Bovine Fundic Exam And End Of Week 7

You might get the idea from looking at these photos that examining the eye of a cow is not easy. Well, that's not true. I'm just a novice though. And direct ophthalmoscopy (which I am practicing here) is much harder at first than indirect ophthalmoscopy but apparently indirect ophthalmoscopy is not frequently used on cows.

I was able to see the blood vessels on my fundic exam but a little disappointed that despite several attempts I could not visualize the optic disc and white stringy thing coming up from it whose name I forget but which is an embryonic remnant of the vessel that fed the lens I think.

In other news, I finally got my midterm back and so have a feel for how I am doing in the course, which is just fine, and so am much relieved. Up until yesterday, professors kept asking me, 'So how do you feel you are doing?' and I would say, 'I honestly don't know. I'm lost in the abdomen' (which is what we are currently studying). What I really felt like saying was, 'Isn't it your job to tell me how I am doing?!' I mean, after all, for most of my academic career I got frequent evaluations. But Cornell does not believe in that. Exams are few and far between. There are lots of thought provoking questions in class and in the worksheets in the Modular Resource Center but never any answers. We are supposed to learn to decide for ourselves how we are doing and to evaluate for ourselves the level of detail to which we must delve in order to be good clinicians. Needless to say I find this quite challenging (euphemism for frustrating).

This afternoon I got my first chance at ultrasound, on a dog abdomen. I LOVED IT! After all these years of watching ultrasonography, I had a feel for what I was doing and was able to quickly find all the structures that the radiologist asked me to look for (quite rewarding) though I wanted to hunt for the pancreas, unfortunately others wanted a turn and I had to let that go.

Now it is back to the books. I have a short break this weekend and I will probably spend most of it studying as the weather has now really turned cold (New Yorkers of course laugh when they hear me say that as they consider this 'early fall' weather). I am going to look into finding a swimming pool I can use, that is my next project outside the classroom.

Week 6: In The Small Animal Hospital And Pig Handling!

Here I am today in the small animal hospital with a classmate from California! I have blacked out my patient's eyes to protect his identity (actually, this dog belongs to another classmate of mine so I do have permission to use the photo :)

Below: The sunrise and sunset have been pretty spectacular lately. It's hard to tell because it is blurry but on the way to school this morning there was an orange sky below the grey clouds, with the mountains below.


This evening was not quite as eery. It was a lavender and pink sky instead of the pumpkin orange of the morning (taken in the vet school parking lot on my way to a dinner break).


Yesterday I learned about handling pigs. I was lucky to get to go onto a pig farm as the large commercial operations have such strict biosecurity that they do not allow vet students to visit. The reason? Pigs are at a high risk of contracting the flu virus from people and such transmission can be devastatingly costly to a pig farm.


And here I am with my classmates getting ready to enter the farm:


Vet school week 6 is almost over. The pace continues at breakneck speed. Tidbits from some conversations today:

Classmate (owner of dog in photo above): "I try to stay on top of my workload and not get behind. But it's hard. It's like trying to keep your head above water when you keep getting hit with big waves."

Me: "I don't have a game strategy. I'm always behind. It's not like keeping my head above water. It's more like not breathing when you're underwater the majority of the time!"

She laughed good naturedly or maybe she actually thought I was funny.
*
Conversation in the library at 9 pm tonight--

Me admiring free hand drawing of collateral circulation to the stomach and commenting on my classmate's phenomenal ability to picture things three dimensionally.

My classmate: "Well, yes, just today I was picturing what it would be like to walk down the esophagus and all the structures I would encounter along the way."

Second classmate overhearing this: "I was imagining myself as a dorsal mesentery sliding down and becoming the bursa [of the omentum]."

Yes, people, there is a reason that I do not fit in. It is because I do not think like this. I need to learn to be more 3 dimensional and less square!

Update On My Angel Lindy

Lindy has a cyst on her left kidney. It is big enough to initially make it appear on as if her kidney is lying in her bladder on ultrasound. But nope, as she does not have two bladders then one is the cyst containing kidney.

Not sure what this means but it appears it is not compromising blood flow to her kidney and so can be left alone.

She had some fluid retroperitoneally so I may be giving her too much subcutaneous fluids??? and am going to cut back a little.

Her blood work was much better than I expected and she is not as anemic as I feared.

The echocardiogram will have to wait till a day when the hospital is not as busy. No big deal as her heart murmur is very low grade.

I'm happy to have her back at home after a long day (for her) in the hospital.

Below: One gets very sleepy when one is kidney failure! (Lindy sleeping on the screened in porch on a warm towel I had just taken out of the dryer to entice her to curl up in the warmth of the sun). But there is always Simon to get in the way (as in the photo at the top of the page where he is about to jump in from the background) and plenty of interesting things to watch out the window... see below

Rites Of Passage

Today I took my first midterm. I have no idea if I passed or not. All I can say is that it was very hard and I am exhausted from taking it.

It's now definitely fall and we had our first frost the other night.

I'm settling into life here but there is little to report. I study, I eat, I sleep. I hope to figure out a way to start running or swimming again soon.

It's a pretty solitary existence, but I don't mind it. The pace is relentless, but without the added stress of moving all the time I'm hoping the second half of the semester will feel slightly more manageable.

Tomorrow Lindy goes into the vet for a work up complete with abdominal ultrasound and echocardiogram. I'm not terribly optimistic and feel I am already doing everything possible for her but I'll get to find out in more detail how she's doing and if her treatment needs to be modified.

Bovine Handling And End Of Week 4

This is me trying to get a pulse rate on a cow by palpating the coccygeal artery, on the underside of the tail-- I'm counting and watching the second hand on my watch, which is why I look so intent on what I am doing. So far it's been a lot easier to find a coccygeal pulse on a cow or horse than on a dog (which I was sometimes forced, by unusual circumstances, to do in small animal emergency medicine).

This is me listening to the heart. I've been getting all kinds of practice lately at ausculting heart and lung sounds in different species. I also got some practice at 'pinging' the cow's side to ascertain the location of air in the abdomen. And finally, I got to strip some milk (I think that is the right way of saying it).

I really like working with cows so far. They are gentle and curious. It is amazing how much you can do from their back end-- in fact, they don't care to have their faces touched but you can practically do an entire physical exam without having to go near the head (well, not quite, but you can get a whole lot of information just from the rear end-- pulse and temperature as well as hydration and capillary refill time from the mucosa of the labia).

Week four of vet school is almost over. I've heard the fire hydrant analogy for medical/veterinary school (it's like trying to drink from a fire hydrant instead of a water fountain or something similar about the amount of information one has to ingest). My best description would be that it is like running on a treadmill that is constantly being turned up. (Those of you who know me well know that I love running, albeit not on a treadmill). This summer I watched horses running on a treadmill (for research) at 80%, 90% and 100% of their maximum effort (based on prior data gathered for their baseline heart rate etc). I've felt since about the end of the second week like I was running at maximum effort. Yet at the end of each week I feel like the speed is turned up a notch. I'm running harder than I've ever run before. Just when I think I've hit my stride and caught my breath and adjusted to the new pace, which feels like all I can handle, they throw a whole bunch more at us. This weekend is the beginning of our comparative anatomy labs, which they set up and we teach ourselves on our free time. I know where I'll be all weekend if anyone is looking for me...

Love At Every Sight (Not Just First Sight)

That's my angel, Lindy and my menace, Simon, curled up on my bed when I got home from school yesterday while it was still light. (Can you guess which is which? Hint: Simon, as usual, looks mad or at the very least suspicious). The house is usually empty, but seeing the two of them curled up together always melts my heart and cures any loneliness.

It was already getting to be dusky. Below is a blurry shot of my room. I will decorate at some point. I kind of like my spartan existence though.

2.5 Weeks Into Vet School

It dawned on me yesterday while looking at some CAT scans of a dog's head that I might actually become a doctor. I mean, c'mon, I've only been in vet school for 2.5 weeks and I'm looking at CAT scans! In case you haven't done this yourself, looking at a transverse section of the head for the first time is pretty confusing. I'm usually quite good at picturing things in 3 dimensions but this was HARD! It involved some pretty serious mental contortions to try to figure out the structures I was seeing and their relative position to each other because when I dissected my canine cadaver we cut the head in a sagittal plane, not a transverse one, so I had to flip everything around in my head and then try to figure out in what part of the head the section had been cut by looking at the structure shown on each CAT scan.

I've also gotten to look at some angiocardiography-- that's where you inject contrast material into an artery to visualize blood flow through the heart. It's neat! I was looking at patent ductus arteriosus, that's when the blood vessel present in fetuses that connects the aorta to the pulmonary trunk in order to bypass the fetal lungs does not close after birth.

Possibly my favorite lecturer and topic is embryology, taught by a world famous researcher (my rooommate told me that once he was watching a program on the Discovery channel called 'In The Womb' and he thought the voice narrating the program sounded kind of familiar, and then when he looked at the credits for the program he saw the narrator was our very own embryology professor!)

This professor, I'll call him Dr. Entertaining for short, is very witty. When he was explaining the development of the embryo, he asked us, "Have any of you ever been on a date where someone told you 'I like your trilaminar structure!'?" Of course, none of us had. And the reason, according to him, is that humans are not flat like a stack of three pancakes (that would be a pancake of ectoderm, a pancake of mesoderm, and a pancake of ectoderm). The embryo folds to create a tube, and eventually a whole human even though we all start out flat like a stack of pancakes!

Dr. Entertaining was in fine form in our lecture on Friday. He presented a mini-case on a white foal that was colicy, weak and dyspneic. I quote him:

What the horse does with its ascending colon is not unlike what I did putting on my bowtie this morning, except I wrapped my bowtie around my neck and not a mesenteric artery.

In an analogy on misfolding of the intestines to origami: Not every attempt at folding gives you a prong-horned antelope-- I never got beyond a sailboat or a hat!

After substituting the word impaction for obstruction: You can tell experienced faculty because they can come up with five syllable synonyms at the drop of a hat.

I really enjoy his lectures, not just because it is like watching a stand up comedian (unfortunately I cannot re-create for you his finger puppet projections of various embryological structures), but because he clearly loves his work. He reminds me a bit of my physiology professor at San Jose state, who was also an excellent and funny lecturer. I will always remember him starting a lecture on the parasympathetic system and when he ran out of time at the end of class, saying, 'We'll stop there and save eating and sex for next time!'

Embryology is, however, a hard subject. It's hard to believe I was ever an embryo, just a clump of a few cells. Was I really ever that little? It's kind of like trying to grasp quantum mechanics-- it's beyond any experiental knowledge I have of the world (for example, I cannot tunnel like an electron and I also find it hard to believe that I once had gills/aortic arches!)

I've got to get back to studying though. This week they threw the nervous system and larynx at us. Actually, the larynx may be more challenging to understand than the nervous system. The muscle that abducts the vocal folds is called the cricoarytenoideus dorsalis muscle-- try saying that ten times fast! The nervous system is not simple either because most structures receive both parasympathetic and sympathetic structure (and that is just the autonomic nervous system for starters). The only structures that just receive sympathetic innervation are the erector pili muscles that make your hair stand up on end and the smooth muscles of blood vessels that contract during 'flight or fight.' The only structures that just receive parasympathetic innervation are the salivary glands (I wonder if that gives new meaning to 'drooling over' something?)

Well, back to the books. I would best describe vet school as RELENTLESS! We don't even get labor day off so I'll be up bright and early tomorrow to discuss larngeal hemiplasia.

Sheep Handling 101

Above: I am semi-successfully restraining my sheep. Key aspects of restraint-- keep the head pointed up and if possible back the rear end into a corner.

Below: Me getting taken for a ride on the same sheep.


My hair was driving me crazy in the lab but I resisted brushing it out of my face because this herd is known to carry orf, which is a zoonotic virus that causes nasty skin sores in people. So I'm wearing gloves and avoided touching my face. Less likely is the risk of Q fever, and since these are older animals, there is a decreased risk of cryptosporidiosis.

Overall, sheep handling was a lot of fun, if a bit intimidating. The sheep all outweighed me and were stronger than me, so I got thrown around a fair bit but I think that is to be expected even with more experience. My first sheep must have sensed I was hesitant because she reared up like a horse twice and dragged me all over. Once I finally gained some confidence and learned to straddle the sheep high up, almost over the neck, things got easier. But then a stray sheep decided to use me as a platform to get over the fence and springboarded off my back. I didn't even see it coming!

Not only did I restrain, but I got practice evaluating body condition, mucous membrane color, drawing blood, giving vaccines and trimming hooves.

Next up: cows!