New Blog Alert- Veterinary Brainstorm

I have been on blog hiatus since graduating veterinary school in 2011. My hiatus has been due to a number of factors including a veterinary internship in small animal emergency and internal medicine, relocating to Phoenix, AZ and starting a career as a small animal emergency clinician, and writers bloc. As I began to settle into my career and make my way up the learning curve, I found myself closing 2012 wanting more from my career and thinking, "is this it?" Before my previous fans get too upset let me explain.

I enjoy small animal emergency medicine and become more confident each day.  There are frustrations, however, and after 4 months in practice, I started to revisit my long-term career goals. I realized that I missed my connection to the broader veterinary community, as well as veterinary students. I signed up to be a mentor through the AZ VMA and joined their Young Leaders Advisory Council and PR task force committees. These groups have been invigorating and enabled me to network with veterinarians in the local community and have an impact on the community outside of my practice.

While hiking with my husband, I was mentioning how I'd like to compose another blog, but I had nothing to write about. Writing a blog in vet school was easy, there was always something new and exciting happening or an exam to stress on. Daily practice, even emergency, is not always that exciting once it becomes a job.  He came up with many ideas such as discussing transitioning from school to my internship into practice, inspiring cases, and the list kept going. The foundation for Veterinary Brainstorm was forming.

The excitement to start another blog occurred on a trip visiting Mississippi State veterinary school as a representative in training for Veterinary Pet Insurance (VPI). This position will be discussed in a future blog entry, but it made me realize that a new blog would further my connection to prospective veterinarians, students, and others in the profession beyond the local level.  My prior blog (lifeofaveterinarystudent.blogspot.com) inspired many people who reached out to me via email, telephone, and even spawned some in-person meetings. I hope this blog will inspire similar connections and discussions about relevant topics in veterinary medicine and my new career as it takes shape. 

4 Years in Reflection

Clearly, I like lists I am a type A vet student. As the week of graduation quickly approaches, I wanted to reflect on the top 10 things that have happened to me over the past 4 years.

1. Traveled to China, Jackson Hole, Wyoming, Scotland and England, and Spokane, Washington.
   
2. Attended many veterinary conferences: North American Veterinary Conference, Merck Summer Scholars Conference at Michigan State, VBMA National Meeting, SAVMA Symposium at Ohio State, VVMA conference in Roanoke, VA.
3. Rescued my dog on a Humane Society RAVS trip.
4. Learned how to handle wild raptors, songbirds, and mammals.
5. Lived alone.
6. Lived in Blacksburg, VA, a special place indeed.
7. Became a crossfit junkie.
8. Discovered rock climbing and kayaking.
9. Created and developed lifelong friendships.
   
10. Became a Doctor of Veterinary Medicine.

There are countless other moments that occurred over the past 4 years that have changed my life and shaped who I am. I have become stronger and wiser, while remaining humble and ignorant of many things left to learn. I left a lifeless career to enter a bright, challenging career with the bills to prove it.

Thanks vet school. Thanks to all my friends for their endless support. Thanks to my amazing 3 cats and wonderful dog. Thanks to all my teachers. Thanks to myself for persevering and finding the strength to get through the 4 years. Lastly and most importantly, thanks to my husband. He never wavered when I wanted to quit and drive 500+ miles a week to support me. I cannot wait to support you on your journey of higher education.

This blog entry marks the end of life of a veterinary student. I hope to create a new blog entitled "Life of a Veterinary Intern." Thank you followers for making me a part of your journeys. You can always email me with questions or for inspiration. 7+ years in the making and I can tell you, anythign is possible if you are passionate and work hard enough.

Wildlife Center of VA

This rotation presented challenges and amazing learning opportunities, much like my last few blocks of vet school. I realized how much I have committed to memory about small animals and how little I know about birds, other mammals and wildlife management. After 3 weeks, however, I can collect blood from turtles, vultures, foxes, owls, raptors and songbirds. Today I collected blood from a painted turtle (super hard because you can’t see a vein) and a Turkey vulture both on the first attempt. I am now familiar with radiographs of these species as well. I learned how to identify baby birds, how to bandage broken wings, and when to try and when to euthanize wildlife based on injury. I absolutely loved the cultivated learning environment. Every single case was made into a learning experience by the staff in a hands-on fashion. Kudos to an excellent wildlife teaching hospital.

The first 10 days were extremely challenging, but I persevered and the reward has been invaluable. I am equipped to answer wildlife and exotics questions from my clients. I am no longer afraid of handling birds; in fact I love birds. This block in many ways was similar to my equine block. I went in fearful and apprehensive and left loving it. However, wildlife medicine has its downsides. Many animals cannot be released and are euthanized and many days it feels like you kill more than treat. On the upside to that, for many animals you stop their suffering and there is no client or financial decisions to interfere with the medicine.

The past 3 weeks have again confirmed that I love emergency and critical care; it's where my passion lies. I watched a blockmate who truly is passionate about wildlife and realized that is exactly how I feel about emergency. I am so thankful I had the chance to explore different areas of vet med over the past 4 years: Research, government work, lab animal medicine, wildlife medicine, organized veterinary medicine and many others. It is ironic that all of my exploration led me back to emergency medicine. We'll see how much I still love it after the next year of hard hours. I am ready...bring it on!

Block 16 into Block 17

Spring fever has arrived and graduation fever arrived with it. My locker is cleaned out. My coveralls, surgical gowns, extra scrubs, old stethoscope sold to other students. Received my internship schedule today for the next 12+ months. Only 1 more rotation left between Class of 2011 and graduation day. That day we thought was impossible, that now is going to happen. I have been reflecting on how much I have grown through this process and how excited about my new career I am.

My last rotation at the teaching hospital has been more fun than I ever expected. My week on equine field services included going to Mill Mountain Zoo to help work on a 15 year old snow leopard with chronic vomiting. I jumped in and drew blood, ultrasounded his abdomen and learned once again that a regular vet can do zoo work on the side. The vet was humble, nice and applied his small animal knowledge to the leopard. I felt comfortable ultrasounding him and with his work up and thought to myself, "I could do this." It was a great trip and I learned they make portable endoscopes...so fun.

I have truly enjoyed working with horses. WHile I still don't know the lingo or how to lunge a horse, I do know a nice horse when I meet one and totally understand why they are deemed amazing creatures. I hope to have some trail/pleasure horses one day and definitely want to learn how to basic ride.

Meanwhile, I can count my days left in the Burg on 1 hand, but they are fun days. Saturday is 3.2 mile for 32 run in remembrance, a run I have done every year while I was here. Saturday is also Spokane's last agility lesson. Then it is off to Northern VA for a day to unpack the house and transport the cats for the final time. When I return to Blacksburg it will be graduation week, time to celebrate, canoe and camp with friends and get ready for a new chapter.

37 Days

I am currently on the last senior rotation I will have at the veterinary teaching hospital at VT and I cannot believe it. In some ways I feel ready, in some ways I don't want to leave. It has been one busy block on large animal services, but I absolutely love horses. They are amazing, and I am no longer afraid. I have been blessed with some really great patients to work with, including a baby camel and her mom, who was thankfully nice as far as camel mom's go. I barely had a weekend last week, but as for my last few weeks in Blacksburg I cannot complain. The cases have been rewarding and I have learned a lot. I am more comfortable than I ever imagined I would be and I hope to learn more about horses as a hobby in the future. Lameness is so much more exciting when it is happening in a horse and not in a lecture.

Today I got to experience some alternative medicine therapies applied to chronic back pain; tomorrow I will massage my horse with a human electric massager! While I am nervous that I have been out of the small animal realm for a while before starting my internship, it will be a long time before I get to do this again and it's fun. I realize more each day that life really is the journey and not the destination, although reaching your destination is extremely fulfilling it's the journey that makes it that way.

9 more days of horses than off to work with wildlife. I cannot believe that my life as a veterinary student is coming to a close.

Only 2 Rotations Left!

I have mentioned it before in recent postings, but I cannot tell you how odd it is to be happy and sad at the same time with a dash of disbelief on top. I can vividly remember second year feeling as if becoming a veterinarian was a path with an unattainable destination. Well the destination is heading toward me very quickly.

Recently on lab services, I have had time to do some activites with my 2 year old dog, Spokane. We are in the midst of grasping the sport of fly ball, starting the trail running season, and this weekend started agility lessons, with an amazing trainer in a beautiful Blacksburg setting. Of course as these activities start becoming rewarding for myself and my dog, they will need to wind down soon. While they can be continued when I return to Northern VA/Washington DC area, they will be more expensive, hectic to travel to, and impersonal. I am so grateful to everything this town has given me these 4 years, so here is a list for those Type-A's out there:

Blacksburg Greats:

1. Blue Ridge Parkway proximity- a vista, mountain, trail, friendly face at every mile
   
2. Pandapas Pond- best place on earth for biking and trail running
3. Virginia Tech's spirit- 3.2 for 32, VT football, VT vs Duke basketball, etc
4. Crossfit Blacksburg
5. Akke's Yoga Place & In-balance Yoga- Akke you kept me level-headed years 2&3
   
6. Blacksburg Farmer's Market-always seeing a friendly face and acquiring local goods
   
7. Nellie's Cave Park and all my neighbors- the unofficial offleash dog area
   
8. The lack of chain restaurants and quality of the independent restaurants-Gillie's, Souvlaki, Cellar, Cabo, Easy Chair, Bogens, Sal's, Sake House, Bangkok Bistro, Lefty's, Daily Bread
   
9. Roanoke Non-Ultra Trail Series & Roanoke's charm
   
10. The mountains all around at the end of hard day.

When I think of vet school, I think of the fun and my lifelong friendships that have developed and the sense of community I have never experienced before. I have tuned out the bad because at the end of this experience what remains is an appreciative, stronger (mentally and physically thx X-Fit), smarter, more confident, person, with a sense of self and better friends than I could have ever imagined. I will search the rest of my life to find those friends and community again; I wouldn't be at all surprised if in the end I return to Blacksburg.

There is a tension that develops inside all of us when facing a transitional period between what you are leaving behind and what lies ahead. I have chosen to embrace and feel that tension and it has helped face the reality that this crazy chapter of my life that has been so hard and so rewarding is coming to a close. I decided this week that I wanted to commemorate this time with a class ring, something I never thought or wanted to purchase before.

On a completely separate note, I enjoyed necropsy much better this week. I diagnosed Yew toxicity in a dog that died a sudden death and saw some other cool cases. I love histopathology (the microscopic aspect) and I may be coming around to gross pathology; however, I know for sure I do not want to be a pathologist when I grow up.

This week will involve more free time than I know what to do with. Time to pack, get organized and play wtih SPokane. Next block is primary care land of no life and horses, horses, horses.

Only 3 rotations left...Lab Services Finally Arrives

Anesthesia was an absolutely busy and amazing block. One of my favorites and 3 weeks where I learned an exponential amount of material and gained amazing clinical experience. It was also my last small animal clinical block.

So here I am 2 days into laboratory services, the "vacation rotation." It has been exhausting due to an extremely high caseload of large animal necropsies. The last 2 days I have left after 5 PM, smelly, dirty and tired with homework to do and a dog to play with. I truly hope the caseload lightens up, I feel beaten down and too tired to be a good mom to Spokane and make time for exercise.

In the morning it is crash review of previous material from bacteriology, virology, toxicology, parasitology and clinical pathology. The -ologies coming back from the dead. What I remember amazes me, what I forgot depresses me. But reviewing the material is helpful and so far the instructors have made it fun.

In the afternoon, it's time to play Dexter. Each day we have had 1 horse and 1 cow, and because we do not have an incinerator cutting up the animals for disposal along with the odor are the worst parts. You get pretty messy (#1 dirtiest job ever) and it is physically taxing. I, for one, need knife use 101. I truly hope that Spokane's energy level decreases slightly and that we don't have this level of cases for the rest of the block. In the past few months, I have heard my classmates complain about no necropsy cases today; well I want that complaint.

While I enjoyed pathology classes in years 1 & 2, this rotation made it clear to me that becoming a pathologist is not my gig. Even clinical pathology, which I do love, is not something I would want to do exclusively. Slides are fun, but patients and critical care is much more fun. I keep reflecting on how open my mind was 3 years ago. While I feel a tad guilty to not be as open-minded as I once was, I feel good that I know where my strongest interests lie. It took a long time and a lot of exploration to get to this point. For that reason I beg, please no more horses to cut into pieces please.

Will the Real Vet School Please Stand Up?

Before the start of 4th year, the clinical year of vet school at Virginia-Maryland, I heard horror stories of never sleeping, the pager going off in the middle of the night, etc. While I have had a few days or a week here and there of being stuck at the hospital and away from my bed and family, in reality it hasn't been too bad. There were maybe 3-4 nights where I was at school dealing with critical patients or emergency duty until the wee hours of the morning, 1-2 AM at worst. However, this week, the true vet school "horror story" reared its ugly head.

I was on call for anesthesia and due to an 8-hour shunt surgery case earlier in the day, the rest of the surgical cases were late into the OR for the rest of the day. My assigned case rolled into the operating room around 4PM, and for reasons that will go unmentioned, finished at 8:45 PM. The recovery went well, and I headed home for a bowl of cereal and some zzz's. Around 1:36 AM my cell phone rang. A colic (the second of my anesthesia rotation) needs to go to surgery. Luckily, or not, I was sent home around 4 AM to sleep for 2 hours until morning rounds, with the hope I would compete my case for the next day and be released home to finish my sleep.

Murphy's law continued to be in effect that day. We rolled the kitty into the MRI only to find the special MRI-compatible, recently serviced anesthesia machine was leaking some Isoflourane gas. Awesome. 2 hours later the MRI scan began. I was sent home promptly after the case was completed, however, I never got a lunch break and actually got home at 4PM, not very early after all.

On the bright side, I survived and performed better than I thought possible on only two 2 hour sessions of sleep. In fact, I was proud of myself for making it through, despite feeling like a cloud of bad luck was over my head for 36 hours. In addition, I still absolutely love my anesthesia rotation. I am extremely excited to be off the entire weekend. I have found it amazing that while the hospital has seen 4 colics in the past year, 2 have occurred when I am on call in the past 2 weeks. Dropping a horse is exciting, it's just not where I see my career headed, especially when I know first-hand now that colics really do occur in the middle of the night. But if life has taught me anything, it is that you never know where it will take you.

Special Guest Post by Veterinary Technician Tina Marconi

3 Reasons Why Veterinarians Should Honor Thy Veterinarian Technician

Anyone with even the minimal knowledge of the medical field knows that saving lives and curing illnesses is a team effort – no one doctor or other health care professional is able to handle everything by themselves. It’s the same in a veterinary practice – no one can operate a one-man show unless they want to end up becoming overworked and unable to handle their cases with the required care and efficiency. This is why assistants and technicians are hired – to help out with a veterinarian’s practice, and just as nurses are important to the scheme of things in a people hospital, so too are veterinarian techs extremely important in the world of animal care.

Veterinarian’s who think they know it all and so abuse their techs and assistants or treat them badly should remember that unless they respect those who work for them:

· Their practice could go downhill: Veterinarians who don’t respect their assistants and techs could end up losing their services; no one wants to work for employers who don’t treat them well. And when the word gets around that the veterinarian in question can’t hold on to an assistant or technician, his/her practice begins to go downhill because no one wants to work with them. Overworked veterinarians are not effective, they soon start making mistakes, and they end up losing their clients because they are perceived as not being proficient at their job.

· They could lose regular customers: Veterinarian techs are not just responsible for assisting the veterinarian in all his/her tasks; they’re also the ones who liaise with clients, set up appointments and follow-up visits, and provide aftercare for animals that have undergone surgeries or which require hospitalization. So when a veterinarian does not respect his/her veterinarian tech, their unhappiness and dissatisfaction spills over to the client and patients, and soon enough, the regular ones too start looking for other veterinary practices to handle their pets.

· They tend to show the same attitude toward the animals they care for: Veterinarians are perceived to be kind and gentle people, simply because they’ve chosen to work with animals, creatures that cannot talk and must be handled with love and kindness. But if a veterinarian is abusive towards or does not respect the people who work for him/her, it stands to reason that they’re not going to adopt the right attitude when providing care for animals. They could be skilled and well-trained, but the clinical approach does not work well on animals that can sense hostility from a mile away. Veterinarians who are warm human beings make the best kind of animal doctors, and those who fail to respect their veterinarian techs and assistants may as well shut down their practice and find another occupation.

This guest post is contributed by Tina Marconi, she writes on the topic of online veterinarian tech programs . She welcomes your comments at her email id: tinamarconi85[@]gmail[.]com.

Let the Bittersweet Feelings Begin

My anesthesia rotation has started off great! It has been really fun and an excellent learning experience. It is one block I felt adequately prepared for from the previous years and rounds are pertinent and helpful. We receive a lot of hands-on experience too, no resident in our way. For each patient we devise anesthetic drug protocols and as long as we can justify why, we can experiment (safely) with new drugs and ways to use them.

I performed my first successful epidural on a live patient Friday and it was very rewarding. I used multimodal pain management for a jaw fracture and the patient's plane of anesthesia was very stable. It was amazing to see how effective multimodal pain control can be. Many people think anesthetic gas=pain control, but it doesn't. Better pain management before, after and during surgery decreases anesthetic complications, the amount of gas needed to keep the patient in a good surgical anesthetic plane, and aids in recovery. Anyway, I have been learning a tremendous amount and loving it. The aspects I like are very applicable to critical care medicine and are making me more curious about a residency in critical care. I feel like I am starting a new career exploration journey in that respect.

As I sat in the small animal OR monitoring anesthesia last week, however, I had a moment when I realized I only had 2 more weeks in the small animal hospital. A wave of sentimental feeling and sadness came over me. In fact, as I spend some of my last days with good friends, I find that this feeling of sentiment for Blacksburg, vet school, vet school relationships and all the nuances of the teaching hospital is very strong. I am doing my best to savor the great things I have experienced the past 4 years. It will be hard to leave. I really have despite the long distance marriage and all the obstacles of vet school, loved my four years. I would not want to repeat it, but it was an amazing life changing experience. I cannot imagine having to go through all that I endured in any other town than Blacksburg.

At the same time, when I think of graduation weekend, I become giddy like a school girl. It is hard not to be proud and happy at the accomplishment of a DVM. Transitions are difficult for me, even with a strong plan in place. I hope that taking the time to savour the next 82 days will help make the transition back to life in Washington, DC a little bit easier.

Murmurs and Protocols

My Cardiology/Dermatology rotation quickly became one of my favorites. My ECG reading ability improved, skin allergy understanding and diagnostic skills developed, andcardiac auscultation aural memory expanded. I was sad for the rotation to end.

Luckily, the first few days of anesthesia have been amazing. I really needed a refresher of the drugs, practice making my own sedation and pain management protocols, and clinically watching these drugs in action. The department personnel is amazing, with great energy, advice, and patience. No ICU duty is an added bonus to my enjoyment. I am assured I will learn an exponential amount this rotation and I am pretty excited about it in a nerdy way. Brand new protocols abound with Fentanyl CRI's with lidocaine, combining propofol with ketamine for induction, learning about new opioids, it's all fun and games!

Having anesthesia directly after cardiology and medicine rotations has made me realize why I love critical care and emergency medicine so much. It has made me question whether I will do a residency or not after my internship. I still stand by my position to practice for a few years before re-entering academia, but I am beginning to wonder whether further specialization is inevitable for me. One of the anesthesiologists believes it is. She told me to email her in 1-2 years letting her know I am pursuing a residency and she said it with such conviction I believed her.

Let the anesthesia fun continue. Life is good.

96 days Left and Life Post-Vet School is coming together.

Today is February 7, 2011. A long awaited day in the veterinary profession for those awaiting placement in the internship and residency match program; for those in the know, today is "Match Day."

It is hard to believe I started as a kennel assistant at the Hope Center, a state of the art referral center and will be returning as a veterinarian. I could not be more excited to spend my first year as a doctor learning from some of the best doctors and working with amazing technicians!

Only 96 days remain before graduation. My remaining rotations include: anesthesia, equine services, and lab services and an external block at the Wildlife Center of VA. I feel I have made many strides as a senior student when I look back on the first few rotations, but I still have a lot to learn. Because transition periods can be hard for me, I am trying to reminisce as well as think of the future. It is easy to like vet school in retrospect, but it is also hard to forget the sheer exhaustion and stress that came with the ride.

I am only beginning to comprehend the reality that I set out 7 years ago to become a veterinarian and with boards and match day behind me that journey was a success. In addition, that journey was only the beginning of a long career of learning, helping animals, helping people, being frustrated and exhausted, fulfilled, and longing for boredom. Veterinary medicine is an amazing career, but it comes with a price. Balancing that price will be a challenge next year,but as I have learned the past 7 years, each difficult step forward prepares you for the next difficult step left to take.

I am so thankful to the clinicians that wrote my recommendations, were patient enough to teach me, and everyone who has believed in me. The experience came at the cost of a modest home, but truly has been priceless.

96 days left...

Small Animal Med Take 2: Better and more tiring than ever!

Confession: I love small animal medicine. Despite the intense work that a critical patient requires, so far every case I have seen continues improving. This is quite a change from the usual depressing outcomes I have experienced this year. It has also made this a very rewarding and exhausting 2 weeks.

Confession: I need a work-life balance; I need to exercise, I need to get 8 hours of sleep, and I need to have some time with my family and friends. All of these things make me a much better vet student and person. What is amazing to me is that I have found the right career. In finance, I couldn't wait to leave to have "a life." Now despite being tired, run down and wanting "a life" I willingly sacrifice these things to my detriment for the benefit of my patient and I don't mind. It does make me cranky without the other aspects of life trickled in.

I have learned a lot this block. I have learned new material, more about patient care and decision making for critical patients. I have continued to confirm that I heart critical care, the challenges, the heartache and the reward. The cherry on top was passing the NAVLE!

Becoming a vet has never felt more real. It will become more real in a few weeks when I find out if I got into a match internship program that will confirm where I will be working as a doctor. While I am looking forward to some less intense blocks, I couldn't have asked for more out of my second small animal medicine block. 1 week left then onto cardiology!

2010 in Review

Despite major east coast snowstorms, I made it from Blacksburg to Richmond to see my best friend and her newborn after 2+ years apart. It was amazing quality time, although this year's actual Christmas not being the most spirited for me. I was on emergency call Christmas eve. While only 1 non-urgent case was admitted, I was at the hospital most of the evening. Then Christmas Day I spent the morning at the hospital and Matt and I didn't do any presents. Matt also left Spokane's box o presents at the other house, so we had no way to pretend it was Christmas. Due to the lurking snowstorm, we decided to leave Blacksburg early Christmas evening. I was happy and relieved to make it to Richmond before the snow, but it wasn't the same holiday without Matt and the cats in our home. It was however, a fitting ending to the turbulent 2010.

Regretful Happenings of 2010:
My 2003 Honda Accord's transmission dies the day after Christmas 2009.
The ice and snow storm create significant water damage and headaches at the townhouse.
Matt takes a 20% pay cut for a few months in the fall.
My 1 week between 3rd and 4th year involves a trip to Boston to see my best friend, but a delayed volcanic cloud inhibits us from meeting up.
Garfield perforates his cornea during the 36 hours I am in Chicago and then endures a total of 3 eye surgeries and almost loses his right eye.
Spokane now resides with dad more than mom.

The Good of 2010:
New hybrid car that gets 40-50 MPG, but has no horsepower (or sunroof).
New hardwood floors, windows and paint job in the house.
Completed 3 academic years of vet school and try on the infamous blue senior coat.
Learned just what a trooper my Garfield really is.
Spent Friday's with Matt again for a few months.
Saw my best friend just before 2010 ends, and we vow to see each other at least once in 2011.
Travel to China for one of the most amazing cultural and veterinary experiences.
Lobbied on Capitol Hill for the welfare of animals.
Canoed the New River on a beautiful day.
Visited Jackson Hole, WY (on the downside Matt broke both wrists snowboarding).
Visited Fallingwater, finally.
Still no cavities for me.

New Hope for 2011:
A DVM degree with board certification
The right internship match
Matt's road to graduate school begins
No major illnesses for my pet family
Matt's 1997 Acura keeps on truckin'
We begin the part of our marriage where we live together again.
Isabelle gets the dental cleaning she deserves.

While 2010 created a lot of debt for us, on the whole like many hard times it made us all stronger. Who needs money anyway when you have 4 amazing pets, and a great husband. Thankfully, I'll be able to treat my own pets soon enough.

Back to the Grind and a Long Winter

Vacation is officially over as I type from Blacksburg. It is 20 degrees here with snow and ice all around. My 4 days as an extern at the Hope Center were eye-opening. I started to feel like a doctor because I was being treated like one for the first time. I started writing practical medical records and became more proficient and slightly confident in my physical exam skills. I detected an abnormal kidney on palpation and did not miss that many things when the doctors reviewed my physical exam findings. I performed open chest and closed chest CPR, and saw everything from an abscess to pericardial effusion in just 4 days. I kept thinking I sort of know what I am doing, and my gosh, someone is going to pay me to do this in just 5 months! It was exciting.

Over vacation I got a chance to do more yoga than I have done in months, and it was amazing. I also spent time with Spokane and successfully taught her to shake, but the roll over is proving difficult. The gentle leader intro was a success as well. I saw some friends and family, but there as just not enough time spent with anyone. They will be there in May, although rumor has it I won't have too much free time either if I get an internship.

Now I begin community practice, a rotation I have been looking forward to for a while. It should be a little more like the real world then some of the other hospital rotations and propel me forward toward May 14!

In the meantime, I am in a state of limbo. With board results and the internship match program pending until early February the suspense is killing me. I am trying to channel back to 2006 when I had to wait a similar period of time to find out if I got a vet school interview. I recall the first few weeks hard to not think about it, but after that I was able to put it out of my mind. I'll miss you vacation, but with only 3 primary care rotations left I must persevere.

Vacation Block-the good, bad and ugly

Small animal medicine, block, 9, ended very well. A very prestigious clinician agreed to write me a very strong letter of recommendation. Garfield's eye was healing well finally and I drove home. I visited some doctors, and spent the rest of my first week studying for the stupid NAVLE. Studying didn't help at all. The only thing that may have helped would have been memorizing the Merck Veterinary Manual, an impossible task for anyone without a genius IQ and photographic memory. After 7 hours, I left the exam center feeling depressed and brain fried, unsure that I would ever be a licensed DVM. I didn't talk to anyone but Matt for 2 days, I was so embarrassed, assured that I failed. I finally got the courage to call a fellow classmate and found out she felt the same way. In her self-doubt she looked up the statistics over the last 10 years and those in the top 25% of the class had a 100% pass rate. That made me feel a little better. Then I spoke to some other current DVM's and the story was the same. It was more trivia than clinically relevant questions, and no one was happy afterward. Feeling a little more confident I headed to my first internship interview. I believe this went very well and boosted my confidence. I am once again back to feeling how I did when I drove back to DC a week ago; excited about my career.

The vacation is flying by, but I have started to catch up with some old friends. I am getting a lot of sleep and am almost finished with my internship application. This weekend I will finally get to see my much-awaited Fallingwater by Frank Lloyd Wright. I am very excited. Matt will visit a graduate school he is considering. Next week I will be working out by day and externing at the Hope Center by night before heading back to school for community practice.

I have finally narrowed down my interests to general practice (there is something to be said for a balance between healthy and sick animals), emergency and critical care (it is what I know best and the initial thrill of stabilization and medicine is invigorating) and internal medicine ( I heart endoscopy). The 1 year internship will allow me to further explore these 3 fields and choose the one that is best for me. The beauty of it all, is that I know my preference may change over time, and all 3 fields are accessible with a DVM.

Here's hoping I passed the NAVLE by some miracle and get a great internship next year. It will all be known by early February, just over 2 months away.

Small Animal Medicine- So Far So Good

It is the end of my second week of small animal medicine and it has been very enjoyable and only a little depressing. I do believe, however, that soft tissue surgery has toughened me up a little bit. The all-intimidating rounds have gone well thus far and are actually fun and great learning opportunities.

I do truly enjoy medicine and the challenges and I absolutely love the eondscope, but again I find that the healthy patient is refreshing to see.

In the meantime, Garfield had a second prophylactic surgery in his right eye that did not go well. He had a second procedure to try to re-do the graft that seems to be doing better, but not healing as well as the other "emergency eye." I will second-guess the decision, but it is clear that that eye is diseased and we did the surgery to provide the best care for him, even if the outcome made the situation worse. Poor little cat. He has many days ahead of trips to the vet, eye medications, and e-collar fashion. Hopefully, he will not lose this eye in the end.

As NAVLE and internship application time approaches I am a little more optimistic that I will get some strong recommendations needed to secure a good internship in the Washington area.

Soft Tissue Surgery Part 2

The rest of soft tissue surgery was not quite as depressing, but was busy. I no longer think I am cursed, but learned the hard way that death and disease are the nature of the job. The past 2 blocks I have realized that there may be something more appealing to general practice. Perhaps the healthy puppy vaccine visit is a needed break from diagnosing cancer or untreatable diseases.

The last week of surgery was a combined orthopedics/soft tissue service due to the surgeon conference. It was pretty busy, I got another liver case, a gallbladder rupture, which did well post-op. My last patient was an emergency and an uplifting story. A dog was found with an arrow in its chest and abdomen. We removed the arrow surgically, which miraculously did not penetrate any organs other than a small defect in the diaphragm and I got to spay her at the same time. She came in to the hospital slightly feral and panicky and left as a healthy, female spayed, super sweet dog with a true home.

Soft Tissue Depression Week 1

My first week on soft tissue surgery has been one of the hardest weeks of my life. I have not exercised all week, I haven't eaten a true dinner all week, and I have seen a lot of poor prognoses and death.

My first day of the block we diagnosed a dog with splenic neoplasia and the owner elected euthanasia. My next case was the cutest Pomeranian ever. He had Adrenal Cushing's disease and came for an adrenalectomy. The mass was very large and intimately associated with the vena cava and the renal vein...out came the kidney too. His recovery was a disaster. I was with him in ICU all day until 1AM. The next morning I walked in at 6:15 to find out he had just passed. The owners were so sad but grateful. He was a legend in our hospital because he had his own human wheelchair to be pushed around. He had a ton of personality, and was loved like a child. He apparently was also included in TJ MAXX employee newsletters as their mascott.

My most promising case was a 13 year yorkie who had a liver mass removed and was doing better. 30 minutes before the owners arrived he had a seizure. We did a further workup on him the next day to find he has multiorgan failure, DIC, and half his spleen needs to be removed and he is a horrible candidate. He also likely has central vestibular (brain) disease. For lack of a better outcome he is going home to be with his owners for the time he has left.

My last case of the week is a super cool cat, with never seen before biliary cystic disease that could not be removed surgically and may not resolve medically. I got to do a lot during the surgery and place a feeding tube, but the owners are distraught over his unknown prognosis and what we don't know.
Note: All 3 cases written with owner's permission.

Between stress, lack of sleep, and poor outcomes I am depressed. Seeing Spokane last night was such a breath of fresh air. To see an healthy happy lively dog made me so grateful. I hope the coming weeks have slightly more optimistic cases. I gave me a lot to consider in terms of career choices, and dealing with death and disease on an emotional level.

My own little ophtho case

The reason there have been no new posts in over 3 weeks is simple, many other issues have come in between me and my blog. The most important was my first hand experience with an ophtho emergency.

I traveled to Chicago for a Pfizer career workshop and hired a cat-sitter to watch my 3 buds. When I returned home Saturday at 12 am, I found Garfield with his eye shut and filled with pus. When I attempted to open his eye he screamed and tried to bite me. I have never seen an animal in such pain. My second attempt to help him was the same. I debated whether it was an emergency, and wished I had my DVM to get him pain meds ASAP. I decided not to call the clinicians grading me at 12 AM Sat night, but did call first thing that morning. Upon exam, he had perforated his cornea due to corneal degeneration and lipid keratopathy. His other eye had extremely thin corneas as well, and is at a high risk of perforating. He went to surgery right away and did very well. An a-cell implant was placed (pig bladder tissue) and a conjunctival graft was sewn to his cornea. He has been a trooper. In order to treat him 4 times a day he came to school with me every day. He purred from his cage and let ophtho examine him without a fuss. He will likely need a second procedure to prevent the other eye from perforating, but we would like this eye to heal.

In an ode to Garfield, this poor cat has a heart murmur with a possibility of developing hypertrophic cardiomyopathy, FLUTD with a history of blocking, herpes, and now this serious ocular condition. He is quite the trooper and special guy though. I am so proud of him and how well he is done. He doesn't even mind his e-collar.

Ophtho went well. I do not want to be an ophthalmologist, but I really enjoyed learning about eyes and seeing some successful cases.