Block 6: OBX SPCA

(That photo is actually from last year, but that's pretty much how you'll find me at any given time on the OBX!)

I was lucky to spend almost 3 weeks on the Outer Banks working at the OBX SPCA/Dare County Animal Shelter in Manteo.  I found an awesome townhouse to rent via AirBnB.com, and I used my senior travel scholarship to pay for it.  I worked from 8-5 and sat on the beach for at least an hour every afternoon.  Although my days were mostly spent cleaning litter boxes (literally 2-3 hours each morning!) and feeding cats, it was a good experience.  I learned how the shelter was funded and managed, and I saw the effects of the difficult decisions the staff has to make.  Over the Labor Day holiday, the AC was broken; I used money from my mom and my friends to buy box fans to help keep the cats cool while we waited for the county employees to fix the problem.  Those were sweaty days of litterbox cleaning!  I didn't really get to "play doctor" much during this externship, but I did feel that my contributions helped the shelter (especially the cats, who didn't get much individual attention unless I was there).  I learned a lot about shelter management and I can say: if you want to help shelter animals, donate time/money/food/litter/toys/bedding to your local shelter instead of a national organization.  Ask them what they need the most; they will be grateful for the help.  Better yet, adopt a shelter pet!

My time on the OBX was cut short by the death of my grandfather on September 5.  Luckily, I was able to leave the SPCA early to spend time with my family.  I was fortunate to celebrate Papa's birthday with my family in Charlottesville the Sunday before I drove to NC, so it hadn't been long since I'd seen him and shared a few laughs about how I'm going to treat cats instead of cows.

Next stop: Washington Animal Rescue League

Block 5: Anesthesia

After the whirlwind of orthopedic surgery, 3 weeks of anesthesia seemed like a vacation!  We had regular hours, lunch breaks (usually), time to study, and we got to wear scrubs all day.  I learned a lot and took some risks with new drug combinations by the end of the rotation.  It was a great block because the techs and clinicians trusted us to know what we were doing and take responsibility for creating anesthetic protocols and monitoring patients.  The easier schedule (easier as in fewer hours) was important, because all that time in the OR was stressful!  I got to watch (what little I could see from the head of the table) several interesting surgeries and administered an epidural.  This was one of my favorite blocks for sure.

Next stop: 3 weeks at the SPCA of the Outer Banks!

Block 4: Orthopedic Surgery

The fact that I didn't post anything during surgery block should tell you how much free time I had.  Unfortunately, the experience was not any better than I anticipated in my previous post.  It was 3 hard weeks of paperwork, intense patient care, and grunt work.  We even had to come in on the weekends when we didn't have a patient in the hospital! (That only happened once...I always had patients!)  What salvaged the block for me was our team: my classmates, the techs, the resident, and our visiting surgeon.  They really made things bearable and kept a very positive attitude despite the long hours.  Using power tools during surgery was pretty cool too.  Ortho is an exceptionally busy service...really the bread and butter of the VTH.  There are a lot of dogs with fractured bones and ruptured ACLs out there!  I had more wonderful patients and owners this block too...that helps keep things in perspective.

Surgeries during this rotation:
-Chihuahua with fractured femur
-Sealyham terrier with IVDD (I didn't help with the surgery, but boy did I get a work out with the post-op care...and client care...)
-Boston Terrier with angular limb deformity
-mutt with cranial cruciate ligament (ACL) rupture
-Weimaraner hit by car
-assorted rechecks, poor surgical candidates, medical management cases, and folks who ran out of money

Coming soon: Anesthesia!

Block 3: Neurology

The past 3 weeks have been a blur!  I've loved neuro, but hated my quality of life.  During week 2, I worked 94 hours!  I didn't even know that was possible.  But I loved what I was doing, and I was excited to go to work every day.  I enjoyed neuro much more than I expected, and I think that was because (much like internal medicine) it's a puzzle.  You have to take the history, the physical exam, and the neurological exam, and put them all together to localize the animal's problem.  It was frustrating at first, because we'd only had 1 lab session about neuro exams.  I remembered a lot of what we'd learned, but it takes a really long time to do a neuro exam if you have to pause after each test to remind yourself what's next.  By the end of the block, I was much more efficient with my exams and much better at listing likely rule-outs.  I thought for about 10 minutes that I wanted to be a neurologist, but then I remembered that I don't really like surgery...that won't really work!

I saw 2 surgeries: a cervical (neck) dorsal laminectomy (removing bone to access the spinal cord) to remove a meningioma (locally invasive tumor) on an American Bulldog, and a thoracolumbar dorsal laminectomy for Type 1 IVDD (intervertebral disk disease) in a Dachshund.  My job during the tumor surgery was to flush the site with sterile saline and suture the drain into place.  For the disk surgery, I actually got to chisel away some of the bone...scary but really awesome.  Surgery is a great part of neurology because, depending on the problem, you can improve the animal's quality of life almost immediately.  (Not to mention that it's pretty cool to look down and see the spinal cord!)  It's very delicate, though, and can take hours to complete.

I've now had a euthanasia on every block.  I wasn't there for the first 2, as I had transferred those patients to other services before they were euthanised.  This time, I inherited a patient from a friend who had sent the dog home after seeing great improvements.  He came back a few days later, unable to walk and having seizures.  We nursed him for a week before his condition worsened and he developed complications that made recovery unlikely.  I sat with him for a few hours last weekend while we waited for the owners to arrive, and I hope it made a difference in his last hours.  His owners fed him his favorite treat for his last meal: peppermints.

I've gotten more encouragement to pursue an internship, so that's a decision I'll be making in the next couple of months.  I'll need 3-4 letters of recommendation and an amazing personal statement, so that will take some work.  I've signed up for the NAVLE (licensing exam) and the online study materials.  Things are moving quickly!  Only 2 more blocks before I get to spend 9 weeks away from Blacksburg...3 of them on the OBX!

Speaking of not liking surgery and having a poor quality of life: next block is orthopedic surgery.  I'm on call 1 day every weekend and a couple of weekdays, and I'm sure to have patients in the hospital nearly every day.  I've gotten pretty good at keeping my head above water with very little sleep and an irregular eating schedule, but it's really not a good way to live.  I hope my next entry will reflect that surgery is much more fun than I expect it to be.   

Block 2: Community Practice

Community Practice (aka Cprac) is the VTH's own small animal clinic.  Anyone who lives within a 30-mile radius of the vet school can use Cprac as their regular vet clinic.  I wasn't really looking forward to this block because I loved Medicine so much, and I knew that the busy schedule in Cprac wouldn't allow as much time for researching cases and really going in depth.  By the end of the 3 weeks, though, I found that I really enjoyed my time there...I'm actually sad to leave, and I wish I'd had the foresight to schedule an elective rotation through Cprac at the end of the year (when I'll have had much more experience!).

Cprac is like a self-contained clinic just off the main waiting room of the VTH.  It has its own pharmacy, supplies, doctors, techs, exam rooms, surgical suite, and, of course, paperwork!  With 8 students on this block, we didn't usually have more than 1 surgery and 2 or 3 appointments each per day.  With only 3 clinicians, things were still really hectic!  It still took over an hour for simple vaccine appointments, because there was the same routine of exam/fill out form/present to clinician/exam again/treatments, bloodwork, vaccines, etc/paperwork/discharge.  The best part of the Cprac experience is that I got to make more independent decisions and spend more time talking to clients.  It was much more of a real world experience than the "ivory tower" of Medicine, so we got to develop skills and habits that were more practical.

I completed my first dog neuter, ran anesthesia 3 times, and did 2 cat dentals (including extracting a canine tooth and performing a crown amputation on a premolar).  I drew blood from several sites, gave lots of vaccines, worked really hard on ophthalmic exams, and restrained many dogs.  I did get to see a LOT of cats this block!  Cprac also tends to be a drop off point for wildlife that clients "rescue" (which means: find baby animals in their yards or on the side of the road and assume that the mother has abandoned them...this is usually not the case).  We saw a 3-day old turkey, fledgeling robin, woodpecker, and 2 fawns.  They all went to wildlife rehab, but they all would've done just fine without any human intervention!  Juniper (yes, we named her) is pictured above.

Although the days in Cprac were shorter (10-12 hours versus 14-16 on Medicine), I found myself much more exhausted by the time I got home.  Part of that was the faster pace, and part was being in such a small space constantly surrounded by people and dogs!  I told quite a few people that I was living out my Myers-Briggs personality test results: I'm an introvert, which doesn't mean I'm shy...it means I draw my energy from quiet time spent alone rather than spending time with other people.  Being surrounded by 15 people (wonderful, helpful, smart, funny people) in a small space with no windows all day made me really tired!  I learned to take the long way through the hospital to go to the bathroom, stop by the ICU, or pick up lab results just so I could have a few minutes to myself.  I was lucky that I was already good at tuning out distractions, so I never had a problem concentrating on paperwork or phone calls with barking and talking in the background.

I do wish that this rotation had been closer to the end of the year.  It's great practice for what I'll be expected to do on the first day of being a doctor.  On my mid-block evaluation, I was told that I was well-rounded and level-headed, had a professional attitude and an appropriate amount of confidence, and that I took criticism and instruction well.  I'm really proud of that, because those skills as well as client communication and teamwork are the "soft" skills that are learned over a lifetime.  I don't mean to brag...I'm just lucky that I've had so much work and life experience prior to vet school that I've had the opportunity to hone those skills.  My physical exam and surgery skills will improve over the next year...although I'm a bit of a perfectionist, those are things I know I will be working on for the rest of my career.

Fourth year is really flying by!  I can't believe I'm already done with 2 blocks and my family has made hotel reservations for graduation!  I have to register and pay for the NAVLE (national board exam) by August, sign up for a NAVLE prep program, and take the exam in November.  I've also planned my elective blocks (yay for time away from Blacksburg!) for August-October.

Next stop: Specialty Medicine-Neurology.

Here's your Lucy photo:

End of Block 1 (of 17)

I only worked 59 hours this week...I was very lucky!  By chance, I was only scheduled for 1 shift for the holiday weekend.  ICU was slow on Saturday morning, so I was dismissed after an hour and was not paged to come back in.  I enjoyed a much-needed fun and relaxing long weekend.

I'm excited to have completed my first block, but I'm sad to leave Medicine.  It was so much more wonderful and exhausting than I imagined, and I learned so much.  Just when I started feeling like I knew how to manage my time, it's time to move on.

Cases last week:

-Golden Retriever with prostatitis

-Pomeranian with heart murmur

-transfer from ER: Yorkie with respiratory distress: kept in oxygen cage overnight

-DSH with chronic vomiting: endoscopic biopsies pending, treated for Giardia

Next stop: Community Practice!

Block 1: Small Animal Medicine

It's hard to believe that I only have 1 more week on Medicine block.  The days are long and no one gets enough sleep, but it's the greatest experience ever.  I swear I'm learning at least 10 new things every day!

Our days start at 7:30 in the ICU to take over any patients that came in overnight on emergency (if their condition requires transfer to medicine, versus neuro, surgery, etc).  If I already have a patient in ICU, I come in around 6:15 or 6:30 to do their morning treatments and write their records before presenting their case to the resident/intern and Dr. P.  We have rounds from 8-9 every morning, and appointments start at 9.  I'm on the Tues/Thurs team, so we see appointments on those days and do procedures on Mon/Wed/Fri.  Otherwise, we help out our classmates, help out in ICU, or read up on the next day's appointments or procedures.

An appointment at the Teaching Hospital is an all-day affair.  We do our initial exam, take a history, and then leave the client in the exam room while we shuffle through notes, books, and articles and consult with our classmates about our ideas about the patient.  We then present the case to the intern/resident/clinician and are grilled about our findings, our rule-outs, our recommended tests/treatments, and our general lack of knowledge :)  There's so much to forget from the past 3 years, but once you've had a case or two that are similar, or have heard about a classmate's case, it gets easier.  By now at least an hour has passed, and the client is pacing the room.  We go back in with the DVM and they repeat our exam and ask any questions we forgot.  Then we take the patient back to our ward to draw blood or do a more thorough exam and start submitting the reams of paperwork required to get anything done.  Radiology and neuro consults are usually done within a few hours.  Procedures (endoscopy, colonoscopy, etc) are scheduled for the next day (more paperwork!).  Stable animals stay all day or overnight in our ward.  Sicker animals are transferred to ICU for more intensive treatments (i.e. IV fluids).  A patient remains in my care until it is discharged or a new block starts (when it is transferred to a new medicine student).  This includes 7s (we try to group major treatments at 7am and 7pm), walks, medical records, daily written reports, discharge letters, paperwork for additional diagnostics, etc.  On weekends, we have ICU rounds at 8am and are also responsible for regular patient care.

We are also assigned ER shifts (4:30-midnight for most blocks, midnight-7am for radiology students who have an easier daily schedule) during the week, and ICU duty (4:30-midnight during the week, midnight-8am/7:30-4:30pm/4pm-midnight on weekends).  In addition, someone is responsible for 11pm treatments of any patients in our ward.  An ER patient remains in the care of the ER student until the next day's transfer (or Monday if it's a weekend).  All of this makes for a MINIMUM 12-hour day.  I worked 74 hours the first week and 77 this week.  It's a marathon!

Here's a link to a tour of the VTH: VTH tour

Cases so far:
-Boxer with chronic vomiting and weight loss: developed seizures and was euthanized this week when MRI showed a forebrain tumor

-ER patient: mixed breed with 1 seizure episode

-ER: Husky with a probable pheochromocytoma (stress hormone-secreting adrenal tumor): cool case as this tumor is very uncommon. She goes to surgery this week with my friend Jeremy on her case.

-Dachshund with intervertebral disk disease (didn't really need an exam to suspect that's what he had!): 4 weeks cage rest and NSAIDs

-taken over from ER: Yorkie with immune-mediated thrombocytopenia

-Lab with bladder mass: polyps, not cancer! This lady gave me a hug just because she liked me and I loved her dog. Imagine how happy she'll be when she hears it's probably not cancer!

-beagle with icterus and immune-mediated hemolytic anemia:went home yesterday on immune suppressive drugs to be reevaluated at the referring vet next week.  This lady is my new best friend...she was so happy her dog is getting better, even though we're not sure what caused her illness.

-Lab with intermittent vomiting

Senior Year!

After no new posts in over 2 years, your sporadic photos of everyone's favorite disapproving tortie will now be interspersed with tales of J-Woo's vet school clinical year. I promise to try to post once a week, and at least once each block (every 3 weeks).

Block 1: Small Animal Medicine. Get excited!