Simon The Brave: Feeling Much Better! :)

Moving= Vomiting

Simon (pictured above with his beloved orange carrot catnip toy in background) started vomiting at 4 am last night. I tried to go back to sleep. He proceeded to continue to vomit small piles of white foam everywhere. By 8 am I estimated he had vomited about 50 times. Of course, I got teased mercilessly for this once he was at the hospital (50? not 49? or 47? were you counting?).

I got him the first available appointment in the morning (it didn't seem to be a true emergency in the sense that I felt he could wait the four hours until the non-emergency part of the hospital opened). I would have liked to ignore it and wait longer but one thing that I learned as an emergency technician is that things can go wrong pretty quickly if you are unlucky and that ignoring a problem does NOT actually make it go away much as you might wish it did.

My student clinician did a thorough physical exam. A good look under the tongue with a tongue depressor to help revealed nothing. Kidneys are on the small side of normal at 3-3.5 cm. Stool in colon. Nothing very remarkable.

Radiographs, much to my relief, were also unremarkable.

My student clinician sent Simon home with some SQ fluids and pepcid on board.

He CONTINUED to vomit at home. I was just about to lie down for a nap after lunch when my student clinician called to check on him and so I brought him back in for more diagnostics.

Bloodwork was unremarkable. I was relieved. His total protein was high but his hematocrit was normal. BUN, creatinine, everything else normal (except his cholesterol was a little high).

Urinalysis by cystocentesis revealed some WBCs, RBCs and bacteria. He had a urinalysis and culture and susceptibility last week because of his intermittent inappropriate urination problem and it came back negative. What the heck that he now has some bacteria this week on UA??? At any rate, we couldn't attribute his vomiting to a UTI as he has no other clinical signs of one. (Though we will probably start him on antibiotics tomorrow and we did submit a sample for culture and susceptibility so we can switch antibiotics if need be).

We gave him Cerenia (which I know from school inhibits neurokinins)-- he tried to eat me alive while I restrained him for it and I almost got bit (way to go, almost getting bit by my very own fractious cat) and I took him home.

He hasn't been vomiting since.

I just gave him his next dose of pepcid SQ. He tried to eat me alive again. I swear, if he gets kidney disease I am NOT treating him for it. Thank goodness Lindy is sweet for her treatments, if she weren't then she wouldn't still be alive.

We have a recheck appointment scheduled in the morning. Did I mention my student clinician rocked? She was awesome.

Fingers crossed no more vomiting tonight.

And yeah, as for one possibility of what caused it-- stress related to my upcoming move. Same thing happened last year, when Lindy had a bout of prolonged vomiting just before I moved (see this post). Have I mentioned how much I dislike moving?

Barn Next To My New Place

Above: Barn one house down from my new place.
Below: Lindy in a pensive moment. I'm giving my cats to a classmate Sunday so I can go back to California for the summer and I'm feeling sad about leaving them.

It's Hot (By Ithaca Standards)

Above: Coral, my old landlord's dog, grinning after a game of catch.
Below: Another view from the new place.

Love To Water My Soul

is the name of the book I am reading by Jane Kirkpatrick. I think it is my favorite book of the year. The back cover summarizes, "Based on historical characters and events, Love To Water My Soul recounts the dramatic story of an abandoned white child rescued by Indians. Among Oregon's Paiute people, Shell Flower seeks love and a place of belonging... only to be cast away from her home."
Describing her work, the main character says:
"It is not easily described. I find pleasure in making the calves stand firm after a bout with scours or stopping a cat's cough or relieving a horse's bellyache."
And yet there is so much more to it than that, but of course it is icing on the cake that she has veterinary predilections.

If you're going to read this book, I highly recommend first reading Jane Kirkpatrick's _A Sweetness To The Soul_ and also Sarah Winnemucca's _Life Among The Piutes_.

Today I Radiographed

A ferret and a goose with a feeding tube (and yes, its tip was in the proventriculus if you are curious).

Cornell University Hospital For Animals Main Hallway

I liked the patterns made by the sunlight coming through the roof. I just happened to be going down the hallway in a rare quiet moment.

Moving X 4

I started moving into my new place today. It is my fourth move in the last 12 months. I like the early stages of moving when everything is neat and tidy-- above is my new closet. I'm not looking forward to the next stage of moving when things get messier though...

While I was standing chatting with my new landlady and looking out the window that I plan to put my desk at, I noticed a Northern Flicker just in front of us taking a dust bath. It seemed to be having a really good time just fluffing its feathers and rolling in the dirt. I take this to be a good omen. Anyone who knows me knows how much I love woodpeckers. Seeing a Northern Flicker in my new backyard bodes well.

Year One: Done!

I got out of my last exam and it was HOT and SUNNY and SUMMER. It hit me all of a sudden that it really is no longer winter. Even though it snowed on Mother's day which was less than two weeks ago it is not going to snow anymore!
And I get a real vacation. That part has yet to sink in.
With any luck, I passed and won't have to be a first year vet student every again.

Along with the warm weather, these purple and white flowers popped up everywhere along the roadside here. I'm assuming there's a good chance they are native since they are so ubiquitous and I don't know any nasty invasives that look like them... I'd love to know if anyone recognizes them.

One Down, One To Go

I had an eight hour exam today. One down. One to go tomorrow. Hopefully not eight hours long though.

The photo above is the new view at the end of the street that I am moving to. I think it is very pretty. I'm really enjoying my new camera (thanks again, Dad).

And just to clarify, I'm not graduating. Not even close. Though after tomorrow I will be done with my first year of veterinary school.

Welcome To Vet School: What You Don't Know Can Hurt You

I'm studying for my final exams on Wednesday and Thursday. The way I have been studying is a combination of reviewing notes and also working through vet cases, an online compendium of veterinary cases put together by our wonderful professors where they give us pertinent facts and then pose questions. When you submit your answer, you are then shown the model answer, pretty neat, huh?

So I'm working on this case that involves a mare who is anemic. And on page 3 (yes, page 3, as first one has to generate a problem list and all that good stuff before you actually get down to diagnostics) we're given the CBC. I characterize the anemia as a severe, normocytic, normochromic, heterogenous regenerative anemia. Regenerative? Well, that's where it got a bit confusing. There was no information for reticulocytes on the CBC. I thought anytime there was an anemia there is a reticulocyte count done, right? So I assume if there is no reticulocyte count then the anemia just has to be regenerative or they'd say otherwise. It's not till I go on to the next page (electronically of course) and look at the blood smear that it hits me-- horses don't release reticulocytes into circulation practically ever! They are, as is often the case, an exception to the rule.
Horses do, however, produce normochromic macrocytes, which are young erythrocytes. Do not ask me the subtle points on distinguishing an old reticulocyte from a young erythrocyte. Don't get me wrong, I love clinical pathology, I just don't know that much.

People always say veterinary school is extra hard because of all the species. It's really true. There's just so many species specific idiosyncracies to remember!

For a more eloquent and lengthy post on vet school being hard, I refer you to the blog My Vet School Days, "Wow, vet school IS hard." Despite vet school being hard, the author of that blog just successfully graduated. It can be done.

Sunset Out My Window

Client Interactions And The Spanish Inquisition

I wanted to use that title because it reminds me of Monty Python and makes me laugh.

But seriously, one of the things they've stressed to us in our communication class is to avoid rapid fire closed-end questions and instead ask open-ended questions when interviewing clients (some are really more open-ended invitations). According to our professors, you can get more information that way in the same amount of time all while establishing better rapport. (Seems counter-intuitive that one would get more information in the same amount of time without guiding the client to focus on what you want to hear but apparently it's true in most cases).

Some examples-- "I'd like you to take a minute or two to tell me about Pip."

"Describe what you saw."

"What are your ideas about this problem?"

"What kinds of changes have you been seeing in Blue?"

It's easier said then done. In emergency, I used more closed-ended questions than open-ended questions. At Cornell, we have a list of questions on the history form such as travel history, diet etc and so my client interactions often turn into the Spanish Inquisition, which is even more awkward when you are consciously trying not to ask too many closed ended questions because then you get flustered trying to think of other ways to phrase things.

What are your favorite phrases for eliciting information from clients? Do you actively think about using closed-ended versus open-ended questions? Just curious... Or, do you ever feel like you are being interrogated by your doctor?

Anamnesis (NOT Amnesia)

Anamnesis is another word for medical history.

Deglutition is another way of saying swallowing.

And micturition is the technical term for peeing.

I swear we can obscure anything in medicine all in an attempt to sound erudite (because we all know we are definitely not cool).

I'm studying for my block 7 final exam tomorrow. Tips for talking to clients-- avoid using medical jargon.

While on the subject of medical history-- here's a sample from our lecture:

• Any C/S/V/D/PU/PD/PP/Seizures?

What this stands for is: Any coughing/sneezing/vomiting/diarrhea/polyuria/polydipsia/polyphagia/seizures?

Because if we can't come up with big words, we can still confuse you with our endless abbreviations!

Boron Is My Boyfriend

I'm having an affair with Boron and Boulpaep's _Medical Physiology_. Yes, it's true, I've been spending all my time with Boron lately, ignoring my other favorite text on this subject, _Physiology_ by Linda Costanzo.

Some books just stand out as memorable in one's education. I'd used Boron before (first edition then) and loved it for its exhaustiveness and great illustrations.

Some other books I've fallen in love with:
Robbin and Cotran's _Pathologic Basis of Disease_, my other vet school love so far, such clear explanations!

(Some in my family are enamored of Alberts' _Molecular Biology Of The Cell_ but I wasn't overly smitten, of course, I didn't spend long with this text).

From my pre-vet coursework:
Campbell's _Biology_

And from college:
Stryer's _Biochemistry_ (I still have it!)

What classics do you remember from your school days? I'm curious to hear...

Commitment Phobia

I bought a bed today.

This has made me feel rather anxious.

You see, I have only once before purchased or owned a bed. When I was in college the dorm provided the bed. When I moved off-campus I did buy a used mattress (which I remember as being pretty trashy), and when I was unable to transport it to my apartment, SurrogateSyracuseParents kindly transported it for me with their van (an act of kindness that is not forgotten all these years later). Then, when I graduated college I was in a relationship and so did not need to acquire a bed. Since my divorce several years ago, I have always rented fully furnished rooms.

I like not owning furniture. I don't feel tied down. It makes moving easier. It gives me a sense of freedom.

Purchasing a bed was a major step for me in my adult life. It represents a commitment to staying in vet school, to settling into Ithaca as best I can.

I seriously considered just buying an air mattress so as to feel less weighted down. But I'd have to pay a lot of money to get a really nice air mattress if I was going to sleep on it for months and months and it would probably be the same price as a bed. So I bought a bed.

Of course, I did not buy a new bed. I went on craigslist and was able to find a practically new bed for half the price the people had bought it for. They bought a full bed and then shortly thereafter bought a headboard but the headboard was for a queen and so they decided to get a queen bed and sell the full. I'm quite pleased with my purchase. Especially since it was delivered!

I also bought an antique oak wood desk off a graduating senior. It too will be delivered, hopefully tomorrow.

In The Library

With just over a week of classes left, I'll be spending my time in the library. Above-- main study area (note all those photos of emeritus professors-- among the dozens there are only two women out of the whole bunch and the photos extend into the other room). Below is the poisonous plant corner of the library, which is a favorite place of mine to curl up and read in a comfy chair.

Horses and Elephants, Oh My!

On Monday, while we were discussing our current case, which involves a horse with a respiratory disorder, one of my classmates gave an explanation that made reference to elephants not having pleura. We were all astonished, and of course laughed too, finding it a bit of a non sequitur given that our current patient was a horse.

But it turns out, she is right. Elephants do NOT have a pleural space. The things one learns in vet school.

If you want to read more about it, here's an article titled, "Why Doesn't The Elephant Have a Pleural Space?"

Monitoring My Moods: Noticing Sunlight

Light impacts my mood greatly-- I'm almost always happier on a sunny day. Light also tells me a great deal about my mood. When I'm sad, I barely notice light. When I'm feeling better, I notice the pattern of light everywhere.
This morning I admired the rays of sunlight streaming down from the clouds (above) while driving to school and it reminded me of a beautiful photograph that my roommate took while hiking in the Adirondacks.

Then this afternoon I was struck by the interplay of shadows and tree branches on the window by the student mailboxes.
I know I'm feeling a little better than I have been just because of these two observations alone.

The Amazing Efficiency Of The Avian Respiratory System

I've been entranced by birds for my entire life. I've read tons about different aspects of bird life but never really understood the avian respiratory system until this morning when we covered it in our overview lecture of the respiratory system.

We watched a beautiful animation of bird breathing in class that I just loved but unfortunately it is password protected and so I cannot link to it:( I'll describe what it showed below, though.

In the avian respiratory system, air is moving through the lung (the arches in the middle of the diagram) in the same direction during both inspiration and expiration (airflow is unidirectional)! This means that birds have air with a high partial pressure of oxygen available to their lungs all the time. That's why birds can fly at altitudes that people cannot survive at, even at rest-- because they have a constant supply of fresh air to their lungs, unlike people whose lungs are filled with waste gases during expiration.

How exactly does this happen? On inspiration some of the inspired air moves into the caudal thoracic and abdominal air sacs while an equal portion flows into and then across the lung into the cranial air sacs. On expiration, the fresh air in the caudal thoracic and abdominal air sacs is expelled and flows into and across the lung while the used air in the intraclavicular and cranial thoracic air sacs exits the respiratory system via the trachea. (For images and description by the same professor who did the animation-- Dr. Ludders,one of the anesthesiologists at Cornell-- see chapter 8 of the 12th edition of _Duke's Physiology Of Domestic Animals_).

The View At The End Of The Street

Herd of Hereford cattle at the end of the street. Note: I knew what breed they were from memorizing all my breeds of different species in block 2.

Interesting Saturday In Radiology

I saw two really neat cases while working in radiology Saturday that tied into case presentations we've gotten in block 3. The first was a dog with NSAID toxicity-- it was getting a blood transfusion and had melena. Made sense to me. Decreased prostaglandin production as a result of inhibiting cycloxygenase enzyme 1 (cox-1)-- those prostaglandins are protective for the gut.

And then I saw a dog with an adrenal mass, likely pheochromocytoma (the other differential was a carcinoma but the dog was showing clinical signs consistent with a pheochromocytoma). What was neat is I had left ultrasound to go take some radiographs and when I came back in everyone was looking at an image on the screen of Doppler blood flow around a mass but I wasn't sure at first where the mass was. Judging from its proximity to the kidney and some other markers, I guessed and asked if it was a pheochromocytoma. I was happy to be able to figure out what I was looking at on ultrasound without anyone orienting me anatomically. And it was only the second case I'd ever seen. We had a mini-case that involved a pheochromocytoma in class recently so that made it even more neat.