Internalizing.

Gah! How does time get away so quickly?

Let’s see…Since I last posted I have started and finished Small Animal Internal Medicine – one of the more intimidating rotations that is known for long hours and incredible amounts of SOAPing (writing of medical records).

Instead, my experience on the Internal Med rotation was one with a great group of clinicians and some rewarding cases - none of which (all things considered) didn’t require the hours of typing that many other students have been plagued with. On top of that, one of my fantabulous rotation mates was fostering orphaned kittens, so down time was spent caring for and cuddling with the tiny furballs…or eating fortune cookies.

Some pointers for this rotation include:

1.       Be proactive and get your diagnostics requested, samples pulled and submitted asap.

2.       Sign up for cases that challenge you! You’ll learn something.

3.       Prepare the best that you can for rounds – make sure to read previous records from other office visits, even if they were with a different service.

4.       Transfer cases coming from other services can be kinda crazy – make sure you are familiar with the results of all diagnostics that are completed or pending. Get as accurate of a history as possible and call the owner if you are unsure about something in the record.

5.       This is a great rotation to get more practice with venipuncture and other technical skills. Especially because Cathy is super amazing. Love her.

6. Spoil the blood donors – the hospital uses several Greyhounds, each fostered by its own veterinary student, to supply the blood that is needed in case of emergency. When “on-call” for blood donation these guys hang out in the Internal Medicine ward, so treat them like the heroes they are. J

Always bring a stethoscope, thermometer, and a pen. It’s also handy to have a calculator, a clipboard and a leash too!

I have also started and finished my food animal block since the last time I updated (man, I’m pretty terrible at staying current). The food animal block is 3 core rotations: 2 weeks of theriogenology + 2 weeks of dairy + 2 weeks of beef = 6 entire fun-filled weeks of smelling like poo and/or goats. Uh-mazing. A follow up to this brief intro will give a rundown of all the fun and silliness (and I guess some of the learning, too) that went on.

War Eagle!

Jess

Scrape, Tape & Smear!

It’s been a while since we last posted, and trust me, a lot has happened…

Uno – Neurology is finished.

Dos – Large Animal Anesthesia has come and gone! (My rotation mates took some fab photos and I will post some with their permission asap.)

Tres – Small Animal Dermatology is where I am currently at in my rotation schedule.

Cuatro – Alabama has suffered a tremendous amount of damage by the recent tornados. Our hearts are with the people and communities who have lost so much. We are so blessed that Auburn and our homes were spared!

Cinco – de Mayo! I couldn’t resist. Kristin & I celebrated a day late on the 6^th with husbands, friends, cheap Mexican food and margaritas, Ole!

(…And meanwhile, back at the Large Animal Clinic and deep in the throes of lameness, colic, and septic foals, Kristin is battling her way through the Equine Clinics block = 3 rotations = 6 weeks! She has some excellent stories to tell and a wonderful new side-kick to boot.)

Large Animal Anesthesia:

Very exciting when something goes to surgery. There is a lot to do in a short period of time, but it’s all routine and gets easier the more you do it. Memorize those triple drips, do the assigned readings, and listen up during topic rounds/class discussions. There is a test at the end of the rotation, so pay attention! Glen and Miss Stephanie are wonderful and definitely know their stuff, so learn from them. Also, be prepared to be on-call for emergency surgeries 7 out of the 14 nights you have on this rotation.  Always have 1-2 pairs of clean scrubs on hand for surgeries, a stethoscope, a pen, a calculator and a watch. (Or if you're that super cool, you might have a calculator that IS a watch...)

Small Animal Dermatology:

Whoa. This rotation has been the fantastic break that everyone has cracked it up to be! The hours are great, our technician Missy does so MUCH to help us out, there are no emergency/after-hours responsibilities, and we get to do fun things like cytologies and IDATs! Brush up on your differentials, vocab, and common treatments and you’ll be golden. Missy puts a letter in your mailbox the week before you start with a lot of this info – don’t be like me and find out about it on the first day of the rotation! J

Up Next:

Small Animal Internal Medicine. And all the SOAPing I’ll ever need in a lifetime – or so I hear. If you need me you can probably find me in a copy of Ettinger – somewhere in the index between the letters F, M, & L.

War Eagle,

Jess

Hope on Horseback

I know that I’m currently on neurology, and as such should be talking about the wonderful world of neurons and synapses. Instead, I felt compelled to share about an amazing organization that I was introduced to while still on ambulatory. But don’t worry – I’ll throw a little plug in about neuro at the end!

The place I’d like to introduce you to is called Storybook Farms. A quiet little country paradise, hidden in the outskirts of Opelika/Auburn, Storybook Farms provides a wonderful service to the surrounding communities. To quote their website,

“The year-round equine assisted activities are tailored to serve children ages 2 years to young adults who are challenged with life-threatening illnesses, disabilities, mental and/or emotional trauma, and grief.  The gentle nature of our horses provides hope and healing.”

The organization, also known as Hope On Horseback, provides such a wonderful learning experience for all those involved – from the children who truly need this form of counseling and comfort to the volunteers and counselors who put so much time and effort into making this program what it is today.

Not only were there cute and cuddly horses and ponies all around, but there were also goats, dogs, cats, and a miniature Zebu! Who, by the way, was not as thrilled about the idea of receiving a pedicure as we were to administer it.

I felt very blessed and honored to be a part of our ambulatory calls to Storybook Farm, and I hope that by sharing a little bit of their story here, some of you out there might also be as touched and humbled by their mission as I am.

For more information about Storybook Farms, please visit:

http://www.storybookfarm.info/Home.aspx

 

And, as promised, a little info on Small Animal Neurology:

• You know that thing that sits inside your skull, about 6-8 inches above your shoulders? You know, your brain? It's important. Use it.
• Dress nicely for this rotation, but be prepared that what you wear will most likely get dirty. And have a set of scrubs ready in case you go to surgery.
• The technicians are amazing on this rotation! Thank them for all their help, and don't get between Ms. Judy and her coffee.
• Be prepared to talk with your clients, in front of the head clinician, before he speaks with them. Have a game plan, and know which way you'd like the conversation to go. Try not to get side-tracked. ;)
• There are a lot of ward cats that hang around in this rotation. Be sure to learn what their names are so you don't accidently lock one of the ortho cats up with them.
• Good reading topics for this rotation: seizures, intervertebral disc disease, peripheral neuropathies. Brushing up on advanced imaging would also be a good idea.
• And while on the topic of advanced imaging - Be prepared for an interrogation at the MRI doors, not too unlike an experience with airport security. NO METAL OBJECTS enter the MRI room (exceptions - emergency drug syringes inside the clipboard box, a stick pen - not a clicky pen, metal on/in your shoes, metal underwire in a bra, esophageal stethoscope, digital watch). There are ear-muffs available to wear once inside, I highly recommend you use them. :)

Up next - Large Animal Anesthesia. For now, Kristin and I are about to head out for a run and then end up at Chill - a delicious, self-serve, frozen yogurt heaven. Be jealous.

War Eagle,

Jess

Let us Ambulate.

Ambulatory is amazing. It makes me fall in love with veterinary medicine all over again.

The ambulatory rotation consists of 5 students, one clinician, and in our case, one resident, who all pile into one extended cab truck for 10 fun-filled days on the road. The service is responsible for pre-made appointments, from lameness evaluations and joint injections, to stallion castrations and routine herd healthcare. Ambulatory is also responsible for any afterhours emergency farm calls within 35 miles of the veterinary school. Each weekday, the students on the rotation are responsible for one primary job. The positions include Primary Care (doctor), Recorder (responsible for medical records), Pharmacy (responsible for any meds used), Equipment (head technician), and Orderly (low man on the totem pole/ general "go-fer"). Each student is also responsible for being "on-call" for after-hours emergencies on weekday nights and weekends. All in all, I think everyone will have had either 8 or 9 on-call shifts throughout the entire two week rotation.

We had some wonderful experiences with our cases, met some incredible clients, and were pretty much spoiled by our clinicians and residents (thanks for all the late mornings, brownies and long lunches!).

We saw life, death, lameness and soundness. There were horses, cattle, goats, farm dogs, barn cats, donkeys, miniatures of all sorts (including Zebus!), and even a Tarpan. Bonus points if you can tell me what that is.

There are too many stories to tell all in one sitting, from funny to fabulous, sweet to scary. So, instead, I’ve decided to share with y'all a few pearls of wisdom gained during our many road trips through rural Lee (and surrounding) County, as well as some pics I snapped along the way. *All patient photos were taken and posted with the permission of the clients. J

 Chinese Firedrills may be required at 8 am. Practice these as necessary.

 Emasculators: Always position them nut-to-nut.

Good fences make great neighbors…and keep your dog at your own house!

 Pedestals are for falling off of.

 

On dealing with crazy first-calf-heifers: Drop the lead rope, turn into a ball, and when possible, do a sweet cartwheel-vaulting-combo over the fence.

Everyone should experience a double cheeseburger from the gas station X-press Café on Shelton Mill Rd & Hwy 280.

 Everyone should also experience the fried food extravaganza that is Ezell’s Catfish Cabin on S. College St.

 And in keeping with “greasy-food-on-the-go” theme…

Life is a party! And then you throw up.

One more day of fresh air (and then a weekend of emergency backup duty) before I head into the small animal hospital for Neurology. It's a good thing I'm taking Ambulatory twice - I'm definitely going to miss this.

War Eagle,

Jess



Diagnostic Pathology -- what a lovely way to start!

While poor Jess was thrown into a UVIS (Auburn's dreaded computer system) and Critical Care (stressful rotation) at the same time, I was easing into clinics with a mostly lecture-based rotation. But no worries - unlike most of our classes, these lectures are extremely interactive. In fact, even if you get the answer wrong sometimes, the professors appreciate participation and avoiding those long periods of silence. They just want you to try! 

Diagnostic Path begins at 8am each morning in either Clin Path (near ICU) or in the Bacteriology Lab in Greene Hall. Depending on who you have as your Clin Path instructor, you may be told on the first day to be comfortable and wear jeans everyday. Some of us came in jeans every day, and no one cared. So, you will have about 3 hours of Clin Path cases, microscope time, and bloodwork analysis every morning, followed by an hour of Microbiology. And trust me, Dr. Hathcock is a genius of Micro - she will quickly figure out how much you know and teach right above that level. She asked questions on how to treat various bacterial and fungal infections. Basically, start with Clavamox every time.

In the afternoons, you have necropsy. Four out of the ten days, you will have a quiz and meet in upstairs Greene (down the plant hallway-bridge and to your right). If there are no necropsies that day, you still have to stay on campus until three... We just sun-bathed on the front stairs of Greene for an hour and a half if we had nothing... :) If you do have a necropsy, get your clothes (cover-alls, socks, shirt, shorts) from Greene Annex, pile in a car, and go to State Dx Lab. Be sure to write your necropsy report as soon as your finished. They will tell you that the reports aren't due until the next afternoon, but it only takes a few minutes if all of you work as a team to type it in Histo Lab.

Half of the rotation group will be "on-call" for each weekend, which means you ask the clinician on duty what they prefer... Weisman asked us to meet at 8am on Sat/Sun, and if there were no necropsies, we went home. Sartin does the same, but you meet at 7am instead.

What you need:
Clin Path book (talk to classmates about who will bring this - you don't need 7 copies daily)
Large notepad (great review for Boards, so you will want to take notes)
Pens
Snacks/drinks (you get a 10-min break every hour in Clin Path, and they are fine with eating in that room)
Sunscreen ;)
Necropsy provides all clothes you will need

I think that was it. Fantastic time. Great review. No UVIS. Four quizzes that are mostly short-answer, but all Sartin expects is for you to write something. No way to predict what she'll ask (i.e., the quiz subject may say "hemolymphatic," but the quiz questions may be about musculoskeletal). Not a big deal though. :)

Next --> Internal Medicine!
Kristin

VEGAS! Venetian. Jess almost went with me, so I will include occasional pictures of my trip just for her... ;)

Good Things to Know BEFORE Day 1

The orange screen – If you need to use the internet in any of the hospital computers, double click the big “Log-Off” button on the desktop. Sign back in under your personal id and password. It takes forever, but eventually you’ll be brought back to the main desk top, only this time with an orange background. You can now surf the web, but keep it clean. They’re watching you. If you leave it inactive for 10 minutes it will log you off automatically and you’ll lose whatever you were doing. Always log out or some lucky person will be able to print documents on your dime.

QATS – Pronounced like “quats.” I didn’t know what the heck it was on day one, but if I’d paid more attention during one of our critical care lectures prior to clinics I would have. QATS = Quantitative Assessment TestS. Why they don’t put the U in there to make it spell the way it’s said, I don’t know. QATS include: PCV, TS, Lactate, and Blood Glucose. You can typically run QATS on a small amount of blood – 0.5 to 1.0 ml is more than enough to run these (and you should have some left over in case something gets messed up).

Getting in the building – Make sure your key cards work in the appropriate doors before you need them to. Running around the entire complex of the Small Animal Hospital, Greene Hall, and Overton construction at 5 am really sucks. If your card does not work, see the lovely ladies in the Dean’s office in Greene Hall.

Stickers – If you’re the primary student on a case, put a sticker from their folder in your handy-dandy notebook. If you’re like me, you find it hard to remember number sequences. The sticker has the case number, animal’s name, and client info (like phone numbers) all nice, neat and ready to use when you’re on the go.

Technicians – These folks are AMAZING. Be nice to them and don’t be afraid to ask them for help, or to show you how to do something. Be mindful, though, if they are already busy with something else. Also, help them out if they need a hand with something and you’re free at the moment. It’s all about the team work.

Doctors – Ask your clinician how they expect you to write your medical record. Many have different preferences and knowing what they are looking for can save you a lot of time.

Friends - Be sweet to each other. At some point, we’ll all be in a bind. Luckily for me, I have one of the greatest friends around who was sweet enough to let my dogs out when I was stuck at the hospital for more than 12 hours at a time, AND leave banana bread in my mailbox when I had no time to grab food. Thanks, Kristin!!! J

Common sense – If you break something, tell someone and see if they can help you fix it. If you spill something or make a mess, clean it up. If you aren’t sure about something, ask! Don’t borrow things without asking, and don’t take things that don’t belong to you.

Things to have on hand (for any rotation) – Stethoscope, pens, highlighter, pen light, bandage scissors, hemostats, sticky notes, your handy-dandy notebook, and flash-drive. Make sure you know your VIN account info in case you need to look something up. Having a copy of Plumb’s hanging around is useful, too.

Clinician questions – If a clinician tries to quiz you about something and you don’t know the answer, look it up. Then be sure to grab that clinician as soon as (s)he is free to go over this info, that way (s)he knows that you actually followed through with it. They will NOT seek you out for the answers (they already know them), but not bringing it up with them can be reflected in your grade.

Clay paws – If your patient passes away, you can make a baked clay paw print for it’s family. Not everyone is comfortable with this, so use your best judgment. Just ask someone in ICU or Tumor’s Corner where the materials are and how to make one if it is ever needed.

Pet food – As a 4^th year student, you get a free bag of food from Hill’s once a month. Don’t everyone go at once and wipe the store out, please.

Drug Dosages – Work on learning these prior to clinics if you can. You’ll be a rock-star from day one. (Unfortunately, I did NOT do this.)

These are some of the big things I gleaned from my first rotation; I hope some of you find them useful!

I'm loving my current rotation so far. We're outside most of the day and I actually got a little sunburned yesterday. Now I’m off for a big day of being the “orderly” on the ambulatory truck. Watch out, Lee County.

War Eagle,

Jess

Clay Paws

And….fail. So, apparently it is a lot harder to update on certain rotations than others!

Surprisingly, I thoroughly enjoyed small animal critical care. I’d honestly been dreading the rotation as it’s known for long hours, stressful situations, and the inevitable for some of these little creatures – death. What I found instead was long hours, stressful situations, death, AND life, compassion, dedication, and some amazing rotation-mates, technicians, and doctors who made the mental, physical, and emotional demands easier to handle.

Critical care is a lot of statistics and luck – some of my rotation-mates had several patients go home happy and healthy. Others discharged patients to go home and spend their final days with their families. Unfortunately, I was one of those students who (through no fault of her own) was not able to send very many live patients home with their families. It was easier in some cases - where euthanasia was elected in the best interest of the animal, and much harder in others - when the loss of a patient was out of our control.

I certainly did a lot of praying for the people affected by the conditions and/or losses of their dear pets.

I’m running out of time at the moment, but I promise I’ll post another, more up-beat article soon – with little pointers on surviving clinics for the underclassmen who might be reading this.

Off to ambulatory!

War Eagle,

Jess