Ophthalmology Week 1

The first 2 days of this block were insanely busy. My first day I had 3-4 appointments and a consult for a dog with Blastomycosis. The second day I had 2 surgeries, and both nights I came in at 10 PM to do eye treatments. The last couple of days have slowed down thankfully. The learning curve for using the instruments is pretty steep, and we are all a little intimidated. We have had a few sessions to practice, but looking at the eye closely is tough work. Then figuring out how to characterize what yous see with ophtho vocab is even harder. The clinicians and residents have been great and very fun to work with. Singing Jack Johnson and Usher while removing an eye was fun stuff. On top of that, I could also get use to surgery while sitting down.

Today I watched a cataract surgery and a surgery for a melting corneal fungal ulcer in a horse. That was pretty neat. Horses are less scary when they are asleep and he recovered really well. We put a graft over the defect, which was also neat to watch.

I hope I get marginally better with eye exams over the next 2 weeks. Tomorrow we have a lot of recheck appointments, including a Boxer with an indolent ulcer. I doubt I will be a slit lamp expert anytime soon, but I will just keep on trying. The eye is very complex and interesting, and challenging.

Orthopedic Surgery coming to a close

It is the middle of the last week of Block 6, and I have to admit I am a little sad. I have truly enjoyed orthopedic surgery about 50 times more than I thought I would. I am still a little intimidated by TPLO/TTA surgeries and pre-surgical measurements, but I have loved fracture fixation techniques. Tomorrow I will see possibly my last case on the block for a problem with the dog's jaw. While my orthopedic exam still has a ways to go, I have much improved over the block. Each day I enjoyed interacting with clients, their pets, and watching them regain use of their bones/limbs. Today I saw arthroscopic shoulder surgery that was amazing and a carpal arthrodesis. Tomorrow I will give my presentation on physical rehabilitation of animals.

The slower pace of the service has helped me enjoy the block, and I have not taken that for granted. I have fit many nap times into my schedule somehow, and last weekend I had most of the weekend completely off. That left me time to sleep in on Sunday, canoe the New River, and play with my fabulous pup.

My next 3 week romp will be with ophthamology and the amazing Dr. Pickett. I am excited for that busy service as well. I certainly started enjoying 4th year in the VTH this block and I hope my enjoyment continues. The NAVLE exam is 2 months away and I need to start spending more time studying on the weekends. Speaking of which it is time to get started with an evening session...

Orthopedic Surgery 1

Wow, I cannot believe it's been 18 days since my last entry. To catch up, I finished off neurology with some interesting cases, but the communication among clinicians was a little frustrating. We can just leave it at that. I did learn that corneal ulcers as a result of anesthesia, however, do occur, and can progress quickly.

My first week of orthopedic surgery was organized, fun, and a success. I had my first favorite patient, a well-behaved sweet sheltie with a rheumatoid polyarthropathy that needed a bone plate removal. We removed a bone plate that was infected, and the owners were the nicest people. I also repaired a calcaneal fracture on a cat, and even got to drive the IM pin.

Week 2 has started off a little rougher however. Monday we had a very slow caseload, and I was tired from attempting a 5:30 am crossfit class. We were released early and I took a nap, studied for boards and rounds and still went to bed at 9:30. Today I admitted my one patient for a cranial cruciate partial tear (expected), and took on a GDV on emergency (unexpected). Sadly, she was euthanized on the table. I practiced suturing her up by myself and returned her to her owner.

After surgery I was hypoglycemic, tired, and disappointed. Ortho was not suppose to be a sad block and I was expecting a better outcome, despite that GDV is often life compromising. I was so excited to see a surgery, I asked for the case. Afterward, I thought to myself why on earth did I want that case? I enjoyed learning about how to proceed with this surgery and emergency care beyond just passing the stomach tube which I have done in the past. I just could use some more happy outcomes than sad outcomes these days. I am beginning to think I am bad luck in cases with a poor likelihood of recovery.

I truly hope there will be many better days with better outcomes. I may defer treating future dogs named Maggie for a while. I am 0 for 2 in just 2 weeks.

I hope tomorrow has a better ending. Joys of 4th year continue...

Feast or Famine

This week started off with a bang. On Monday, I had 1 case, but the bureaucracy of a teaching hospital made me run around like a crazy person to work the case up. The dog had disc disease in the cervical spine, but needed an MRI to see if surgery was a viable option. The owners had a hard time deciding if they should do the MRI and put their 15 year old dog, who is otherwise in good health, through an MRI and possibly surgery. They decided to get answers. Two days later en route to the imaging center, however, they turned around and decided his time was done and euthanized him. While I know how much they cared for the dog and the cost was steep, they wrote him off because of age. Old age is not a disease and he very well had 1-2 good years left. It was disappointing and the news came after an even more disappointing Tuesday.

On Tuesday, we admitted a lab for a clinical treatment trial for a brain tumor. The procedure went very well and his recovery from anesthesia went well at first. Two hours after waking up, he had a seizure which we caught early. The second seizure did not respond to valium and we put him on a CRI of propoflo. After 6 hours we took him off the propoflo and he did fine, but 30 minutes later he went into cardiac arrest and died. He died of aspiration pneumonia caused by delayed gastric emptying. It was such a shame to see a dog with a brain tumor die of aspiration pneumonia. The reality of how common this occurs as a complication to anesthetic procedures hit me hard. I really held out hope that he would make a great recovery and live out some time with a shrunken brain tumor. Before the necropsy, I also wasn't sure if it was our fault for not intubating him while he was on the CRI of propoflo. Around 7 pm his heart rate picked up, blood pressure spiked, and his oxygen saturation was low. I knew something was wrong, but the doctors elected that he was okay. I now know it couldn't have been prevented or alleviated. He had a full stomach, but hadn't eaten in 12 hours before surgery, so something else was going on. He was an amazing dog with a dedicated owner and the story was tragic for me.

Besides being exhausted from 13 hour days, I was questioning how I would get through this year on lack of sleep and so much mental stimulation. For the millionth time in vet school, I was wondering "can I do this?"

Of course the latter half of this week our neurology service caseload has slowed down, perhaps someone looking out for me or just pure luck. I appreciate that I had time to process my feelings and get rest. I am terrfiied of surgery next block though, when a day off will cease to exist.

My mid-block evaluation went well. I need to "own" my cases more, and be more independent of the clinician, which has come a long way since last Monday, but has a long way to go. I have no clue how I will be ready to be a DVM in just 9 months. Time to take things just 1 day at a time again.

Back to Vet School and the "Real" 4th Year

Sadly, my 2 blocks of personal growth and development are over, and so are the fun and games. I am so happy and fulfilled that I had both of those amazing opportunities in China and at the Humane Society, but it was time to learn how to become a doctor. After my first week back, I realized how much I have to learn.

I was humbled by how difficult it was to take an accurate history. I was also so nervous meeting clients and trying to do a complete physical exam in front of them. I missed tons of things, most that were obvious, like the patient was dehydrated. I had major confidence issues that I haven't had since high school and it showed to my clinicians. Most importantly, I have no idea how I will pass boards or be a doctor in less than 3 months and a year, respectively.

On a positive note, my first discharge and SOAP's were pretty good and by the end of the week things were turning around. My shifts in ICU went well since my main exprience was working as an emergency technician. I also really enjoyed following up with clients on the phone.

What makes 4th year so hard is that you are part student, part technician, and part doctor (or trying to be). Who has time to wear that many hats and sleep? It's also hard because your best friends may not be around for the support they provided the 3 years before. This weekend I remembered why my vet school friends are so amazing.

I miss having a life, but I got some reprieve with the terrific Steppin' Out Festival in town with friends Friday and Saturday night and a lazy Sunday with Matt and our dog. It's been 1 year since I brought her home from Washington and she now listens off leash. She is a great compliment to our family.

The hours are long again. I had an 18 hour welcome back Monday and 12 hour days except for Friday. The best part is you're suppose to read for rounds and study for boards on top of that! The truth is compared to surgery, that isn't even as bad as it will get. Finding time and energy to work out or eat was difficult. I will just do my best and take it one day at a time. I will also enjoy neurology since next block is surgery and having a life and sleeping will be harder to do.

Lobby Day Recap

Lobby Day with the Humane Society was an excellent culmination of the Taking Action for Animals Conference. My day began by leading some citizen lobbyists from the hotel to the Russell Senate Building. 11 fellow Virginians and I strategized on our approach for our joint meeting with Senators Webb and Warner's staff. The meeting went very well. Webb's staffer had some tough questions and wanted data and support, while Warner's staffer was much more warm and fuzzy about our animal issues. Nonetheless, we learned at the end of the meeting that Webb's staffer was shocked by the puppy mill information we provided. He expressed that he was now bnervous about where he and his girlfriend should look to get a puppy. Some of the constituents said I was an excellent leader and well-spoken. I was flattered, and only hope to improve in that respect. I was proud of myself, because I added the public health risks to children regarding unvaccinated and non-dewormed puppies. If someone is not an animal advocate, they usually cannot argue the public health side. It was my version of thinking on my feet and again an outgoing moment for me.

The Rally was fun and the weather, thankfully, was not too hot. Wayne spoke first and got the crowd pumped up. Wendi Mallick, from the TV show "Hot in Cleveland" spoke out on the ROAM Act. The ROAM Act (Restore Our American Mustangs) looks to end round-ups and slaughter of wild horses and burros, by implementing a immunocontraception program.
The Rally concluded with Rep. Jim Moran. I was told beforehand that he is a staunch supporter of our issues, but sometimes goes off on odd tangents during his speeches. This speech was no exception. Toward the end of his speech he started to bash the NRA, which is okay with me and funny, but seemed a little inappropriate.

I missed photo ops with Wendi to rush off to my 1 pm meeting with a staffer from my Rep. Boucher's office. She was very nice and I thanked him for being a co-sponsor on the PUPS Act, and voting in favor of many of our issues. She told me that Boucher heard from his constituents that they were upset about puppy mills and he listened. "All it takes is a few calls from his constituents and he listens and acts, she informed me." I mentioned the upcoming Truth in Fur Labeling House vote (which passed yesterday!), and started awareness on the Prevention of Equine Cruelty Act. As many people are, the staffer was outraged that some of her faux fur, is quite possibly real fur. Thank goodness for consumer protection loopholes.

After my last meeting, I walked back to our home base in Russell 385 and felt a slight let down that it was all over for the day. I really enjoyed meeting with the offices and felt for the first time what democracy can feel like. To be able to make an appointment and walk into my senators or congressman's office and voice my opinion was amazing. It would never happen in China.

Taking Action For Animals Conference: A Summary

Attending TAFA was invigorating, representing the Humane Society of the United States at TAFA was an honor. The workshops were very well-run and informative. Topics ranged from how to be an active citizen lobbyist, how to stop puppy mills, to advances in farm animal cruelty prevention and .


Many other organizations were represented on each panel in the many different workshops, including Farm Sanctuary, Animal Welfare Institute, among others.


The all vegan menu was surprisingly delicious and included a vegan rendition of chicken cordon bleu and chocolate mousse.


Working at the registration booth Friday night reminded me of working retail during my college days, but it was fun. I ran into a girl, Nicole, who was on my RAVS trip last summer. She won the award for HSVMA student of the year. She created a student chapter of HSVMA and helped to end terminal surgeries at her vet school. Her work inspired me to try to form a HSVMA Chapter at my vet school before I leave.

While working the government affairs table, I discovered a new side of myself. I was energized by the many interested citizen lobbyists, and those that may not have been interested in our lobby day bills I actively chose to engage. I urged people that could not attend lobby day to cal or write their senators and representative. I learned that 1 personal call or letter statistically represents 10,000 people with the same interest. So 1 call really does matter!


In another outgoing moment, I spoke to Nigel Barker and asked for a photo op. His work as a celebrity spokesperson, filmmaker and photographer has helped to end baby seal hunting in Canada.


The banquet was great. Congressmen Rahall from WV gave a great speech and we commended him for passing 11 wildlife bills through his committee during 2010. Hal Sparks was hilarious and I laughed harder than I had in a very long time. Wayne's speech was passionate and serious, but was interrupted by Spanish music in the adjacent ballroom. All the speeches made me question my own choices and made me wish our country was more in line with change. Wayne argues that the American public is ready, but government and interest groups are slowing the change process.


While the conference was exhausting on many levels, I am not only glad I was able to attend but that I was able to represent the Humane Society. And once again during the last 6 weeks, I feel invigorating and passionate for my career and all the many directions I can take.