I completed my second spay lab, in which third year veterinary students spay a dog from a shelter or low income family. Unlike my first spay lab dog, this dog had a uterus! (In fact, she was in heat, so I was pretty confident ahead of time that she would. My boyfriend: “How can you tell she’s in heat?” Me: “She has a vulva the size of Texas.”)
Linnea was an extremely nice dog who was extremely unhappy about being in the spay clinic for two days. She pawed at the cage door so much the first night that we gave her a sedative to take the edge off. Her spay went well, but when it is only your second spay, you still don’t trust that you haven’t done something stupid and that the dog isn’t in real trouble. (One of my classmates reports that she actually went to visit her spay patient at the shelter several days later, to make sure she was okay. My classmate pretended to be interested in adopting the dog in order to get time alone with her, so she could look at her spay scar.) So when Linnea started making a lot of noise the evening after her surgery, I was very anxious.
First I asked the anesthesia technician if he thought she needed more pain medication. He pointed out that she had been a very vocal dog before the surgery, and was almost certainly just stressed now, especially due to the after- effects of all the other medications we had given her making her feel less than mentally competent. My spay partner Lily and I looked at Linnea anxiously after letting her out to pee. Lily said: “Well, she seems to be standing sort of hunched over.” I said: “Yes, I really would like to give her more meds!”
The veterinary intern came by around that time, for evening rounds, and I explained how Linnea looked painful to us. (It is veterinary jargon to say an animal is “painful” rather than “in pain,” and I have seen this usage really annoy non-veterinarians. I am not sure why we say it that way, but that is how it is.) Now, Lily and I had recently completed our anesthesia course, which had several lectures about how to tell if dogs are painful, but of course in the heat of the moment we had completely blanked on this. The veterinary intern simply put her hand gently but firmly on Linnea’s spay incision. Linnea didn’t even blink; she didn’t turn her head or growl or flinch. The intern said confidently, “She doesn’t appear to be painful,” and this time, I believed it.
Dogs do sometimes vocalize when they are in pain, but it is not the best way to tell. Many dogs in pain do not vocalize, and there are tricks of body language that you can use to tell what is going on in their heads. We had some fascinating lectures on that, unfortunately far too image-filled for me to reproduce here.
I learned from this experience. When you’re not sure how to proceed, take a deep breath and think back to what you were taught in class. We actually have received a very good foundation for clinical work, but it can be really hard in the moment to pull the appropriate fact out of the mass of information packed into our brains after three years of veterinary school!
Sunday, December 19, 2010
Sunday, December 5, 2010
How to learn how to do ... lots of procedures
Recently I had my Small Animal Procedures lab, in which my classmates and I learned how to perform dentistry, take skin biopsy samples, do trans-tracheal aspirates, take bone marrow biopsies, and a raft of other procedures. I wouldn’t feel comfortable doing any of these procedures unsupervised yet, but I did get to actually do them with my own hands rather than just pick “do a trans-tracheal aspirate” as a multiple-choice answer on a test.
In the past I have described learning on shelter animals that need low-cost procedures, or ex-research dogs that are living at the school until they can be rehomed. This lab used the bodies of animals who had been euthanized at our hospital, and whose owners had agreed to allow us to use them. It is always somewhat disturbing to spend several hours with a dead dog, but this is the one use of animals for teaching that I am one hundred percent happy about. Learning on live animals is never perfect, although my school does its best to find constructive ways to obtain animals for us to use. We had to do so many procedures for this lab, and such invasive ones, that it made sense to use cadavers.
The trans-tracheal aspirate is a particularly interesting procedure to do. The idea is that an animal has some sort of infection in its lungs, and you want to know exactly what. So you thread a catheter into its trachea and down into its small lower airways, pump some fluid in, suck the fluid back out, and test it for bacteria. Okay, but if you thread that catheter in through the mouth, it is going to be contaminated with all kinds of bacteria that you’re not actually interested in, right? So how do you get the catheter in to the trachea without getting mouth bugs all over it?
You stick a big needle in through the outside of the dog’s throat directly in to the trachea, and thread the catheter through that. This means when you stick the needle in, you have to know when its point is inside of the trachea. You can’t see where the point of the needle is, obviously, and that’s why it’s a learning experience. This procedure was particularly hard for me. I kept sticking the needle in, being convinced it was in the right place because I felt a “pop” as it passed into the trachea, and then not being able to thread the catheter in. A tech told me patiently, “if the catheter won’t thread, that means it’s not in the trachea.” Goddammit. I tried again. And again. And eventually it worked.
This was a really enjoyable lab. Four of us worked on one dog cadaver. There were also a few cat cadavers for multiple groups to share. It felt good to do some of the procedures we had learned about, but scary to imagine doing them on living patients in the near future.
In the past I have described learning on shelter animals that need low-cost procedures, or ex-research dogs that are living at the school until they can be rehomed. This lab used the bodies of animals who had been euthanized at our hospital, and whose owners had agreed to allow us to use them. It is always somewhat disturbing to spend several hours with a dead dog, but this is the one use of animals for teaching that I am one hundred percent happy about. Learning on live animals is never perfect, although my school does its best to find constructive ways to obtain animals for us to use. We had to do so many procedures for this lab, and such invasive ones, that it made sense to use cadavers.
The trans-tracheal aspirate is a particularly interesting procedure to do. The idea is that an animal has some sort of infection in its lungs, and you want to know exactly what. So you thread a catheter into its trachea and down into its small lower airways, pump some fluid in, suck the fluid back out, and test it for bacteria. Okay, but if you thread that catheter in through the mouth, it is going to be contaminated with all kinds of bacteria that you’re not actually interested in, right? So how do you get the catheter in to the trachea without getting mouth bugs all over it?
You stick a big needle in through the outside of the dog’s throat directly in to the trachea, and thread the catheter through that. This means when you stick the needle in, you have to know when its point is inside of the trachea. You can’t see where the point of the needle is, obviously, and that’s why it’s a learning experience. This procedure was particularly hard for me. I kept sticking the needle in, being convinced it was in the right place because I felt a “pop” as it passed into the trachea, and then not being able to thread the catheter in. A tech told me patiently, “if the catheter won’t thread, that means it’s not in the trachea.” Goddammit. I tried again. And again. And eventually it worked.
This was a really enjoyable lab. Four of us worked on one dog cadaver. There were also a few cat cadavers for multiple groups to share. It felt good to do some of the procedures we had learned about, but scary to imagine doing them on living patients in the near future.
Wednesday, December 1, 2010
Veterinary fact of the day: feeding guinea pigs
We are having some of the final lectures for our zoo medicine course, and today’s was about pet rodents — guinea pigs, rats, chinchillas, mice, and gerbils. Coincidentally, we also covered many of the same animals in our lecture on laboratory animals, earlier in the day. Both lecturers emphasized the fact that guinea pigs require vitamin C supplementation. Unlike most other species, they can’t make it themselves, and if you don’t provide it in their diet, they will get scurvy. Some owners, we were told, are so dedicated in their C supplementation that they actually provide too much, which can also be problematic.
A lot of our zoo medicine course has covered good feeding and management practices. It seems like a large part of practicing on exotic pets (a term which includes things you might not think of as exotic, like rats and rabbits) includes making sure that people are managing their pets right. Basic husbandry is something that is rarely covered in our small animal medicine course, which is about cats and dogs. We assume that people know how to feed them and what temperatures to maintain them at. I think the really good small animal veterinarians, though, are asking their clients about all kinds of management issues and offering advice, not just waiting for a problem to crop up. Maybe vet school should prepare us more for that.
What I’m up to: I am sliding in to the last few weeks of the semester, and don’t have a lot of extra emotional energy for blogging. I miss it and will certainly be writing more when final exams are over. Next week is my second and final spay lab. Wish me luck for getting a dog with a uterus this time!
A lot of our zoo medicine course has covered good feeding and management practices. It seems like a large part of practicing on exotic pets (a term which includes things you might not think of as exotic, like rats and rabbits) includes making sure that people are managing their pets right. Basic husbandry is something that is rarely covered in our small animal medicine course, which is about cats and dogs. We assume that people know how to feed them and what temperatures to maintain them at. I think the really good small animal veterinarians, though, are asking their clients about all kinds of management issues and offering advice, not just waiting for a problem to crop up. Maybe vet school should prepare us more for that.
What I’m up to: I am sliding in to the last few weeks of the semester, and don’t have a lot of extra emotional energy for blogging. I miss it and will certainly be writing more when final exams are over. Next week is my second and final spay lab. Wish me luck for getting a dog with a uterus this time!
Monday, November 15, 2010
How to learn how to ultrasound a dog
I’ve seen a bunch of ultrasound images (still and moving) throughout vet school. Lecturers will flash up a picture and say things like “and that’s what a pyometra looks like on ultrasound.” And what do I see? MASS OF GREY AND BLACK.
[Image source: Imaging 2003;15:72-78.]
Today we had our first lab in which we got to actually handle ultrasound machines. When you’re driving, everything makes a little bit more sense.
The procedure
Take a dog. Sedate it. Put it on its back (padded to stay in place). Slather gel on its belly. Watch as someone who knows what they’re doing shows you how to find the liver, gallbladder, and kidneys with the ultrasound probe.
The liver isn’t so hard: it’s tucked up under the rib cage, so you put your probe at the end of the rib cage, right in the middle of the belly, and look around. The round black circle that is the gallbladder tells you that you’ve found the right spot. The liver is all around the gallbladder, and once you know that, you can see that it is indeed a slightly different color and texture of grey than all the grey around it. Move the probe back and forth along the dog’s belly, following that particular grey texture until it disappears. You have imaged the liver!
The kidneys are a lot harder to find, as they are not so near the surface of the dog’s body, and they don’t have as clear a landmark. When you do find them, they are super cool to look at, though. The liver is a plain mass of grey, but the kidneys have a pattern to them that looks exactly like a kidney looks when you cut it in half in gross anatomy lab. It convinces you that what you’re looking at is for real and not just made-up images on a computer screen.
Try again with the urinary bladder. That’s easy to find, a nice big black circle. You can change its shape by pushing down with the ultrasound probe. As you are being pleased with how easy this is, the radiology resident comes over and asks if you want to try to find the prostate.
The prostate is hard to find, I tell you what. The resident had to find it for me (I held on to the probe while he moved it, so that I could feel where to put it), and when he pointed it out to me, I was like, “That’s a thing? A thing I am supposed to be able to recognize later? It doesn’t look like anything!”
Wipe the gel off the dog. Call someone to give him his reversal agent to counteract the sedative. Wrap him in a warm blanket and cuddle him while he wakes up.
Success! You saw a liver, gallbladder, urinary bladder, and prostate!
The students
There are two labs for the class of 82 students, so this lab had 41 students in it. There were 5-6 students per dog, 6 students in my group; we took turns with the probe. The dogs were sedated for about 80 minutes, which didn’t feel too long to me.
The instructors
The instructors included: a private practice veterinarian; two radiology residents; a representative of the ultrasound equipment company (who may or may not have been a vet, I wasn’t clear, but certainly knew how to ultrasound a dog).
The equipment
A manufacturer of ultrasound equipment lent us the equipment for the day, so that we could have several ultrasound machines in use at once. They did this out of the kindness of their hearts, and perhaps with the idea that we would think well of them and perhaps purchase some of their equipment some day.
The dogs
The dogs came from my school’s teaching colony. These are ex-research dogs. The research laboratories can’t place the dogs directly in homes once their stint as research animals is over, so they give them to my school, which socializes them for a few years and uses them in procedure labs like this one, then adopts them out. They retire to pet homes for the rest of their lives. I also learned how to do a neurology and cardiology exam on these dogs, among other non-invasive procedures.
The dogs represent a complex moral question for me. Is it acceptable to use them like this? They are cared for well, but they live in kennels rather than homes, and they do have procedures like this done on them, which while non-invasive must be at least a little stressful. However, my school is doing a good thing by helping them to transition from a research environment to pet homes. And the alternative would be that I would learn ultrasound techniques on patients, animals who were actually sick, and perhaps less able to tolerate my bumbling around. In the end, I like this solution.
So thank you to the dog who let me practice on him (although it was not his choice). Thank you to the people who taught me. Thank you to the company who lent the equipment. It was a good lab.
Today we had our first lab in which we got to actually handle ultrasound machines. When you’re driving, everything makes a little bit more sense.
The procedure
Take a dog. Sedate it. Put it on its back (padded to stay in place). Slather gel on its belly. Watch as someone who knows what they’re doing shows you how to find the liver, gallbladder, and kidneys with the ultrasound probe.
The liver isn’t so hard: it’s tucked up under the rib cage, so you put your probe at the end of the rib cage, right in the middle of the belly, and look around. The round black circle that is the gallbladder tells you that you’ve found the right spot. The liver is all around the gallbladder, and once you know that, you can see that it is indeed a slightly different color and texture of grey than all the grey around it. Move the probe back and forth along the dog’s belly, following that particular grey texture until it disappears. You have imaged the liver!
The kidneys are a lot harder to find, as they are not so near the surface of the dog’s body, and they don’t have as clear a landmark. When you do find them, they are super cool to look at, though. The liver is a plain mass of grey, but the kidneys have a pattern to them that looks exactly like a kidney looks when you cut it in half in gross anatomy lab. It convinces you that what you’re looking at is for real and not just made-up images on a computer screen.
Try again with the urinary bladder. That’s easy to find, a nice big black circle. You can change its shape by pushing down with the ultrasound probe. As you are being pleased with how easy this is, the radiology resident comes over and asks if you want to try to find the prostate.
The prostate is hard to find, I tell you what. The resident had to find it for me (I held on to the probe while he moved it, so that I could feel where to put it), and when he pointed it out to me, I was like, “That’s a thing? A thing I am supposed to be able to recognize later? It doesn’t look like anything!”
Wipe the gel off the dog. Call someone to give him his reversal agent to counteract the sedative. Wrap him in a warm blanket and cuddle him while he wakes up.
Success! You saw a liver, gallbladder, urinary bladder, and prostate!
The students
There are two labs for the class of 82 students, so this lab had 41 students in it. There were 5-6 students per dog, 6 students in my group; we took turns with the probe. The dogs were sedated for about 80 minutes, which didn’t feel too long to me.
The instructors
The instructors included: a private practice veterinarian; two radiology residents; a representative of the ultrasound equipment company (who may or may not have been a vet, I wasn’t clear, but certainly knew how to ultrasound a dog).
The equipment
A manufacturer of ultrasound equipment lent us the equipment for the day, so that we could have several ultrasound machines in use at once. They did this out of the kindness of their hearts, and perhaps with the idea that we would think well of them and perhaps purchase some of their equipment some day.
The dogs
The dogs came from my school’s teaching colony. These are ex-research dogs. The research laboratories can’t place the dogs directly in homes once their stint as research animals is over, so they give them to my school, which socializes them for a few years and uses them in procedure labs like this one, then adopts them out. They retire to pet homes for the rest of their lives. I also learned how to do a neurology and cardiology exam on these dogs, among other non-invasive procedures.
The dogs represent a complex moral question for me. Is it acceptable to use them like this? They are cared for well, but they live in kennels rather than homes, and they do have procedures like this done on them, which while non-invasive must be at least a little stressful. However, my school is doing a good thing by helping them to transition from a research environment to pet homes. And the alternative would be that I would learn ultrasound techniques on patients, animals who were actually sick, and perhaps less able to tolerate my bumbling around. In the end, I like this solution.
So thank you to the dog who let me practice on him (although it was not his choice). Thank you to the people who taught me. Thank you to the company who lent the equipment. It was a good lab.
Sunday, November 14, 2010
Links post
- Scared or feral: How do you know? (Pet Connection)
- Repost: The ethics of snail eradication (Adventures in Ethics and Science): “Plenty of people are happy just to get the food without knowing the details of its provenance. I’d rather shoulder the responsibility of doing my own dirty work here. The karmic costs of my food are not hidden out back in the fields behind the farm stand.”
- Canine Cogniton and Pointing Gestures – An Update (The Other End of the Leash)
- Vaccination, Confirmation Bias, and Knowing Your Audience (The Thoughtful Animal): on effective communication of science
- Enrichment in Captive Cephalopods (Cephalove)
Sunday, November 7, 2010
More on women in veterinary medicine
Some while back I wrote a post asking why there are so many more women than men in veterinary medicine. Recently, that post received a comment from Anne Lincoln, whose research into exactly that subject has just been published. Her findings are summarized at Eurekalert. You should read that summary, but in short:
I also recently encountered Science IS Sexist, in which Alexandra Jellicoe asks, Do you think that women are more intuitively than logically intelligent and do you think that as scientific research has been designed to only include this logical, evidence based approach, it alienates women? She concludes that the female brain is likely to find the existing scientific research approach dull, dull, dull. It is too narrow and systematic and does not maximise the use of the hive of activity going on in a female brain. Men approach problem-solving from a task-oriented perspective while women typically solve problems more creatively.
What I find particularly interesting about this idea is that my friend LPK and I have observed that in vet school, dominated by women as it is, we tend to have different approaches to problems than most of our classmates. We tend to approach problems more intuitively and creatively; our classmates are more likely to approach problems more systematically. LPK and I also differ from most of our classmates in that we spent significant time out of school, in non-veterinary careers, before entering vet school. (Five years for her, more like 12 for me.)
So is vet school the place for women to go who think like men? Did it take me so long to realize I wanted to become a veterinarian because (in part) I had to overcome the obstacle of having different approaches to problems than the rest of the veterinary community?
Food for thought. I usually like to leave you with an opinion, but I don’t have one here, just questions.
Women now dominate the field of veterinary medicine — the result of a nearly 40-year trend that is likely to repeat itself in the fields of medicine and law...That's the conclusion of a new study that found three factors that appear to be driving the change: the 1972 federal amendment that outlaws discrimination against female students; male applicants to graduate schools who may be deterred by a growing number of women enrolling; and the increasing number of women earning Bachelor's degrees in numbers that far exceed those of male graduates, says sociologist Anne E. Lincoln.I still have questions! If veterinary medicine, medicine, and law are all changing, why is veterinary medicine changing first? Why are more women earning bachelor’s degrees than men these days? Enquiring minds want to know. Hopefully Dr. Lincoln is continuing research in this area.
I also recently encountered Science IS Sexist, in which Alexandra Jellicoe asks, Do you think that women are more intuitively than logically intelligent and do you think that as scientific research has been designed to only include this logical, evidence based approach, it alienates women? She concludes that the female brain is likely to find the existing scientific research approach dull, dull, dull. It is too narrow and systematic and does not maximise the use of the hive of activity going on in a female brain. Men approach problem-solving from a task-oriented perspective while women typically solve problems more creatively.
What I find particularly interesting about this idea is that my friend LPK and I have observed that in vet school, dominated by women as it is, we tend to have different approaches to problems than most of our classmates. We tend to approach problems more intuitively and creatively; our classmates are more likely to approach problems more systematically. LPK and I also differ from most of our classmates in that we spent significant time out of school, in non-veterinary careers, before entering vet school. (Five years for her, more like 12 for me.)
So is vet school the place for women to go who think like men? Did it take me so long to realize I wanted to become a veterinarian because (in part) I had to overcome the obstacle of having different approaches to problems than the rest of the veterinary community?
Food for thought. I usually like to leave you with an opinion, but I don’t have one here, just questions.
Tuesday, November 2, 2010
New comments policy
I just turned on moderation for comments. I hate to do it, but lately I have been getting a lot of spam comments (put in by real people who can pass the spam filter, but with links to commercial pet supply sites — I have heard about this on other dog-related blogs). I will do my best to approve real comments promptly. I know this is inconvenient for all; sorry!
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