Week 8: Back In The Saddle Again

Above: Me in my bovine abdomen lab today. One of my professors commented that I must enjoy the hands-on labs because I smile so much during them. It's true. Like he said, I like getting to actually touch the animals. I miss working. I miss putting my hands on a patient. I know I picked the right career because I am happier doing it than studying!

I'm in the middle of week 8 and it's back to the frenetic pace of the first semester of vet school after a luxurious long weekend.

So what have I been up to lately?

• New York State Veterinary Conference-- I went to a session geared towards students and learned some of the pluses of being in a small, rural practice and of owning one's own business, both of which I hadn't given serious thought before.

• I also attended a fabulous talk by Dr. Bonnie Campbell, DACVS who spoke on the "Amazing Omentum." The omentum facilitates hemostasis, releases angiogenic factors (new vessels invade omentalized tissues within six hours), releases neurotropic factors that promote re-innervation and help modulate pain (algolytic products), is involved in immune surveillance and can absorb fluid via peritoneal lymphatic drainage (thereby acting as a physiological drain). To take advantage of all these amazing properties, one can increase the size of the omentum by releasing the ventral leaf from where it attaches to the greater curvature of the stomach or one can reflect the omentum cranioventrally and release the dorsal leaf from the dorsal body wall. To further elongate the omentum one can make an L shaped incision in it. One then places the omentum over the desired site or you can even tack it in place. One can tunnel omentum through subcutaneous fat to non-healing axillary wounds. One can even omentalize the brain and spinal cord. Pretty darn cool.

• I helped paint part of the OTS house as my pledge promise. Friday is my initiation. All I know is that I am supposed to wear coveralls. Only in a veterinary fraternity does one have to wear coveralls to events.

• I went to the farmer's market and bought a ton of vegetables and made a vegetable stew kind of like the ones I enjoyed so much in San Jose last fall. I got to test my brand new crockpot, which is great because I don't have to pay any attention to the stew while it is cooking (I've been a bit of a space cadet in the kitchen lately and that has posed something of a fire hazard).

• I enjoyed the cat-dog interactions in my house, watched the cats and studied while the cats and dogs watched me and the whiteboard I draw on intently.

• I tried to get outside and enjoy some of the good weather that we had on Saturday.

• I got a flu nasal spray in an effort to try to avoid the seasonal flu this year (the H1N1 flu vaccine is not yet available).

• I caught up on sleep.

• I got in some nice runs on nearby trails.
  

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.