little bit of red around her eye. This is a good example of how shelter medicine differs from general practice. In general practice, a slightly red eye is not really worthy of note unless it goes on for a few days or gets worse. In a shelter, it is a sign of impending upper respiratory infection (URI), which about half of cats will come down with while in the shelter environment. URIs don’t kill very many animals, but they do keep animals from being adopted out of shelters while sick, and they of course add expense to managing animals. I recommended just keeping a close eye on this kitten, and Dr. Senior Resident agreed.
As the afternoon got hotter, Dr. Intern-mate and I headed over to the dog kennels to do some physical exams and give some rabies vaccinations. One dog was recovering from kennel cough, so we had to don Personal Protective Equipment (PPE) to go in to his run. This entailed putting on booties, a gown, and gloves over our scrubs. The dog runs were not air conditioned. On an already miserably hot day, it was almost unbearable: welcome to the South. Hopefully I will toughen up as this summer goes on.
Finally, Dr. Intern-mate and I headed over the the kitten house. Kitten house! It is an entire little house, a few blocks from the main shelter, entirely dedicated to housing kittens. It is staffed by volunteers, and the main room has rocking chairs for them to sit in with kittens on their chests. The cuteness was unbearable. Dr. Intern-mate and I were sent in to the Upper Respiratory Infection room (again in PPE, but this time there was A/C) to weigh, feed, and medicate about 40 kittens. They were in a rack of cages against the wall, and as they were mostly feeling pretty good with their medications (yay) they were all bouncing off the walls of their cages. It was hilarious. The next hour or two were populated by the sounds of kitten bodies hitting all possible sides of the cage (including the top), and Dr. Intern-mate saying things like “oh no, you mustn’t bite me in the face” and “it’s not nice to beat up on your sister like that.” My favorite moment was possibly when one kitten escaped from her and got under the rack of cages. I closed the door to the room while she fished him out. As she went to put him back, we realized from the records that he had come out of the wrong cage (which cleared up some confusion as to why there had been only two kittens in the previous cage, when the records suggested there should be three). So far as we could tell he had been in the wrong cage for several days. With the level of chaos in the room, we could easily see how it had happened. We had a good-natured argument about which cage to leave him in. I won with the argument that his original cagemates were on medications which he was supposed to be getting as well.
Finally the day was over. I was exhausted, hot, and hungry; we had been working for eleven hours. We piled back into the car and set off on the hour and a half drive for home. Twenty minutes in, Dr. Intern-mate realized her wedding ring was not in her scrub top any more. It must have fallen out. Yes, we turned around, and it was right were she suspected it would be, but at this point I was not sure I would survive the trek home without food. I pulled the hero of the story out of my pocket, and it told me that an excellent “fit for foodies” restaurant was very near by. We went, and ate the best fried zucchini you can imagine, along with a very good noodle dish which I could barely stuff in after the amazing appetizer. We finally got back on the road, missed a turn, drove for quite a while in the middle of very dark nowhere under a lovely harvest moon, hanging on every word of the smartphone as it guided us back to civilization.
I got home sixteen hours after I had left. I think this day was a sign of good things to come in the internship. I’ll let you know how it goes.
Tuesday, May 22, 2012
The Dog Zombie, DVM, MS!
Next: shelter medicine internship in Florida!
Saturday, March 31, 2012
Navel gazing with a dog zombie
I am at the end of something. I am a senior in veterinary school, a short-timer, with seven weeks left. It feels just like the end of high school or the end of college: I know this place inside and out, I know my relationships with everyone, I know what I am good at and what I am bad at. I know which faculty member was my nemesis during my first few years, and which one became my nemesis in clinics, and my heart rate no longer speeds up when I encounter either (but put me in a room with both of them together and all bets are off). I know which resident everyone has a crush on. I know who is a “drop everything and go to that talk” captivating speaker. I know where to find the free food (even if I forget about Radiology Food Day every Wednesday morning). I know who to ask for under the table care of my animals and who will charge me. When I think about what it will be like to start my new life, I am filled with panic: everyone will be different. I will have to learn who is a friend and who is not, who shares my interests and who will look at me as though I am an alien.
My teachers, of course, love to ask us as we near the end of this program where we see ourselves in five years. Five years from now, I imagine I’ll be a senior again. I have a lot more that I want to learn before I settle down at a job. I set out to learn some stuff about how dog brains works and what makes a dog a dog, and I didn’t learn that at vet school, but I did learn the right words to use in describing what I am interested in. “I'm interested in dog brains but I want to find a way to study them without cutting open dog heads” became “I'm interested in behavioral neuroendocrinology in dogs, particularly the HPA axis.” “I'm interested in stress in shelter dogs” became “I have studied stress in dogs using cortisol levels as a marker, and am interested in exploring mechanisms of stress by looking at canine genetics.” “Dear god doesn't anyone else out there want to learn more about the Belyaev foxes?" became “I know where domesticated foxes are studied in this country and it sure would be nice to end up in a program there.”
So there will be more learning. In five years I hope I'll finally have completed my quest to assemble some base of information and skills that I originally set out to learn, and have had so much trouble finding all in one place. It seems likely this will involve completing a PhD program. Afterwards, I hope I will feel ready to be employed again; “going back to school” can only last you so long as a career. I expect I will at that point be asked again, “Where do you see yourself in five years?” So where do I see myself ten years from now, when I've been working for a few years, when I have gotten a good bite taken out of the process of building a career?
I could work at a shelter, organizing programs to enrich and train shelter dogs, doing research on how to get dogs into homes faster and how to keep them from coming in to a shelter in the first place. I know someone who has this job. I am jealous of her.
I could teach at a university, one with an animal sciences program or a vet school. I love teaching enough that I could imagine any number of jobs of this sort that would tickle my interest, but the dream job here would be starting a Master’s degree program in companion animal behavior. There's a need for programs like this, and damn would I love to set one up.
The very best job, though, would be one entirely devoted to outreach about how to manage dogs and cats. I’d find ways to get the information into many more of the crevices of society where it has so far failed to permeate: training dogs is a good thing. Extra litterboxes for cats are a good thing. Spaying and neutering are good things. Be a responsible pet owner and all will go well for you. Finding ways of making these things easier for people, like organizing training classes for low-income families, would be an essential part of such a job. I want to immerse myself in changing the world. I want to be able to die saying that I made a significant difference in the number of animals surrendered to animal shelters throughout the country. Does an organization ready to pay me to do this exist? Maybe, maybe not, and at any rate I’m up for starting my own.
Our teachers also like to ask us how we intend to earn enough money to pay off our staggering student loans. I do owe less on my student loans than on my house, but it is decidedly comparable, and could easily have gone the other way. I'm taking a leap of faith here. If I need to get a less interesting job in order to pay the bills, I will. But in the current climate of increasing frustration with corporations, I wonder to myself if companies will end up donating more and more money to organizations for social change in order to buy public goodwill. I know what I want to do, and I'm going to try to figure out how to get someone to give me money to do it.
I live in the future more than most people do. I always look forward, never content with where I am now, always wondering what the next thing is and how I can get there faster. In these last seven weeks of veterinary school, as I scramble to stuff information into holes in my knowledge base as fast as I encounter them, I'm also trying to pause to savor the here. Vet school has made me rant, it has made me cry, it has made me curl up in my bed and never want to come out again. It has changed me at a very deep level. I see the world in an entirely different way now than I did before. And it is almost over. I hope that what comes next is equally revelatory.
My teachers, of course, love to ask us as we near the end of this program where we see ourselves in five years. Five years from now, I imagine I’ll be a senior again. I have a lot more that I want to learn before I settle down at a job. I set out to learn some stuff about how dog brains works and what makes a dog a dog, and I didn’t learn that at vet school, but I did learn the right words to use in describing what I am interested in. “I'm interested in dog brains but I want to find a way to study them without cutting open dog heads” became “I'm interested in behavioral neuroendocrinology in dogs, particularly the HPA axis.” “I'm interested in stress in shelter dogs” became “I have studied stress in dogs using cortisol levels as a marker, and am interested in exploring mechanisms of stress by looking at canine genetics.” “Dear god doesn't anyone else out there want to learn more about the Belyaev foxes?" became “I know where domesticated foxes are studied in this country and it sure would be nice to end up in a program there.”
So there will be more learning. In five years I hope I'll finally have completed my quest to assemble some base of information and skills that I originally set out to learn, and have had so much trouble finding all in one place. It seems likely this will involve completing a PhD program. Afterwards, I hope I will feel ready to be employed again; “going back to school” can only last you so long as a career. I expect I will at that point be asked again, “Where do you see yourself in five years?” So where do I see myself ten years from now, when I've been working for a few years, when I have gotten a good bite taken out of the process of building a career?
I could work at a shelter, organizing programs to enrich and train shelter dogs, doing research on how to get dogs into homes faster and how to keep them from coming in to a shelter in the first place. I know someone who has this job. I am jealous of her.
I could teach at a university, one with an animal sciences program or a vet school. I love teaching enough that I could imagine any number of jobs of this sort that would tickle my interest, but the dream job here would be starting a Master’s degree program in companion animal behavior. There's a need for programs like this, and damn would I love to set one up.
The very best job, though, would be one entirely devoted to outreach about how to manage dogs and cats. I’d find ways to get the information into many more of the crevices of society where it has so far failed to permeate: training dogs is a good thing. Extra litterboxes for cats are a good thing. Spaying and neutering are good things. Be a responsible pet owner and all will go well for you. Finding ways of making these things easier for people, like organizing training classes for low-income families, would be an essential part of such a job. I want to immerse myself in changing the world. I want to be able to die saying that I made a significant difference in the number of animals surrendered to animal shelters throughout the country. Does an organization ready to pay me to do this exist? Maybe, maybe not, and at any rate I’m up for starting my own.
Our teachers also like to ask us how we intend to earn enough money to pay off our staggering student loans. I do owe less on my student loans than on my house, but it is decidedly comparable, and could easily have gone the other way. I'm taking a leap of faith here. If I need to get a less interesting job in order to pay the bills, I will. But in the current climate of increasing frustration with corporations, I wonder to myself if companies will end up donating more and more money to organizations for social change in order to buy public goodwill. I know what I want to do, and I'm going to try to figure out how to get someone to give me money to do it.
I live in the future more than most people do. I always look forward, never content with where I am now, always wondering what the next thing is and how I can get there faster. In these last seven weeks of veterinary school, as I scramble to stuff information into holes in my knowledge base as fast as I encounter them, I'm also trying to pause to savor the here. Vet school has made me rant, it has made me cry, it has made me curl up in my bed and never want to come out again. It has changed me at a very deep level. I see the world in an entirely different way now than I did before. And it is almost over. I hope that what comes next is equally revelatory.
Thursday, February 16, 2012
Future of the Zombieverse
I matched at an academic shelter medicine internship in Florida! But I bet you don’t completely know what that means.
Internship: Like human doctors, many veterinarians do internships their first year out of school (I am graduating in May). Unlike human doctors, veterinarians are legally able to go straight into practice without passing through an internship first. Veterinarians who do this tend to try to find practices which are prepared to mentor them for a year or two. Internships provide loads of good clinicial experience, and are offered by hospitals or larger private practices with a high case load and access to specialists and expensive toys like advanced imaging modalities. This gives the intern a chance to see a variety of diseases and to work with a variety of specialists, to be very prepared to practice on their own if need be. Similarly to human medicine internships, veterinary internships are very poorly paid.
Match: As in human medicine, veterinarians don’t apply to internships as to a regular job. You apply through a match program. After you have filled out your applications, you rank the internships to which you’ve applied in your order of interest. They do the same for their applicants. Then a third party matches you with the internship you most want, which also most wants you (in theory).
Academic: Internships are offered by either veterinary schools or by private practices. The internships at veterinary schools are “academic” internships and do tend to be more academically oriented, with more emphasis on things like journal clubs, publishing, etc.
Shelter medicine: Traditionally, veterinary internships allowed the intern to specialize in small animals vs large animals, but nothing more specific than that. These rotating internships allow the intern to rotate through various sub-specialties (cardiology, neurology, ophthalmology...) with plenty of time spent as the primary clinician in the emergency room for a more general view of medicine. Recently, however, specialty internships have sprung up. Most of these are intended for veterinarians who have finished a rotating internship and want a year of specialization to make them more competitive for their residency application; competitive specialties like surgery and radiology were some of the first to have specialty internships. Shelter medicine internships started appearing a few years ago, with two new ones being offered for the first time this year, for a total of five that I know of in the US. It is fairly common for shelter medicine interns to approach their specialty internship less as a bridge between rotating internship and residency, and more as a year’s experience to allow them to go straight into shelter practice. This is what I am doing, except that I expect to continue my education in other ways after my internship. Shelter medicine residency programs do exist and some shelter medicine interns go on to those.
Florida: As an inveterate New Englander I am a little nervous about Florida. But it’s just for one year.
What kinds of things will I be learning about? Community cats (also known as feral cats), animal hoarders, veterinary forensics, managing disease outbreaks, disaster response... I will do my best to cover it all here.
Internship: Like human doctors, many veterinarians do internships their first year out of school (I am graduating in May). Unlike human doctors, veterinarians are legally able to go straight into practice without passing through an internship first. Veterinarians who do this tend to try to find practices which are prepared to mentor them for a year or two. Internships provide loads of good clinicial experience, and are offered by hospitals or larger private practices with a high case load and access to specialists and expensive toys like advanced imaging modalities. This gives the intern a chance to see a variety of diseases and to work with a variety of specialists, to be very prepared to practice on their own if need be. Similarly to human medicine internships, veterinary internships are very poorly paid.
Match: As in human medicine, veterinarians don’t apply to internships as to a regular job. You apply through a match program. After you have filled out your applications, you rank the internships to which you’ve applied in your order of interest. They do the same for their applicants. Then a third party matches you with the internship you most want, which also most wants you (in theory).
Academic: Internships are offered by either veterinary schools or by private practices. The internships at veterinary schools are “academic” internships and do tend to be more academically oriented, with more emphasis on things like journal clubs, publishing, etc.
Shelter medicine: Traditionally, veterinary internships allowed the intern to specialize in small animals vs large animals, but nothing more specific than that. These rotating internships allow the intern to rotate through various sub-specialties (cardiology, neurology, ophthalmology...) with plenty of time spent as the primary clinician in the emergency room for a more general view of medicine. Recently, however, specialty internships have sprung up. Most of these are intended for veterinarians who have finished a rotating internship and want a year of specialization to make them more competitive for their residency application; competitive specialties like surgery and radiology were some of the first to have specialty internships. Shelter medicine internships started appearing a few years ago, with two new ones being offered for the first time this year, for a total of five that I know of in the US. It is fairly common for shelter medicine interns to approach their specialty internship less as a bridge between rotating internship and residency, and more as a year’s experience to allow them to go straight into shelter practice. This is what I am doing, except that I expect to continue my education in other ways after my internship. Shelter medicine residency programs do exist and some shelter medicine interns go on to those.
Florida: As an inveterate New Englander I am a little nervous about Florida. But it’s just for one year.
What kinds of things will I be learning about? Community cats (also known as feral cats), animal hoarders, veterinary forensics, managing disease outbreaks, disaster response... I will do my best to cover it all here.
Thursday, November 10, 2011
How to spay a cat fast
Yesterday I spent the day on a spay/neuter trailer. The shelter which owns the trailer sends it out to low-income areas to spay and neuter a large number of cats and dogs at low cost. Yesterday was a slow day; we spayed and neutered sixteen cats. Well, the vet spayed seven and neutered three; I spayed one and neutered three. Meanwhile, she explained high volume spay/neuter techniques to me.
The key to high volume spay/neuter is, obviously, speed. She can spay a cat in seven minutes. It takes me about thirty; a general practitioner who has more experience than I do, but isn’t as obsessed with speed, might take ten or twelve. This is what I learned:
The key to high volume spay/neuter is, obviously, speed. She can spay a cat in seven minutes. It takes me about thirty; a general practitioner who has more experience than I do, but isn’t as obsessed with speed, might take ten or twelve. This is what I learned:
- Keep your surgical field (the animal!) clear. Take the time to replace your instruments on your instrument tray when you are not using them, so that you have less visual clutter.
- Always know where each surgical instrument belongs. Don’t leave them in a pile or even a random row on your tray. Have an order for them — any order, so long as you are familiar with it and can reach for a particular instrument and know right where it will be.
- Don’t waste movements. If you’re reaching to the right to grab a new instrument, don’t twist all the way over to face the tray; just reach your right hand over.
- Don’t get tangled up in your instruments. Be willing to take a second to switch hands if you have yourself in an awkward position.
- As you’re working on one step, have your next step in your mind. What instrument will you be reaching for next?
- Relax. Stand up straight. Breathe, breathe, breathe.
Friday, September 30, 2011
Being a food animal veterinarian, day 8
Day 8 was not like the other days. My rotation-mate Delilah and I signed up to spend the day assisting with embryo collection at a farm that works with my school to preserve heritage breeds. The farm acquires (usually on loan) individuals from heritage breeds of sheep, cows, and goats. They superovulate and breed the females, then collect the embryos and cryogenically store them. Del and I kept asking what the plans were for the embryos. No plans! We are just storing them in case they are needed some day when these breeds are extinct.
The facility was beyond lovely, a 1920s folly farm that looked like a crazy cross between a medieval castle and a Mexican mansion. Biosecurity was a big concern there, so we had to cross a little bridge with a foot wash on the way in, and multiple signs about the premises said things like “This is private property. Please go away immediately.” The grounds were so immaculately clean that it was hard to believe there were animals there, but there were, beautifully cared for (with lots of pasture!). The farm was restored and updated, so you would for example pass through a stone archway into a modern cryogenic storage facility. Also, it had the cleanest bathroom I had encountered on a farm yet, but then again, that is not saying much. Most farms have bathrooms that rival the worst truckstop bathrooms, so that the vets who drive the trucks will say things like “hang on, we’re passing by a gas station in less than an hour” when you ask about facilities.
Del and I traded off assisting on surgeries and running anesthesia for three ewes. We premedicated, intubated, and maintained each ewe under anesthesia on gas. Then we helped Dr. Thery go in laparoscopically to make sure she had in fact successfully been superovulated. Ideally the ovary would look like a bunch of grapes. We would count the post-ovulatory structures on each ovary. Then we would laparasopically find and grasp the uterus, and pull it out of a small incision. Once it was exteriorized, we flushed it to get all the embryos out of it. The embryos were carried over to the lab, and we watched on video as they were identified, counted, and graded (the more vs less viable ones selected out). We closed up the ewes and recovered them. Each ewe would be kept for two surgeries, then returned to her owner.
It was a lovely day, and of course the surgery experience was a fun bonus. Del and I had some interesting conversations about whether this effort to preserve heritage breeds was worth the investment. Whether or not it is, it was a beautiful facility, and nice to see how a farm can be run when money is essentially not a factor.
The facility was beyond lovely, a 1920s folly farm that looked like a crazy cross between a medieval castle and a Mexican mansion. Biosecurity was a big concern there, so we had to cross a little bridge with a foot wash on the way in, and multiple signs about the premises said things like “This is private property. Please go away immediately.” The grounds were so immaculately clean that it was hard to believe there were animals there, but there were, beautifully cared for (with lots of pasture!). The farm was restored and updated, so you would for example pass through a stone archway into a modern cryogenic storage facility. Also, it had the cleanest bathroom I had encountered on a farm yet, but then again, that is not saying much. Most farms have bathrooms that rival the worst truckstop bathrooms, so that the vets who drive the trucks will say things like “hang on, we’re passing by a gas station in less than an hour” when you ask about facilities.
Del and I traded off assisting on surgeries and running anesthesia for three ewes. We premedicated, intubated, and maintained each ewe under anesthesia on gas. Then we helped Dr. Thery go in laparoscopically to make sure she had in fact successfully been superovulated. Ideally the ovary would look like a bunch of grapes. We would count the post-ovulatory structures on each ovary. Then we would laparasopically find and grasp the uterus, and pull it out of a small incision. Once it was exteriorized, we flushed it to get all the embryos out of it. The embryos were carried over to the lab, and we watched on video as they were identified, counted, and graded (the more vs less viable ones selected out). We closed up the ewes and recovered them. Each ewe would be kept for two surgeries, then returned to her owner.
It was a lovely day, and of course the surgery experience was a fun bonus. Del and I had some interesting conversations about whether this effort to preserve heritage breeds was worth the investment. Whether or not it is, it was a beautiful facility, and nice to see how a farm can be run when money is essentially not a factor.
Sunday, September 25, 2011
Being a food animal veterinarian, day 7
Day 7. Just me and Dr. Gray (my favorite doctor to ride with). He blasted out of the clinic at high speed, announcing that we were extremely late and that we were going to check on a herd which had a problem with cystic ovaries. He tossed me a copy of Merck’s Veterinary Manual and said, “Let’s get smart about cystic ovaries.”
He and I at least knew what cystic ovaries are, but I am betting you do not. What you want an ovary to do is to grow a bunch of follicles, and then have one follicle decide it is the queen follicle and ovulate an egg. You probably know what happens from there. If this process is stymied at some point so that the follicle just hangs out and doesn’t develop, but becomes a bump on the ovary full of liquid, it is a cyst. The cow may recover from this and return to a normal reproductive cycle, or her system may become confused by the particular mix of hormones circulating and get hung up. The a veterinarian has to figure out what is going on. The most common explanation is that the cows are not eating well enough, so we came prepared to look into that.
We pulled up at a lovely little farm. This was a hobby farm in the sense that the owner had income from elsewhere, but a real farm in the sense that he was trying to make a profit on selling milk. He actually had a farm store where you could buy milk from that farm (unheard of!) and ice cream made from the milk (even better!). I purchased both, since the cows were out on grass, which made me happy. (The milk later spilled in Dr. Gray’s truck and went bad so that he became cranky with me, but that is a different story.)
Herd check. Why did the cows have cysts? The usual veterinarian for the herd was present; we had been called out as consultants basically because we had an ultrasound machine to help us better see what was going on inside the cows. We checked cow after cow. Some follicles (excellent), some post ovulation structures (also excellent). No cysts. It turned out that what had appeared to be cysts were actually normal structures. The cows were in fact somewhat skinny, so we also did some education about how to body condition score a cow. This was a learning experience for me; it is more complicated than with a dog, involving a flow chart. We also gave advice about how to synchronize the cows so that the farmer would know when to breed them. Without a solid synchronization program (or a bull, which most people find dangerous to keep around), you just have to watch the cows to see when they might be in heat. They are in heat for such a short period of time, less than a day, that it is very easy to miss. Best to know ahead of time when it’s going to happen.
We got back in the truck. I ate my ice cream sandwich for lunch. It was a good lunch.
The next farm was very different. Instead of the welcoming committee of three people who had received us at the first farm, we were left to find the sick cows on our own. Eventually one of the employees handed us a list of numbers: three cows with possible twisted stomachs (displaced abomasums) and one that might have a dead calf inside her. Usually farmers catch the cows up for us and have them in headlocks, but not here. Go find them!
The sick pen had dozens of cows in it. Dr. Gray and I wandered through until we found our girls, then chased them into a small side area where we could put them into the single head lock one by one. The cow with the presumed dead calf was pretty sick, so Dr. Gray dealt with her while I checked TPRs (temperature, pulse, respiration) and gave physical exams to the other three. I couldn’t see him, as he was behind a barrier from me, so I was on my own.
First cow: already in the head lock thanks to Dr. Gray. Normal TPR. No pings (the sound they make when you thwack your finger against their belly and they have a twisted something or other inside there). Looked bright and alert and not dehydrated. I relayed this to Dr. Gray, he came over and double checked, said we would just recommend some oral fluids, and I should move on to the next cow.
Second cow: obviously not in the head lock. I released the first cow and tried to get the second cow in. They will move away from you, so you can basically chase them into where you want, but she would not actually put her head in the lock. They weigh a lot more than you; sometimes you can shove on the back end and they will be nice about it, but there was no way this girl was cutting me a break. It was a little embarrassing, but I did my TPR while she was loose.
This time Dr. Gray came back with blood on his arm up to his shoulder, looking stressed. He checked over the cow (who he also failed to get into the head lock), gave her a rectal exam (this was all with a bare arm — iew), gave her the same diagnosis as the first cow, and went back to what he was doing. I walked back to watch as he shot the sick cow with the dead calf inside her in the head with a captive bolt gun, standard euthanasia technique on farm for a cow who cannot make it on to a truck to be shipped to slaughter.
Dr. Gray explained that the cow had had a dead calf in her for several days, and had a large rip in her uterus, which she could not recover from. I will save you from some of the gorier details. He was clearly somewhat bothered by the fact that the calf had died at least four days before and she had not gotten medical attention before then. “To be fair,” he said, “the calf wasn’t in the birth canal so she probably didn’t show any signs of labor for them to notice.” I said, “Is this maybe a case where on a smaller farm, someone would have realized something was going on with the cow which was supposed to have freshened a few days ago?” He allowed as to how that was probably the case.
Then we checked out the fourth cow, the one which was also supposed to have a displaced abomasum. Amusingly, this cow stuck her head into the head lock enthusiastically. We were running late, so Dr. Gray did this exam himself, and did find a problem. He is a fan of a toggle procedure to fix displaced abomasums, so that is what we did, instead of the surgical procedure I had seen previously. With the help of a farm hand, we sedated the cow, put ropes around her, pulled her over on her side, and rolled her on to her back. Once she was on her back, her stomach floated into the correct place. Dr. Gray put two pins into her belly, puncturing through the skin and into the stomach. He used the pins to secure the stomach in place. The cow was allowed to stand up and was good to go (with dextrose, steroids, oral fluids, oral calcium, and B vitamins to help her out).
Then we washed off in a bucket. There was a lot of scrubbing to be done. And that was day seven.
He and I at least knew what cystic ovaries are, but I am betting you do not. What you want an ovary to do is to grow a bunch of follicles, and then have one follicle decide it is the queen follicle and ovulate an egg. You probably know what happens from there. If this process is stymied at some point so that the follicle just hangs out and doesn’t develop, but becomes a bump on the ovary full of liquid, it is a cyst. The cow may recover from this and return to a normal reproductive cycle, or her system may become confused by the particular mix of hormones circulating and get hung up. The a veterinarian has to figure out what is going on. The most common explanation is that the cows are not eating well enough, so we came prepared to look into that.
We pulled up at a lovely little farm. This was a hobby farm in the sense that the owner had income from elsewhere, but a real farm in the sense that he was trying to make a profit on selling milk. He actually had a farm store where you could buy milk from that farm (unheard of!) and ice cream made from the milk (even better!). I purchased both, since the cows were out on grass, which made me happy. (The milk later spilled in Dr. Gray’s truck and went bad so that he became cranky with me, but that is a different story.)
Herd check. Why did the cows have cysts? The usual veterinarian for the herd was present; we had been called out as consultants basically because we had an ultrasound machine to help us better see what was going on inside the cows. We checked cow after cow. Some follicles (excellent), some post ovulation structures (also excellent). No cysts. It turned out that what had appeared to be cysts were actually normal structures. The cows were in fact somewhat skinny, so we also did some education about how to body condition score a cow. This was a learning experience for me; it is more complicated than with a dog, involving a flow chart. We also gave advice about how to synchronize the cows so that the farmer would know when to breed them. Without a solid synchronization program (or a bull, which most people find dangerous to keep around), you just have to watch the cows to see when they might be in heat. They are in heat for such a short period of time, less than a day, that it is very easy to miss. Best to know ahead of time when it’s going to happen.
We got back in the truck. I ate my ice cream sandwich for lunch. It was a good lunch.
The next farm was very different. Instead of the welcoming committee of three people who had received us at the first farm, we were left to find the sick cows on our own. Eventually one of the employees handed us a list of numbers: three cows with possible twisted stomachs (displaced abomasums) and one that might have a dead calf inside her. Usually farmers catch the cows up for us and have them in headlocks, but not here. Go find them!
The sick pen had dozens of cows in it. Dr. Gray and I wandered through until we found our girls, then chased them into a small side area where we could put them into the single head lock one by one. The cow with the presumed dead calf was pretty sick, so Dr. Gray dealt with her while I checked TPRs (temperature, pulse, respiration) and gave physical exams to the other three. I couldn’t see him, as he was behind a barrier from me, so I was on my own.
First cow: already in the head lock thanks to Dr. Gray. Normal TPR. No pings (the sound they make when you thwack your finger against their belly and they have a twisted something or other inside there). Looked bright and alert and not dehydrated. I relayed this to Dr. Gray, he came over and double checked, said we would just recommend some oral fluids, and I should move on to the next cow.
Second cow: obviously not in the head lock. I released the first cow and tried to get the second cow in. They will move away from you, so you can basically chase them into where you want, but she would not actually put her head in the lock. They weigh a lot more than you; sometimes you can shove on the back end and they will be nice about it, but there was no way this girl was cutting me a break. It was a little embarrassing, but I did my TPR while she was loose.
This time Dr. Gray came back with blood on his arm up to his shoulder, looking stressed. He checked over the cow (who he also failed to get into the head lock), gave her a rectal exam (this was all with a bare arm — iew), gave her the same diagnosis as the first cow, and went back to what he was doing. I walked back to watch as he shot the sick cow with the dead calf inside her in the head with a captive bolt gun, standard euthanasia technique on farm for a cow who cannot make it on to a truck to be shipped to slaughter.
Dr. Gray explained that the cow had had a dead calf in her for several days, and had a large rip in her uterus, which she could not recover from. I will save you from some of the gorier details. He was clearly somewhat bothered by the fact that the calf had died at least four days before and she had not gotten medical attention before then. “To be fair,” he said, “the calf wasn’t in the birth canal so she probably didn’t show any signs of labor for them to notice.” I said, “Is this maybe a case where on a smaller farm, someone would have realized something was going on with the cow which was supposed to have freshened a few days ago?” He allowed as to how that was probably the case.
Then we checked out the fourth cow, the one which was also supposed to have a displaced abomasum. Amusingly, this cow stuck her head into the head lock enthusiastically. We were running late, so Dr. Gray did this exam himself, and did find a problem. He is a fan of a toggle procedure to fix displaced abomasums, so that is what we did, instead of the surgical procedure I had seen previously. With the help of a farm hand, we sedated the cow, put ropes around her, pulled her over on her side, and rolled her on to her back. Once she was on her back, her stomach floated into the correct place. Dr. Gray put two pins into her belly, puncturing through the skin and into the stomach. He used the pins to secure the stomach in place. The cow was allowed to stand up and was good to go (with dextrose, steroids, oral fluids, oral calcium, and B vitamins to help her out).
Then we washed off in a bucket. There was a lot of scrubbing to be done. And that was day seven.
Monday, September 19, 2011
Being a food animal veterinarian, day 6
Day 6. Another herd check. It’s becoming routine. To be fair, I tend to end up riding with the clinicians who do herd checks, because I want to spend these three weeks working with cows. I have so far avoided riding with the clinician who specializes in horses, because equine medicine bores me silly. I like horses, just not horse medicine. And I really like cows, who are endlessly sweet and amusing, and I like herd health, or population medicine. Put me on a farm with a few sick cows and I am perfectly happy to spend hours talking about what is wrong with farm management which is causing these cows to get sick. Ask me to actually do procedures on an individual cow and I start wondering when we are moving on to the next farm.
So. Day 6, herd check. After all the rectal palpations there is inevitably the one or two sick cows to check on, or in this case, three. One was six weeks fresh (gave birth six weeks ago). You always, always ask how fresh a cow is, or if she is not particularly fresh, how many days in milk (how long she has been giving milk, i.e., how many days ago she gave birth — I have been told things like “this cow is 510 days in milk”). They get different diseases depending on where they are in the whole calf-milk-breeding-no milk-calf cycle. This one, being six weeks fresh, should have been past any problems with her uterus recovering from labor, but was not. Which was why we were being asked to look at her. We recommended infusing her uterus with dilute iodine to get rid of the infection.
The next cow had aborted two days previously. She still had bits of placenta hanging out. Normally retained placentas clear themselves within a day or two, but this one was hanging in there a little long, especially for having quite so many pieces still stuck in. My syllabus says it is “controversial” to “manually clean” the uterus of retained placenta (i.e., go in and pull the bits out by hand). It is usually better to let nature take care of this, as upsetting as it is to see cows walking around with pink stuff dangling out of their private parts (what small animal owners inevitably refer to as “down there” and what farmers will refreshingly refer to as “vaginas”). In this case, we manually cleaned. Well, the vet cleaned, and I watched. Good times.
Sick cow #3 had some hair loss on her heels and at the head of her tail. The clinician took one look and pronounced her as having mange. We applied a parasiticide: the vet handed me a big bottle and told me to pour it along the cow’s top line. The stuff was bright purple. Now the cow was bright purple. More fun than cleaning placentas.
Farm two. A big farm, but a well run one. They were having a diarrhea problem with many of their calves (“calf scours”). We drew blood on some four day old calves to check to see if they had gotten enough antibodies from their dams in the colostrum (milk full of antibodies) that they drank in their first few hours of life. (Back at the clinic, the answer was that two of them were fine, and two of them were borderline for not having enough antibodies.) This was a great example of a herd health problem. Why were these calves getting sick? It seemed to be some management problem, but where exactly was the farm going wrong? If the calves weren’t getting enough colostrum, why not? The guy in charge of calf management spent a long time talking to the vet to try to figure it out. So far, we still have no answer. I hope they manage to find one.
So. Day 6, herd check. After all the rectal palpations there is inevitably the one or two sick cows to check on, or in this case, three. One was six weeks fresh (gave birth six weeks ago). You always, always ask how fresh a cow is, or if she is not particularly fresh, how many days in milk (how long she has been giving milk, i.e., how many days ago she gave birth — I have been told things like “this cow is 510 days in milk”). They get different diseases depending on where they are in the whole calf-milk-breeding-no milk-calf cycle. This one, being six weeks fresh, should have been past any problems with her uterus recovering from labor, but was not. Which was why we were being asked to look at her. We recommended infusing her uterus with dilute iodine to get rid of the infection.
The next cow had aborted two days previously. She still had bits of placenta hanging out. Normally retained placentas clear themselves within a day or two, but this one was hanging in there a little long, especially for having quite so many pieces still stuck in. My syllabus says it is “controversial” to “manually clean” the uterus of retained placenta (i.e., go in and pull the bits out by hand). It is usually better to let nature take care of this, as upsetting as it is to see cows walking around with pink stuff dangling out of their private parts (what small animal owners inevitably refer to as “down there” and what farmers will refreshingly refer to as “vaginas”). In this case, we manually cleaned. Well, the vet cleaned, and I watched. Good times.
Sick cow #3 had some hair loss on her heels and at the head of her tail. The clinician took one look and pronounced her as having mange. We applied a parasiticide: the vet handed me a big bottle and told me to pour it along the cow’s top line. The stuff was bright purple. Now the cow was bright purple. More fun than cleaning placentas.
Farm two. A big farm, but a well run one. They were having a diarrhea problem with many of their calves (“calf scours”). We drew blood on some four day old calves to check to see if they had gotten enough antibodies from their dams in the colostrum (milk full of antibodies) that they drank in their first few hours of life. (Back at the clinic, the answer was that two of them were fine, and two of them were borderline for not having enough antibodies.) This was a great example of a herd health problem. Why were these calves getting sick? It seemed to be some management problem, but where exactly was the farm going wrong? If the calves weren’t getting enough colostrum, why not? The guy in charge of calf management spent a long time talking to the vet to try to figure it out. So far, we still have no answer. I hope they manage to find one.
Saturday, September 17, 2011
Being a food animal veterinarian, day 5
Day 5. I was refreshed after a weekend of sleeping 13 hours a night (still catching up after my exhausting small animal surgery rotation the previous month). I signed up to ride with Dr. Gray and my classmates Will and Anna.
Farm one. A largish farm for a family farm, but run by people who clearly really cared about their cows, a mom and daughter team. Anna performed a castration; Dr. Gray said I could show her how since I had done one before (making me an expert, clearly). There was a long discussion about whether to use lidocaine (a painkiller) or not, as there always is when calf castration is discussed. Since this is something I’ve thought about a lot, I was able to present the usual pro and con arguments to my rotation mates. We used lidocaine. The calf was a lot bigger than the one I had done before. My advice: do them younger. The restraint is a lot easier.
Then we did the usual herd check. One cow had had a forced extraction recently, a difficult birth ending in having the baby pulled out of her using chains. Dr. Gray did a vaginal exam, which is more uncomfortable for the cow than a rectal exam, such that students are not allowed to follow after and do their own exam. She had multiple internal lacerations, so Dr. Gray recommended antibiotics and pain killers. This was one of those sticky situations where pain killers weren’t absolutely necessary, just indicated for the cow’s comfort. He thought the farmer wouldn’t want to give them and considered not even suggesting them, but in the end did suggest them (“if you wanted to give some banamine, it wouldn’t be wrong”) and the farmer promptly agreed. I had thought she would, since she seemed to really care about her cows. Veterinarians, it is not wrong to just suggest the best care, even if you think your client will say no! You just have to find a way to do it in a way that won’t make your client feel uncomfortable if they do feel they can’t afford it.
Overall, I mostly liked how these cows were kept; the health of the cows was clearly a high priority on this farm. I am still not happy that the industry standard keeps cows on slippery concrete where they are bound to develop foot problems (10% of a herd is expected to be lame on any given day), walking in manure so that they are caked with it up their legs, and not getting to eat the grass that they evolved to eat.
Second farm of the day: we preg checked (pregnancy checked, rectally) about 100 cows. PHEW. Luckily there were three of us. As the herd check started winding to a close, Dr. Gray put Will and me on the task of giving the cows the injections that they needed. When a cow was preg checked and found to be open (not pregnant), with structures on her ovary to indicate that she had recently ovulated, she got an L written on her side in orange chalk. When she was pregnant she got a P. Otherwise she got nothing. I injected all the P cows with a multiple vaccine. Early pregnancy is a good time to vaccinate so that the mom will pass on the antibodies to the baby in her colostrum after birth. Will injected the L cows with Lutalyse. This is a hormone (prostaglandin F 2α) which causes them to reset their estrual cycle so that they will ovulate in the next three days and can be bred again. In general the female vet students avoid handling Lutalyse, because if it gets in our system we get very bad cramps. I was glad to have Will there to give those injections.
Farm one. A largish farm for a family farm, but run by people who clearly really cared about their cows, a mom and daughter team. Anna performed a castration; Dr. Gray said I could show her how since I had done one before (making me an expert, clearly). There was a long discussion about whether to use lidocaine (a painkiller) or not, as there always is when calf castration is discussed. Since this is something I’ve thought about a lot, I was able to present the usual pro and con arguments to my rotation mates. We used lidocaine. The calf was a lot bigger than the one I had done before. My advice: do them younger. The restraint is a lot easier.
Then we did the usual herd check. One cow had had a forced extraction recently, a difficult birth ending in having the baby pulled out of her using chains. Dr. Gray did a vaginal exam, which is more uncomfortable for the cow than a rectal exam, such that students are not allowed to follow after and do their own exam. She had multiple internal lacerations, so Dr. Gray recommended antibiotics and pain killers. This was one of those sticky situations where pain killers weren’t absolutely necessary, just indicated for the cow’s comfort. He thought the farmer wouldn’t want to give them and considered not even suggesting them, but in the end did suggest them (“if you wanted to give some banamine, it wouldn’t be wrong”) and the farmer promptly agreed. I had thought she would, since she seemed to really care about her cows. Veterinarians, it is not wrong to just suggest the best care, even if you think your client will say no! You just have to find a way to do it in a way that won’t make your client feel uncomfortable if they do feel they can’t afford it.
Overall, I mostly liked how these cows were kept; the health of the cows was clearly a high priority on this farm. I am still not happy that the industry standard keeps cows on slippery concrete where they are bound to develop foot problems (10% of a herd is expected to be lame on any given day), walking in manure so that they are caked with it up their legs, and not getting to eat the grass that they evolved to eat.
Second farm of the day: we preg checked (pregnancy checked, rectally) about 100 cows. PHEW. Luckily there were three of us. As the herd check started winding to a close, Dr. Gray put Will and me on the task of giving the cows the injections that they needed. When a cow was preg checked and found to be open (not pregnant), with structures on her ovary to indicate that she had recently ovulated, she got an L written on her side in orange chalk. When she was pregnant she got a P. Otherwise she got nothing. I injected all the P cows with a multiple vaccine. Early pregnancy is a good time to vaccinate so that the mom will pass on the antibodies to the baby in her colostrum after birth. Will injected the L cows with Lutalyse. This is a hormone (prostaglandin F 2α) which causes them to reset their estrual cycle so that they will ovulate in the next three days and can be bred again. In general the female vet students avoid handling Lutalyse, because if it gets in our system we get very bad cramps. I was glad to have Will there to give those injections.
Monday, September 12, 2011
Being a food animal veterinarian, day 4
Day 4. Friday! I was hugely looking forward to having an actual weekend off, with no responsibilities in the hospital for the first time in 5 weeks.
I was one of the first students in to the clinic. Dr. Cole caught me and my classmate Will as I was coming in and told us that a client had just pulled in. She was bringing her extremely elderly and sick dog in to the clinic for euthanasia. The clinic technically doesn’t handle small animals at all, but Dr. Cole was willing to help out the client in this case. We euthanized the dog in the back of the truck, lying comfortably on his blanket. Will and Dr. Cole handled the actual euthanasia, while I talked to the owner about her dog, what he was like.
I rode with Dr. Thery that day. We went out to a small farm which produces artisanal raw cheese for sale in New York city and directly to restaurants in the area. I loved this farm. The cows were all out on grass all summer. The barn was old but very well maintained, not overly dirty. The cows were extremely friendly; even the calves were not head shy at all. We did a herd check, popped an abscess on a cow’s flank, and vaccinated and TB tested a mess of heifers (about to be sold across state lines) and calves.
I kept ducking out of doing the actual medicine to go talk to the farmer about how she makes grass feeding work. Grass feeding is the norm for beef cattle before they go into feedlots, but for dairy cows, conventional wisdom is that they have to be handled too much to make it work. What a pain to have to round up all your cows twice a day for milking! But the farmer shrugged that off. The cows want to be milked, because their udders get uncomfortably full. They come back in to the barn voluntarily. Once they know the routine, it’s no problem.
I wish all farms could be like this one. I know that’s a pipe dream, but I still really want to find a way to support farms like this one, to make it just a little easier for farmers to do what I consider to be the right thing by their animals.
I was one of the first students in to the clinic. Dr. Cole caught me and my classmate Will as I was coming in and told us that a client had just pulled in. She was bringing her extremely elderly and sick dog in to the clinic for euthanasia. The clinic technically doesn’t handle small animals at all, but Dr. Cole was willing to help out the client in this case. We euthanized the dog in the back of the truck, lying comfortably on his blanket. Will and Dr. Cole handled the actual euthanasia, while I talked to the owner about her dog, what he was like.
I rode with Dr. Thery that day. We went out to a small farm which produces artisanal raw cheese for sale in New York city and directly to restaurants in the area. I loved this farm. The cows were all out on grass all summer. The barn was old but very well maintained, not overly dirty. The cows were extremely friendly; even the calves were not head shy at all. We did a herd check, popped an abscess on a cow’s flank, and vaccinated and TB tested a mess of heifers (about to be sold across state lines) and calves.
I kept ducking out of doing the actual medicine to go talk to the farmer about how she makes grass feeding work. Grass feeding is the norm for beef cattle before they go into feedlots, but for dairy cows, conventional wisdom is that they have to be handled too much to make it work. What a pain to have to round up all your cows twice a day for milking! But the farmer shrugged that off. The cows want to be milked, because their udders get uncomfortably full. They come back in to the barn voluntarily. Once they know the routine, it’s no problem.
I wish all farms could be like this one. I know that’s a pipe dream, but I still really want to find a way to support farms like this one, to make it just a little easier for farmers to do what I consider to be the right thing by their animals.
Saturday, September 10, 2011
Being a food animal veterinarian, day 3
Day 3. I signed up to ride with Dr. Cripi, just him and me. I was hopeful that I would get to do more hands on stuff when I was not competing with other students for opportunities.
I expected to get right in the truck and head out, but Dr. Cripi said that a cow was being brought to us this morning. Some farms are so far outside the clinic’s usual area that they are only worth visiting if there is some other work in the same region. These farms can be our clients, but have to let us schedule our visits to groups of them on the same day. When they have emergencies, they have to bring their animals to us. This was why the cow was coming to us now.
She got off the truck nicely and we put her in the stocks so that she was restrained and could easily be examined. Dr. Cripi noted that her eyes were sunken, indicating dehydration. Some other students were standing around as well, and we all got to examine her. A large part of examining a cow is trying to identify problems with its complicated GI system. If part of the GI is displaced to somewhere it shouldn’t be (a fairly common problem, especially in cows that are fed too little roughage in their diets, e.g., are not out on pasture or fed mostly hay) then that part of the GI will start filling up with gas. You can “ping” the cow to hear this. You snap a finger hard against her side while listening with your stethoscope. This was the first ping I had ever heard, as I had never before examined a cow with a displacement. It sounded like a basketball bouncing on a metal floor. I referred to the ping as “gorgeous,” which amused the farmer no end.
This cow had an RDA, or right displaced abomasum. This means that the cow’s true stomach, or abomasum, had floated up on the right side of the cow. (Normal location: right side, but a lot more ventral, e.g., closer to the ground). We performed standing surgery on the cow to fix the problem. We did not sedate her, as she was so sick that Dr. Cripi thought sedation would make her lie down, which would make the surgery much more difficult. We did give her a local block in the area where we would be cutting. Then she was shaved and prepped (aseptically scrubbed) over her right side.
First we scrubbed in. This was hilariously different from scrubbing in to surgery in the small animal hospital, which I had done a lot of on my surgery rotation over the previous month. A cow holding area is going to be inherently dirty. We scrubbed our arms off with iodine and put on long surgical gloves (they have to go up to your shoulder, because you’re going to be reaching deep inside a big animal), then normal sterile gloves on top of that.
Then Dr. Cripi made a maybe 5 inch incision in the cow’s side. She didn’t seem to notice; hurray for local anesthetics. He pointed: “See? Her abomasum is right there. That’s huge!” The abomasum was hugely distended with gas and floating right under the surgical incision. Dr. Cripi put a needle into it, attached to a long tube, and let a lot of the gas out. He had all the students smell the gas: a sort of sweet smell, much nicer than rumen smell. (The rumen is the largest and possibly most important part of the cow’s complicated four chamber stomach, the part that feed first falls into to ferment.) The farmer declined to take a sniff, and made a face.
Once the abomasum was somewhat deflated, Dr. Cripi tacked it to the body wall with tacking sutures. Then he closed the incision’s lower layers with the biggest needle I have ever seen in my life. Then he showed me how to close the last layer, the skin. I have done my share of small animal skin closures, and this was really different: that cow’s skin was insanely thick and tough. If you’ve sewn leather, you know what it’s like. I had to really put my back into it to get the needle through.
Then we dosed the cow with a liter of intravenous fluids plus dextrose, and a liter of electrolyte solution. I got to hold the fluids up “as high as you can!” If it is going to make your arm tired, it is the student’s job.
Then the cow walked politely back on her truck and went home.
We got in our truck and headed off to our first farm, with Dr. Cripi angsting about how late we were the whole way. En route, we talked about our lives. Some ambulatory vets use the ride as a teaching opportunity (Dr. Mulain); some ride in silence (Dr. Thery); some just want to chat (Drs. Cole and Cripi). Dr. Cripi had a pretty interesting life, it turned out, spending five years just traveling the world before realizing he wanted to work with food animals as a veterinarian.
Farm number one: a herd check. Checking cows in a herd for pregnancy seems to be the bread and butter of the practice. It was a typical concrete floor, feces-covered barn, but with a particularly open design that I really liked, basically just a roof over the cows, no walls. I asked about their plans for winter (this was a brand new structure). They intend to put up some cover then, but nothing permanent. We worked with a fantastic view of rolling Connecticut hills. It was a lovely scene to look at while putting one’s arm up a cow’s butt.
This farm’s staff included a scrawny kid just out of his teenage years who noticed that a female had arrived and immediately took off his shirt. This became even more hilarious when I was told that it was my job to castrate a bull calf and that the kid would help restrain. I later asked Dr. Cripi if the kid took off his shirt every time a female vet student appeared. Dr. Cripi rolled his eyes and said yes.
How to castrate a bull calf: the vet will draw a diagram for you on a paper towel, hand you a scalpel, and send you on your way. I asked if we used lidocaine for analgesia; he said I could if I wanted to. I said yes please. (The debate in use of lidocaine for a local block in castration is that arguably it is more unpleasant to have a needle shoved into multiple spots in your scrotum and have something that burns injected than just to have the stuff ripped off real quick. Personally I think pain meds are mandatory, but even more so if the job is being done by someone who’s never done it before.) I gave the calf lidocaine injections at various locations around his scrotum and waited five minutes for it to take effect.
My experience in castrating dogs and cats was helpful. I cut off the tip of the scrotum, squeezed the testicles out. They are slippery and don’t like to come out, but I had done this before on a smaller scale and knew how to squeeze. Then I grabbed them and pulled until they came off. (The hardest part was getting a grip. In small animal medicine one uses little four by four pads to hold on to them, not your hands.) The kid asked why we didn’t just cut them off. I said that Dr. Cripi hadn’t said, but my guess was that the bleeding would be worse if you cut; ripping provides some hemostasis.
Farm number two. En route, the sun came out. My spirits immediately lifted. It is amazing what a difference some blue sky makes. At this farm we had a sick cow who was two weeks fresh. This means she gave birth two weeks ago and has been being milked for two weeks. The stress of parturition means that many of these fresh cows are at risk for a variety of diseases, like a displaced abomasum such as we’d seen earlier that morning. In this case, she seemed to have some nerve injury from when the baby passed over the obturator nerve along the pelvis. We prescribed rest, TLC, and anti-inflammatories (banamine is what you give to cows).
Farm number three. Another hobby farm, but a somewhat bigger one. This farmer had quit her previous job to just be a cow farmer, and her husband’s income was presumably supporting the operation. The cows were out on grass in a truly lovely setting (we drove over a little covered bridge across what I have to describe as a sparkling brook on the way in). The cows were spotlessly clean. Normally you sort of hesitate to pet them because of all the manure all over them (at least until you have manure on your hands, which inevitably happens). These cows were so clean that I actually sniffed one and discovered that natural (manure free) cow smell is a lot like horse smell. The farmer had put the sick cow into a holding area, which had a concrete floor which was also spotlessly clean. No huge masses of spider webs! No dead birds in the rafters! Crazy! The farmer actually hovered with a bucket to catch the urine when the cows peed, which is farther than I would go in her place, but I really did appreciate the cleanliness. As Dr. Cripi pointed out, these cows were basically pets.
This cow had a left displaced abomasum (same problem as the first patient of the day, different side). LDAs are actually a lot more common than RDAs, which is too bad, as you still have to cut on the right side of the cow (the rumen covers everything on the left side) and as you then have to reach across the inside of the cow to get to the abomasum on the other side, it becomes quite a process. This cow was dry (no longer being milked) and due to freshen (give birth) in a few weeks. Dr. Cripi was amazed that she had an LDA. Dry cows almost never get displaced abomasums; it is a disease of fresh cows. Cows out on grass also almost never get this disease. This particular cow also turned out to have pneumonia, so maybe the stress of that had caused the displacement. Weird.
So, same surgery, except that Dr. Cripi had to reach through the cow this time instead of having the abomasum pop right up under his incision. I did not get to close, as I had inadvertently contaminated myself on the cow’s side while trying to prevent the drape from falling off of her.
Last farm of the day: again, a horse owner. Her horse needed his yearly vaccines. He was 31 years old! He was a super nice horse. Dr. Cripi sat down and handed me the vaccine bottles. I drew them up and injected them into the horse’s neck. He never flinched. Old patients can be the easiest ones to handle.
End of day 3: less wet, more confident, starting to have fun.
I expected to get right in the truck and head out, but Dr. Cripi said that a cow was being brought to us this morning. Some farms are so far outside the clinic’s usual area that they are only worth visiting if there is some other work in the same region. These farms can be our clients, but have to let us schedule our visits to groups of them on the same day. When they have emergencies, they have to bring their animals to us. This was why the cow was coming to us now.
She got off the truck nicely and we put her in the stocks so that she was restrained and could easily be examined. Dr. Cripi noted that her eyes were sunken, indicating dehydration. Some other students were standing around as well, and we all got to examine her. A large part of examining a cow is trying to identify problems with its complicated GI system. If part of the GI is displaced to somewhere it shouldn’t be (a fairly common problem, especially in cows that are fed too little roughage in their diets, e.g., are not out on pasture or fed mostly hay) then that part of the GI will start filling up with gas. You can “ping” the cow to hear this. You snap a finger hard against her side while listening with your stethoscope. This was the first ping I had ever heard, as I had never before examined a cow with a displacement. It sounded like a basketball bouncing on a metal floor. I referred to the ping as “gorgeous,” which amused the farmer no end.
This cow had an RDA, or right displaced abomasum. This means that the cow’s true stomach, or abomasum, had floated up on the right side of the cow. (Normal location: right side, but a lot more ventral, e.g., closer to the ground). We performed standing surgery on the cow to fix the problem. We did not sedate her, as she was so sick that Dr. Cripi thought sedation would make her lie down, which would make the surgery much more difficult. We did give her a local block in the area where we would be cutting. Then she was shaved and prepped (aseptically scrubbed) over her right side.
First we scrubbed in. This was hilariously different from scrubbing in to surgery in the small animal hospital, which I had done a lot of on my surgery rotation over the previous month. A cow holding area is going to be inherently dirty. We scrubbed our arms off with iodine and put on long surgical gloves (they have to go up to your shoulder, because you’re going to be reaching deep inside a big animal), then normal sterile gloves on top of that.
Then Dr. Cripi made a maybe 5 inch incision in the cow’s side. She didn’t seem to notice; hurray for local anesthetics. He pointed: “See? Her abomasum is right there. That’s huge!” The abomasum was hugely distended with gas and floating right under the surgical incision. Dr. Cripi put a needle into it, attached to a long tube, and let a lot of the gas out. He had all the students smell the gas: a sort of sweet smell, much nicer than rumen smell. (The rumen is the largest and possibly most important part of the cow’s complicated four chamber stomach, the part that feed first falls into to ferment.) The farmer declined to take a sniff, and made a face.
Once the abomasum was somewhat deflated, Dr. Cripi tacked it to the body wall with tacking sutures. Then he closed the incision’s lower layers with the biggest needle I have ever seen in my life. Then he showed me how to close the last layer, the skin. I have done my share of small animal skin closures, and this was really different: that cow’s skin was insanely thick and tough. If you’ve sewn leather, you know what it’s like. I had to really put my back into it to get the needle through.
Then we dosed the cow with a liter of intravenous fluids plus dextrose, and a liter of electrolyte solution. I got to hold the fluids up “as high as you can!” If it is going to make your arm tired, it is the student’s job.
Then the cow walked politely back on her truck and went home.
We got in our truck and headed off to our first farm, with Dr. Cripi angsting about how late we were the whole way. En route, we talked about our lives. Some ambulatory vets use the ride as a teaching opportunity (Dr. Mulain); some ride in silence (Dr. Thery); some just want to chat (Drs. Cole and Cripi). Dr. Cripi had a pretty interesting life, it turned out, spending five years just traveling the world before realizing he wanted to work with food animals as a veterinarian.
Farm number one: a herd check. Checking cows in a herd for pregnancy seems to be the bread and butter of the practice. It was a typical concrete floor, feces-covered barn, but with a particularly open design that I really liked, basically just a roof over the cows, no walls. I asked about their plans for winter (this was a brand new structure). They intend to put up some cover then, but nothing permanent. We worked with a fantastic view of rolling Connecticut hills. It was a lovely scene to look at while putting one’s arm up a cow’s butt.
This farm’s staff included a scrawny kid just out of his teenage years who noticed that a female had arrived and immediately took off his shirt. This became even more hilarious when I was told that it was my job to castrate a bull calf and that the kid would help restrain. I later asked Dr. Cripi if the kid took off his shirt every time a female vet student appeared. Dr. Cripi rolled his eyes and said yes.
How to castrate a bull calf: the vet will draw a diagram for you on a paper towel, hand you a scalpel, and send you on your way. I asked if we used lidocaine for analgesia; he said I could if I wanted to. I said yes please. (The debate in use of lidocaine for a local block in castration is that arguably it is more unpleasant to have a needle shoved into multiple spots in your scrotum and have something that burns injected than just to have the stuff ripped off real quick. Personally I think pain meds are mandatory, but even more so if the job is being done by someone who’s never done it before.) I gave the calf lidocaine injections at various locations around his scrotum and waited five minutes for it to take effect.
My experience in castrating dogs and cats was helpful. I cut off the tip of the scrotum, squeezed the testicles out. They are slippery and don’t like to come out, but I had done this before on a smaller scale and knew how to squeeze. Then I grabbed them and pulled until they came off. (The hardest part was getting a grip. In small animal medicine one uses little four by four pads to hold on to them, not your hands.) The kid asked why we didn’t just cut them off. I said that Dr. Cripi hadn’t said, but my guess was that the bleeding would be worse if you cut; ripping provides some hemostasis.
Farm number two. En route, the sun came out. My spirits immediately lifted. It is amazing what a difference some blue sky makes. At this farm we had a sick cow who was two weeks fresh. This means she gave birth two weeks ago and has been being milked for two weeks. The stress of parturition means that many of these fresh cows are at risk for a variety of diseases, like a displaced abomasum such as we’d seen earlier that morning. In this case, she seemed to have some nerve injury from when the baby passed over the obturator nerve along the pelvis. We prescribed rest, TLC, and anti-inflammatories (banamine is what you give to cows).
Farm number three. Another hobby farm, but a somewhat bigger one. This farmer had quit her previous job to just be a cow farmer, and her husband’s income was presumably supporting the operation. The cows were out on grass in a truly lovely setting (we drove over a little covered bridge across what I have to describe as a sparkling brook on the way in). The cows were spotlessly clean. Normally you sort of hesitate to pet them because of all the manure all over them (at least until you have manure on your hands, which inevitably happens). These cows were so clean that I actually sniffed one and discovered that natural (manure free) cow smell is a lot like horse smell. The farmer had put the sick cow into a holding area, which had a concrete floor which was also spotlessly clean. No huge masses of spider webs! No dead birds in the rafters! Crazy! The farmer actually hovered with a bucket to catch the urine when the cows peed, which is farther than I would go in her place, but I really did appreciate the cleanliness. As Dr. Cripi pointed out, these cows were basically pets.
This cow had a left displaced abomasum (same problem as the first patient of the day, different side). LDAs are actually a lot more common than RDAs, which is too bad, as you still have to cut on the right side of the cow (the rumen covers everything on the left side) and as you then have to reach across the inside of the cow to get to the abomasum on the other side, it becomes quite a process. This cow was dry (no longer being milked) and due to freshen (give birth) in a few weeks. Dr. Cripi was amazed that she had an LDA. Dry cows almost never get displaced abomasums; it is a disease of fresh cows. Cows out on grass also almost never get this disease. This particular cow also turned out to have pneumonia, so maybe the stress of that had caused the displacement. Weird.
So, same surgery, except that Dr. Cripi had to reach through the cow this time instead of having the abomasum pop right up under his incision. I did not get to close, as I had inadvertently contaminated myself on the cow’s side while trying to prevent the drape from falling off of her.
Last farm of the day: again, a horse owner. Her horse needed his yearly vaccines. He was 31 years old! He was a super nice horse. Dr. Cripi sat down and handed me the vaccine bottles. I drew them up and injected them into the horse’s neck. He never flinched. Old patients can be the easiest ones to handle.
End of day 3: less wet, more confident, starting to have fun.
Friday, September 9, 2011
Being a food animal veterinarian, day 2
Day 2 of my Ambulatory rotation. Still raining. I rode with Dr. Cole and one other student.
First we visited a lovely hobby farm, meaning a farm which is not expected to bring in enough revenue to support the owner. These owners bred and showed registered Ayershire cows, and sold their milk as a sideline. They had full time jobs elsewhere. This was a tiny barn, milking around just 20 cows, very clean relative to other barns (I never had to wade through an ankle-deep sea of manure, which is more than I can say for some other farms we visited), and the cows seemed very healthy.
Next we did a herd check at another, larger farm. More rectal palpations. I complained to Dr. Cole that I had no idea what I was doing when I put my arm in there. He walked us through a guide of how we should approach the situation, complete with an actual size model of a cow uterus. Awesome! Here are his instructions, because I know you are desperate to know:
Next stop was another farm for a herd check, 2 rabies vaccines, and 2 health certificates for some calves that were being taken to the fair. We’ve actually done a fair number of health certificates this week. Autumn is town and county fair season, so the kids are all taking their cows out to show them. At this farm I got to see one cow being prepped for the trip by being buzzed down smooth with some clippers.
The last farm was a herd check, 3 calves to dehorn, and 3 lame cows to check on. We tied each lame cow to a post by the head, then lifted the problem foot by means of a complicated rope pulley system that I supposedly learned in my Clinical Skills class but which I certainly could not duplicate on my own. (“Throw a half-hitch here... That’s not a half hitch! Well, do you at least remember how to do a quick release knot?”) The cows would then kick and freak out, so someone had to tail jack them to keep them distracted. Tail jacking means holding the cow’s tail straight up. To do this you have to stand very close to the cow and lean into the tail. She won’t kick you once you’re close, because they kick out to the side, not back. But getting close can be tricky. I learned: get in and tail jack her before they lift her leg and she starts hopping around and kicking. That works much better. (Trim feet down so you can see the problem. Declare the problem to be hairy heel warts. Yes, that’s an actual disease, caused by a species of bacteria. Apply powder antibiotic and bandage the foot. Done.)
Day 2 done. Still cold. Still wet. Starting to feel more like I know what I’m doing.
First we visited a lovely hobby farm, meaning a farm which is not expected to bring in enough revenue to support the owner. These owners bred and showed registered Ayershire cows, and sold their milk as a sideline. They had full time jobs elsewhere. This was a tiny barn, milking around just 20 cows, very clean relative to other barns (I never had to wade through an ankle-deep sea of manure, which is more than I can say for some other farms we visited), and the cows seemed very healthy.
Next we did a herd check at another, larger farm. More rectal palpations. I complained to Dr. Cole that I had no idea what I was doing when I put my arm in there. He walked us through a guide of how we should approach the situation, complete with an actual size model of a cow uterus. Awesome! Here are his instructions, because I know you are desperate to know:
- First you feel for the vaginal canal and/or the cervix. These are fairly caudal (the direction of the cow away from the head) so don’t overshoot them.
- Follow the cervix cranially (forward). Behold the body of the uterus.
- The body of the uterus may have fallen off the floor of the pelvis into the abdomen. If so, grab it and pull it back up onto the pelvis so you can handle it.
- Follow the uterus to the right. Ovary! Not necessarily round. It may be more elongated. Often golf ball sized.
- Do the same on the left.
Next stop was another farm for a herd check, 2 rabies vaccines, and 2 health certificates for some calves that were being taken to the fair. We’ve actually done a fair number of health certificates this week. Autumn is town and county fair season, so the kids are all taking their cows out to show them. At this farm I got to see one cow being prepped for the trip by being buzzed down smooth with some clippers.
The last farm was a herd check, 3 calves to dehorn, and 3 lame cows to check on. We tied each lame cow to a post by the head, then lifted the problem foot by means of a complicated rope pulley system that I supposedly learned in my Clinical Skills class but which I certainly could not duplicate on my own. (“Throw a half-hitch here... That’s not a half hitch! Well, do you at least remember how to do a quick release knot?”) The cows would then kick and freak out, so someone had to tail jack them to keep them distracted. Tail jacking means holding the cow’s tail straight up. To do this you have to stand very close to the cow and lean into the tail. She won’t kick you once you’re close, because they kick out to the side, not back. But getting close can be tricky. I learned: get in and tail jack her before they lift her leg and she starts hopping around and kicking. That works much better. (Trim feet down so you can see the problem. Declare the problem to be hairy heel warts. Yes, that’s an actual disease, caused by a species of bacteria. Apply powder antibiotic and bandage the foot. Done.)
Day 2 done. Still cold. Still wet. Starting to feel more like I know what I’m doing.
Thursday, September 8, 2011
Being a food animal veterinarian, day 1
The first day of my ambulatory (food animal medicine) rotation, I got horribly lost on the way to the clinic, which is about an hour from my home. I came in late and missed half of the orientation. Ambulatory is so called because its vets go to the clients rather than vice versa. There are eight students on the rotation right now, but we break up into groups of one to three and ride along with individual vets.
Day one, three students, Dr. Mulain.
Farm one: herd check! Lots of rectal palpations to discover the pregnancy status of cows. If not pregnant, they would get an injection of a medication to reboot their reproductive cycle, so that their owner would know when they were going to come back into heat and therefore when to breed them. Dr. Mulain palpated first and we followed after, one student per cow. Mostly I put my arm in and waved it around aimlessly, hoping to randomly encounter a uterus.
We also dehorned some baby calves at this farm, and checked up on a lame cow who had had a claw (half her foot) removed a few weeks ago. Her bandage was removed and the clients were told to clean her foot regularly. We checked another lame cow, trimmed back her foot, and cleaned out a sore on it.
Farm two: a steer had been hit by a car! The barn had been broken into by thieves the night before and the inhabitants had escaped. The steer was covered in road rash, which we cleaned. His tail was mangled, and we amputated it. His biggest problem was a dislocated hip. We provided anti-inflammatories and advice that he was unlikely to be able to live with a dislocated hip, but that there was a small chance it would heal.
This farm also produced a calf who had injured her eye a few days before. The eye was not salvageable. We put the calf under general anesthesia with an injection and laid her down on the barn floor, then removed the eye. It was an odd experience for me, as I had just finished my small animal surgery rotation. The levels of cleanliness vary tremendously between the two rotations, to say the least.
Farm three: a house with two elderly horses in a tiny barn out back. One had been suffering from neurologic disease for years and was now increasingly lame. We cleaned out an abscess on his hoof and put on medication and a bandage. The horse looked like he was minutes from expiring, but the vet told us that he always looked like that and always pulls through.
So ended my first day of ambulatory, cold and wet. I trust that the weather will improve, though. September in New England is always lovely.
Day one, three students, Dr. Mulain.
Farm one: herd check! Lots of rectal palpations to discover the pregnancy status of cows. If not pregnant, they would get an injection of a medication to reboot their reproductive cycle, so that their owner would know when they were going to come back into heat and therefore when to breed them. Dr. Mulain palpated first and we followed after, one student per cow. Mostly I put my arm in and waved it around aimlessly, hoping to randomly encounter a uterus.
We also dehorned some baby calves at this farm, and checked up on a lame cow who had had a claw (half her foot) removed a few weeks ago. Her bandage was removed and the clients were told to clean her foot regularly. We checked another lame cow, trimmed back her foot, and cleaned out a sore on it.
Farm two: a steer had been hit by a car! The barn had been broken into by thieves the night before and the inhabitants had escaped. The steer was covered in road rash, which we cleaned. His tail was mangled, and we amputated it. His biggest problem was a dislocated hip. We provided anti-inflammatories and advice that he was unlikely to be able to live with a dislocated hip, but that there was a small chance it would heal.
This farm also produced a calf who had injured her eye a few days before. The eye was not salvageable. We put the calf under general anesthesia with an injection and laid her down on the barn floor, then removed the eye. It was an odd experience for me, as I had just finished my small animal surgery rotation. The levels of cleanliness vary tremendously between the two rotations, to say the least.
Farm three: a house with two elderly horses in a tiny barn out back. One had been suffering from neurologic disease for years and was now increasingly lame. We cleaned out an abscess on his hoof and put on medication and a bandage. The horse looked like he was minutes from expiring, but the vet told us that he always looked like that and always pulls through.
So ended my first day of ambulatory, cold and wet. I trust that the weather will improve, though. September in New England is always lovely.
Saturday, August 20, 2011
Things your vet student is good for
Recently, an owner refused to let me perform a physical examination on his dog. That was for the vet to do. I think he didn’t believe that I had any role in his dog’s care, and thought I was just along to watch and learn from the vets. Not so! (The examples below are all things that have happened to me and owners of my patients.)
- At a teaching facility, your vet student is your pet’s primary caretaker. She is the one who knows your pet the best. She has to present your pet’s clinical history to the residents and faculty every day, follow up on test results, and make sure nothing is overlooked or forgotten about. She is also the one who notices things like what kind of food your dog likes best, whether he likes to be taken a little farther from the hospital than usual so that he can pee on grass instead of stones, and takes time out of her day to cuddle with him if he looks sad. (To be fair, the techs also handle a lot of this sort of thing.)
- Your vet student is the one who lets you know how your dog is doing. She will call you at least once a day to tell you if your dog is stressed or not, and give you the updates that really matter, like “today he barked at me while I was writing up paperwork until I took him out of his cage to cuddle with him.” Sometimes hearing stories that remind you that your dog still has the same personality as he does at home is just as important emotionally as getting the complicated medical updates from the doctor.
- Your vet student is your liaison to the doctor. The doctor is a specialist who is very, very busy. He will give you lots of information, and you will try to digest it all, but you will have trouble really absorbing it. Your vet student is the one who will take the time to answer all your questions in terms you can understand. She will also be understanding if you are anxious about your pet and will tell you that you are going to do fine taking care of him once he comes home. Maybe she will even help you pad the blankets in your car just right before you settle him in to transport him.
- Your vet student is required to be a generalist. The faculty and residents on your pet’s case are all specialists. Sometimes having a generalist around is important. If your dog is in for orthopedic surgery, the specialists may be so focused on your dog’s joint problems that they may not think to perform a rectal exam on him, even though he is a ten year old intact male at risk for all sorts of cancer. But your vet student will remember. (The dog had a mass.)
Sunday, August 7, 2011
The curse of the missing uteruses, part three
The first dog I ever tried to spay had no uterus. (She had already been spayed.) And the first cow I ever did a reproductive exam on had no uterus. (She was a freemartin.) That should be enough missing uteruses for one lifetime. But no.
On a recent shelter medicine externship, I was spaying a kitten. On this externship, you get to spay several animals every day, and I had gotten comfortable enough at it that I was hoping to get through the entire surgery without ever asking for help. To understand what I was doing, you have to understand a little about cat uteruses. Human uteruses are one big sac, probably because we tend to have just one or two babies at a time. Cat uteruses are divided into two horns, each with an ovary at the top, and the horn and ovary are attached to the body wall to hold the whole contraption in place. The horns of pregnant cats fill up with kittens, all in a row.The two horns come together at their base, where there is a little uterine body, which connects to the cervix and from there to the vagina and the outside world. To spay a cat, you cut each ovary and horn away from the body wall. Then you have loose horns, and a base which still attaches to the cervix and vagina and outside world. You cut across the base, and then you have a free uterus and a spayed cat.
So I opened this kitten up, careful to make my incision very short. Longer incisions make visualizing your work easier, but obviously are more painful for the animal, and I had just been criticized on my previous spay for making too long an incision. I used my spay hook to fish around in the abdomen, found the first uterine horn and ovary, pulled them out, and cut them away from the body wall. I traced the now-free uterine horn back to the uterine body.
Finding the first horn is hard: you dip in with the spay hook and blindly bring stuff up, mostly intestines, which you have to repeatedly shove back in until you finally get the organ you’re looking for. Finding the second horn is easy: you follow the first one back to the uterine body, and then pull the second horn out where they both split off from the base. Except in this case, I couldn’t find it. I pulled on the uterine body, which should have made the horn pop out, but no go. I pulled harder. The uterine body started to fray. Oops! I didn’t want it to break before I could find the second horn. I had a moment of indecision: I really, really wanted to get through this whole operation without asking a vet for help. And the problem was probably just that I had made the incision too small. But I had seen too many episodes of ER in which overconfident students got into trouble in exactly this way, and if the uterus split apart before I had a chance to put a suture around it to stop any bleeding, that could potentially be dangerous for the kitten. So I called over Dr. Vine.
Dr. Vine assured me that my incision was an excellent size, and pulled on the uterine body some more. It promptly broke off in her hand. (I congratulated myself on setting her up for dealing with that situation instead of getting myself into it.) It was not a big deal, in the end: she hunted down the stump and we put some suture around it. And she said: This cat only has one uterine horn. It only has half a uterus.
Freakish! And cool. And do you know what? Cats that only have one uterine horn always, 100% of the time, have two ovaries. So if you don’t go hunt down that second ovary, they will still have heat cycles. (They won’t get pregnant, of course, but cats in heat are no fun to have around.) Dr. Vine asked me where I thought the ovary might be. I suggested, in my usual precise fashion, “Somewhere sort of near the... kidney?”
It turns out that that was exactly the answer she was looking for, because, even weirder: about 50% of cats who have only one uterine horn also have only one kidney. And this cat was one of them.
In the end, we found the ovary, just sitting there not really near anything, and we removed it. One more missing uterus for my collection, or half of one. These things come in threes, right? Does this experience count as my third missing uterus, or just two and a half?
On a recent shelter medicine externship, I was spaying a kitten. On this externship, you get to spay several animals every day, and I had gotten comfortable enough at it that I was hoping to get through the entire surgery without ever asking for help. To understand what I was doing, you have to understand a little about cat uteruses. Human uteruses are one big sac, probably because we tend to have just one or two babies at a time. Cat uteruses are divided into two horns, each with an ovary at the top, and the horn and ovary are attached to the body wall to hold the whole contraption in place. The horns of pregnant cats fill up with kittens, all in a row.The two horns come together at their base, where there is a little uterine body, which connects to the cervix and from there to the vagina and the outside world. To spay a cat, you cut each ovary and horn away from the body wall. Then you have loose horns, and a base which still attaches to the cervix and vagina and outside world. You cut across the base, and then you have a free uterus and a spayed cat.
So I opened this kitten up, careful to make my incision very short. Longer incisions make visualizing your work easier, but obviously are more painful for the animal, and I had just been criticized on my previous spay for making too long an incision. I used my spay hook to fish around in the abdomen, found the first uterine horn and ovary, pulled them out, and cut them away from the body wall. I traced the now-free uterine horn back to the uterine body.
Finding the first horn is hard: you dip in with the spay hook and blindly bring stuff up, mostly intestines, which you have to repeatedly shove back in until you finally get the organ you’re looking for. Finding the second horn is easy: you follow the first one back to the uterine body, and then pull the second horn out where they both split off from the base. Except in this case, I couldn’t find it. I pulled on the uterine body, which should have made the horn pop out, but no go. I pulled harder. The uterine body started to fray. Oops! I didn’t want it to break before I could find the second horn. I had a moment of indecision: I really, really wanted to get through this whole operation without asking a vet for help. And the problem was probably just that I had made the incision too small. But I had seen too many episodes of ER in which overconfident students got into trouble in exactly this way, and if the uterus split apart before I had a chance to put a suture around it to stop any bleeding, that could potentially be dangerous for the kitten. So I called over Dr. Vine.
Dr. Vine assured me that my incision was an excellent size, and pulled on the uterine body some more. It promptly broke off in her hand. (I congratulated myself on setting her up for dealing with that situation instead of getting myself into it.) It was not a big deal, in the end: she hunted down the stump and we put some suture around it. And she said: This cat only has one uterine horn. It only has half a uterus.
Freakish! And cool. And do you know what? Cats that only have one uterine horn always, 100% of the time, have two ovaries. So if you don’t go hunt down that second ovary, they will still have heat cycles. (They won’t get pregnant, of course, but cats in heat are no fun to have around.) Dr. Vine asked me where I thought the ovary might be. I suggested, in my usual precise fashion, “Somewhere sort of near the... kidney?”
It turns out that that was exactly the answer she was looking for, because, even weirder: about 50% of cats who have only one uterine horn also have only one kidney. And this cat was one of them.
In the end, we found the ovary, just sitting there not really near anything, and we removed it. One more missing uterus for my collection, or half of one. These things come in threes, right? Does this experience count as my third missing uterus, or just two and a half?
Monday, July 11, 2011
Neurology rotation
I just completed my two-week neurology rotation. You might think that, because I love dog brains, this would have been right up my alley. Actually, I love the parts of brains that help us learn, fear, trust, and love. Veterinary neurology, on the other hand, is a big game of Hunt the Lesion. A dog comes in uncoordinated and with a head tilt. Where in its brain, cranial nerves, or spinal cord is the problem?
A good neurologic exam can localize the problem to the cerebrum, the cerebellum, one or more of the cranial nerves, the spinal cord in front of the front legs, the spinal cord over the front legs, the spinal cord between the front and back legs, the spinal cord over the back legs, the spinal cord behind the back legs, or something more general (a diffuse muscle, nerve, or muscle/nerve junction problem). Once we had an idea where the problem was, we usually sent the animal in to the MRI scanner (a luxury at a large referral hospital; we received a lot of animals coming in just for the MRI, referred from places that don’t have them). This allowed us to see exactly where the lesion was, and to get some information about what kind of lesion it was (intervertebral disc extruded into the spinal canal? A stroke? Cancer?).
I did enjoy neurology, even though Hunt the Lesion isn’t my favorite game. There was a surprising amount of basic medicine to learn; I got a lot more comfortable with how to manage post-surgical animals (we did lots of vertebral surgeries), as well as how to approach a diagnosis (young animals are more likely to have congenital or infectious problems or to have eaten toxins; older animals are more at risk for stroke or cancer). Practicing basic medicine is always good! So it was an enjoyable rotation, but now I am really looking forward to my upcoming four whole weeks of elective time.
A good neurologic exam can localize the problem to the cerebrum, the cerebellum, one or more of the cranial nerves, the spinal cord in front of the front legs, the spinal cord over the front legs, the spinal cord between the front and back legs, the spinal cord over the back legs, the spinal cord behind the back legs, or something more general (a diffuse muscle, nerve, or muscle/nerve junction problem). Once we had an idea where the problem was, we usually sent the animal in to the MRI scanner (a luxury at a large referral hospital; we received a lot of animals coming in just for the MRI, referred from places that don’t have them). This allowed us to see exactly where the lesion was, and to get some information about what kind of lesion it was (intervertebral disc extruded into the spinal canal? A stroke? Cancer?).
I did enjoy neurology, even though Hunt the Lesion isn’t my favorite game. There was a surprising amount of basic medicine to learn; I got a lot more comfortable with how to manage post-surgical animals (we did lots of vertebral surgeries), as well as how to approach a diagnosis (young animals are more likely to have congenital or infectious problems or to have eaten toxins; older animals are more at risk for stroke or cancer). Practicing basic medicine is always good! So it was an enjoyable rotation, but now I am really looking forward to my upcoming four whole weeks of elective time.
Saturday, June 4, 2011
Shelter medicine externship
I recently spent two weeks of elective time at a shelter medicine externship at a different vet school. Half the time was spent in academic pursuits on campus — going to journal club, going to talks and lectures about shelter medicine, etc. The other half was at the shelter, doing high volume spay/neuter, temperament tests, treating sick animals.
Highlights:
Highlights:
- Pulling worms out of a kitten’s butt (“Wow, can I?”)
- STRAY GOLDFISH. It is more amusing not to explain, but I will say that it was found in a ditch in a grocery store parking lot.
- Ratlings! Five week old foster rats came in for a visit. They had been well socialized and were extremely friendly. I badly wanted to adopt one, but suspected it would not get along with my cat.
- Seeing exactly how fast 8 week old kittens recover from spay/neuter surgery. Spay surgery is no small deal, but those girl kittens were literally climbing the walls of their cage 30 minutes later. I am sold on pediatric spay/neuter.
- Helping to set up play groups of shelter dogs and getting to watch them play together. It was lovely.
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