Diary of a Dick Vet

I have just wrapped up my first half of final year with a module in small animal soft tissue and orthopedic surgery, and two weeks working in the intensive care unit (ICU). This has been a particularly busy module, which was slightly unfortunate this time of year as I didn’t get a chance to do any Christmas shopping! Instead I will have to join the crowds tomorrow in the last-minute gift buying….

Surgery is obviously an important skill for veterinarians as I will likely be doing regular small surgeries, such as spays, neuters, mass removals, etc. More complicated and lengthy surgeries are not expected to be in my repertoire when I qualify and they don’t really appeal to me, at least not at this point in my training. So, while the surgeries I observed over the two weeks were interesting and impressive, they were often a bit over my head and I’m confident I don’t want to pursue extra training in surgery! More and more, internal medicine really appeals to me.

The last two weeks, I’ve been in the ICU. For the first seven days I was there during the day shift, which meant I saw a lot of the cases that were admitted and got to watch the initial work-up for the presenting problem. During that time I met a very sweet dog that was severely ill, and she became the patient I spent the most time with. Her case was very challenging, and she was eventually put to sleep, which was unfortunate but absolutely the best decision, as the owners only had her best interests in mind. I’m glad I got to spend the week with her, and I know I tried my hardest to keep her comfortable during that time.

The final 7 days of ICU were the night shift, and included looking after the entire hospital in the evening and early morning. Working with emergency medicine means alternating between periods of boredom and excitement, and also only rare snippets of sleep! The wards were particularly busy on Wednesday and Thursday and the ICU was crowded, with cases needing constant monitoring, so my group was very sleep-deprived by Friday, and happy that a lot of the day cases were sent home for the weekend. Emergency medicine isn’t my calling but it’s important to know what to do in cases of acute emergencies, which are inevitable in practice, so I hope I learned something useful.

By the weekend, things had quieted down and I got a chance to spend some quality time with the patients. When you’re busy you are focusing on doing what needs to be done, like treatments and making sure the dogs get a chance to go outside and their beds are clean. But when you have a bit of time, you get the chance to crawl into the kennel and scratch ears and give kisses and belly rubs. It’s nice for the patients, as they can relax a bit in their kennels, and nice for the poor tired students, who can relax a bit as well!

I am utterly relieved to have taken my NAVLE. I won’t have the results until January or February, but in the meanwhile, I can “relax” and turn all of my focus to learning during my rotations.

Having burned out my brain from thinking during the test, I was very happy to get into bed and fall asleep early last night. Today, I treated myself to a coffee at Starbucks (thanks, Mom!), knit loads, and had a productive practice session on my violin in preparation for the concert in a couple of weeks time. I feel like a new woman! In part because I finally got a good night’s sleep - the nights before the exam I had many bad dreams and woke up with a sore jaw from clenching it. Assuming I’ve passed my NAVLE, the last time I have to deal with exam stress will be my final exam in June.

At a recent visit to the Royal College of Physicians Edinburgh

In preparation for my NAVLE exam, I’ve been refreshing my memory of the many parasites we vet students (and vets!) need to know. Because there are so many, I do struggle to keep their identities straight, but a few hold a special place in my mind.

(Note: if you are squeamish about the thought of parasites, you won’t want to read on)

Take, for example, the pig roundworm, Ascaris suum. This parasite likes to make a full journey around the body as it develops into further larval stages. The pig becomes infected by eating the egg, which is passed in feces and will be found on the ground of the pen or soil. The egg travels to the intestines, where it hatches into its first larval stage. Larvae, by the way, are the “juvenile” form of a parasite, which eventual develops into the full adult form. You can think of the early larvae as babies, which become young children, and then teenagers.

An Ascaris egg - from the University of Pennsylvania, please click for more info!

The larvae actually migrate through the wall of the large intestine and enter the blood stream of the liver, where they hang out for a while. After the liver, things get really interesting, as Ascaris larvae then travel to the lungs and live within them whilst they further develop. Next, they move through the airways before being re-ingested – the larvae are back to the intestines, where they first lived. This time, however, most of them become adults, at which point they lay eggs that pass in the feces, and infect the next poor pig. A full 6-10 weeks after first being ingested, they have completed their lifecycle.

Yep, it is indeed gross! But it’s also amazing that a little parasite has evolved such a complex lifecycle. Surely it would be simpler to stay in one place and move through lifecycles, but Ascaris clearly suffers from wanderlust, and its teenage self wants to explore the great wide world of the pig’s body, before coming home, settling down, and having children. Someone should tell Hollywood about this parasite – it’s a crackin’ story for a film.

I keep meaning to give a bit more information about life as a final year.

I’ve just finished with my farm animal medicine module. Things have been a bit slow, as the teaching dairy farm has had an outbreak of contagious disease (likely carried in by wildlife) that means students have had no or restricted access to the cows. Instead, the hospital has scheduled as many visits as possible at other farms. Even so, farm animal practice life is less hectic than the constant frenzied activity of the Hospital for Small Animals across the road.

Modern farm practice is based on prevention of disease and management of the herd to maintain healthy animals. Two weeks ago, we visited an organic farm, and had to write a report on what was good, and what could be improved, on site. It made for an interesting discussion when we presented our findings, as investigating the health of a farm can seem like evaluating the components of a machine: only after looking closely at each part can you step back and properly see the “big picture.” In addition, suggestions made on improvement have to be realistic and based on maximizing what’s available.

This last week I was in the farm animal hospital, where we were somewhat sheltered from the elements (I’m not overly fussy about getting dirty or cold, but I defy anyone to enjoy performing rectal exams on a dozen cows whilst standing in the rain.) On Tuesday I amputated a toe off of a cow, which was hard work and left my back muscles very sore. Wednesday, I watched as another student removed the eye of a pet sheep. I’ve never seen a farm animal under a general anesthetic before - it is quite expensive and comes with its own special set of risks - so I was fascinated by the protocol for sedating and anesthetizing a sheep. The ewe recovered well, and while it would be nice if she still had her eye, it had become infected and failed to respond to multiple antibiotic treatments, eventual resulting in permanent loss of sight. The best option was removal.

Life in the farm animal hospital has been interesting, but I don’t think I’ve found my calling. Funnily enough, I originally wanted to work as a farm animal vet when I first started vet school. Now, five years later, I’m quite glad I had the option to change my mind. I’m looking forward to getting back into the world of companion animals next, when I start my soft tissue surgery rotation.

With Hallowe’en on our doorstep, some may be fearful of an imminent zombie apocalypse. Well, they needn’t fear - as long as they have a veterinarian on their side!

5 Reasons You Want a Veterinarian on Your Team in a Zombie Apocalypse

If you’re familiar with how my vet school works, you’ll know that final year is organized into “rotations,” most being 1 week long, that take place in different parts of the hospitals at the Easter Bush campus. Those in the small animal hospital focus on dogs and cats, with a week of “exotics” thrown in at one point. Some rotations are confined to the equine world, and others are full of farm animals. We even have a rotation  professional skills, such as understanding finances and running a veterinary practice. And some final year students will especially enjoy our weeks in pathology and microbiology.

Right now, I’m not on a rotation, because final year also includes 5 weeks of free time, in which we can schedule further work experience, outside the hospital, if we so please. Personally, I’m spending my so-called “free” time studying very hard for my board exam, which is commonly known as the NAVLE. Veterinarians are required to pass the NAVLE to be allowed to work in the U.S. and Canada, and most students take it in November or December of final year, because if you don’t pass, you can re-take it the following April, and hopefully be legally allowed to practice before your graduate! I’m not sure yet if I’ll be coming back to the U.S. right after graduation or sticking around for awhile afterward, but passing the NAVLE is good for a few years until you need to re-take it, so it’s certainly worth taking either way!

The exam includes 300 multiple choice questions, covering all species, and with some questions about business practices and legislation. In North America, a lot of veterinary schools use a tracking system, which means students take core materials that are universal, but more classes in later years based on their particular interest, i.e. companion animals, farm animals, horses, and laboratory animals. Vet schools in the United Kingdom don’t use this system and everyone learns about everything, which might mean I’m at a slight advantage for the NAVLE! However, many diseases - namely fungal and parasitic - are uncommon in the U.K. but very common in North America (and vice versa) which means there is a fair bit of new material I need to learn. Even within North America, some diseases are found in one region of the U.S. or Canada but not in any other; these are still fair game, because the exam isn’t region specific. Additionally, drug protocols vary between countries, because of accepted practice and because of drug licensing. So, there is a lot of new material to learn, although even more that I need to review and refresh my memory.

I’ve splashed out and bought a subscription to a NAVLE review service. I seem to be getting a lot of the practice questions wrong, which is disheartening, but my practice exam overall score is steadily increasing. Fingers crossed I can pass this!

In my first four weeks of final year, I:

• finally figured out how to position animals for radiographs
• revised and hopefully will now remember my abdominal/thoracic anatomy for radiographs
• tried ultrasound for the first time
• ran my first appointment
• spayed a dog
• castrated a dog
• put in several intravenous catheters - one in a horse
• performed my first fine needle aspirate
• re-checked my first surgery and she was doing great
• chose an anesthetic protocol for multiple dogs
• monitored anesthesia in a horse in a “field” situation
• finally figured out breathing systems and fresh gas flow rates for anesthesia
• put endotracheal tubes into several dogs and a cat
• passed my end-of-module exam

I really like this hands-on, small-group learning. There’s still so much to learn, but I can already tell that Friday-Jessica is far more knowledgeable than Monday-Jessica!

The River Tummel

Final year started 3 weeks ago - after 4 years in the making. It’s good to finally be here, even through moments of panic and crashing self-esteem. Most of the time I feel like I’m on level with my fellow students, and thus just as capable of passing the big, scary exam in June. Others times it seems that my brain is like rubber, and any knowledge thrown at it simply bounces off, away, never to be seen again. The best I can do is try to not get frustrated. But, I’m human, and thus susceptible to failure.

The Black Castle

Even without my rubber-brain, this year would be hard-going. In three weeks I have finished rotations on diagnostic imaging (x-rays, ultrasound, CT scans, endoscopy) and anesthesia, along with spending a week in first-opinion practice. I’ll get bits and pieces of all of these topics at other times in the year, but essentially, I have completed my opportunity to get practical experience in these areas before graduating and working as a qualified vet. Gulp.

Alleyway

The effort required to keep afloat with learning is great, but worth it to be doing what I came here to do. I think being a “real” vet will also feature moments of terror and crashing self-esteem, but it’s all muddled in with the satisfaction of the little successes along the way: learning new skills, watching my knowledge grow with experience, and realizing that someone is grateful for what I can do. I’ve felt bits and pieces of all of that over these three weeks. It’s been a lot to take in. But I’m eager to try.

The River Tummel, again

Photos above from a recent trip to Pitlochry.

…Getting home at 7pm and grumbling about how short your evening is, then looking up at the clock at 9pm and realizing it’s far too early for bed…

PASS!

(And holy smokes, with a 77%!)