Week of Awesome Does Not Disappoint, Part 2

Warning: Standard warning about a post that describes more graphic procedures and/or dead animals. This one has some pictures. Though they are the tamer ones, read with discretion.

Dentistry: Day 2 was dentistry. That's right, everything in part 1 was just tuesday. Dentistry is actually less horrible than you'd expect, although the high-pitched whine of the ultrasonic scaler is still slightly distressing.

Basically, we took out teeth until we got tired of it. Depending on how many roots a tooth has, it's more or less complex, but they all involve sticking a "dental elevator" down into the tooth socket and pushing and rotating until the tooth jiggles out. Only one of the drills was working, so there was a rather awkward queue because everyone lifted up their table with the dead dog on it, and carried it over (because the drill is on a short power cord). So at any given point, there was a group using the drill, and a group next to them that had brought over their giant metal table.

Dogs don't really get cavities. We were actually using the drill for extractions. You use it to slice the tooth apart between the roots, and also to expose the roots from under the bone. The other thing we did was to practice local blocks. As most of the nerves come out of specific holes in the skull, the aim was to feel for those holes and see if we could stick the needle into them. The result was a dog mouth full of needles.

Orthopaedics: Half of day 3 was dedicated to the wonderful world of metal bone implants. Drills, pins, plates, screws, wire, interlocking nails, prosthetic nylon ligaments. There were too many things to practice so each group only picked a few things. Depending on what you picked, the surgeon would come over with the bone saw and make a fracture in your bone of choice.

The first thing my partner and I did was an ulnar fracture. This involved two pins down the shaft of the bone for stability, and a wire inserted in a figure eight to create tension.

Then I did a knee repair of a ruptured cranial cruciate ligament (in people referred to as an ACL). Since it wasn't actually ruptured, I had to go into the joint and cut the ligament, but that's normally part of the procedure since you have to inspect the joint anyway. Then you drill holes into the tibia that are used to hold the nylon prosthesis into a position that approximates the function of the ligament. The nylon loops around a bit of bone in the back, goes around the tibia via the holes, and voila. 

My classmates got up to some other exciting stuff, like external skeletal fixation, where the implants come out of the skin and get connected by bars. They look pretty impressive. 

Ophthalmology: The last thing we did was eye and eyelid surgery, with a boarded ophthalmologist. It's kind of weird and creepy, but it's a lot more comforting to do it on a dead dog, where you know it doesn't matter even if you somehow exploded the eyeball or lost it or something. The downside is that since we only had one eye each to work with, a whole bunch of lid surgeries on one lid tend  to make it look like franken-dog. The most exciting part was cutting or sewing onto the cornea, because it's amazing that you can even do that. It's layered like an onion, so if you have to remove a diseased piece, you cut a little square and it just peels off. Another cool thing you can do is actually use the conjunctiva like a bandage, where you cut a little pedicle flap out of the surrounding membranes, bring it across the eye, and sew it onto the cornea. I wanted to include the picture of this, but dead dog eye surgery is really creepy so I thought better of it.

Also, the lens is surprisingly soft and pliant. You think of it as a hard thing, but it isn't.

Unfortunately, as I was squishing it gently in amazement, I broke it and it burst apart into a pile of clear, gelatinous goo. Whoops. The eruption of laughter at another table a few minutes later indicated that other students encountered this unexpected turn of events as well.

Week of Awesome Does Not Disappoint, Part 1

Warning: This post discusses medical procedures on dead dogs. Neither aspect of that sentence is very pretty, so if you're squeamish, or sensitive about animals, proceed with caution.

As the title suggests, this week has been heaps of fun. Starting tuesday morning, we got our cadavres, and had three packed-full days to get as much out of them as possible. We cut, stabbed, tied, dissected, and tubed every single part of their little bodies.

The dogs come from a nearby shelter, usually a variable amount less than ten, and the roster is kept small so that there can be two students to a dog. In first year, it was five students to a dog, and in fourth year it was groups of three for surgery lab, so this is a huge opportunity. Somewhat distressingly, the shelter purportedly never has an issue with supplying enough dogs, and the animals are not withheld at the shelter for more than a day. Most of the animals are pit-bull crosses, so I think there's an unfortunate excess of unwanted, potentially dangerous young animals in the area. Anyway, we had 8 dogs for 15 students, and when they first arrived we had to be speedy to take advantage of certain things before rigor mortis set in.

First thing we had to do was put a little bottle in their mouths to keep their jaws open. Believe it or not, it's very difficult to later do stomach tubing if their jaw is locked closed. The next step was to jump to the procedures that involved fluids: blood, joint fluid, CSF, and bone marrow. For every procedure, the vets gave a demonstration, and we went off and performed it on our own dogs. Here are some of the highlights.

CSF tap: To obtain cerebrospimal fluid, you stick a needle in between the vertebrae into the space around the spinal cord. You can do this right behind the skull, or in the lower back. After you feel your bony landmarks, you basically just go for it, and pop the needle in. Unless you are awesome(*), it likely will hit one of the bones on either side and needs to be redirected--and let me tell you, the feel of a needle crunching against bone is horrible. When you get it into the joint space, it goes all the way in, nice and smooth. When you don't, it smacks into bone early and won't move, so you have to poke, redirect, poke, and redirect until you get it, with an awful scraping sensation against the not-quite-solid surface.

*I got the lumbosacral cistern on the first try. That one has a slower flow in general, and also our dogs are dead, so I wasn't sure at first. But I didn't want to give up on it, so I waited, and 30 seconds later came the satisfying clear goop oozing out of the hub of my needle.

Bone marrow aspirate: Take what I was saying about bone before, now imagine a giant metal stick with a handle that you shove forcibly down a shoulder into the humerus. Surprisingly good for getting out stress, as you crank that handle back and forth like you're grinding your fist into your worst enemy's face. If you get a little too into it, your marrow aspirate turns into a core biopsy, because you punch through the cortex and get a full piece of bone, rather than sucking up the viscous marrow. There is actually a difference in what they tell you diagnostically.

Chest tube: This one is both terrifying and hilarious, as your big, thick chest tube goes onto a similarly big, thick metal stylette with a pointy end. You grab the bottom about a centimeter up from the pointy end, to avoid skewering the patient, and with your other arm you bang it through the chest wall with one swift smack. Pop! Pointy end into the patient, and your fist stops you from stabbing the heart or something.

Another fun aspect is that you need to make a tunnel under the skin so you don't accidentally let a bunch of air into the chest. This means an assistant grabs fistfulls of dog fur and holds them to the side, so that once the chest tube is in, when they let go the loose skin will fall back into place and make it so the entry point in the skin was several rib spaces farther down than the point through the body wall. When you're all done, you can really see the tube there, right under the skin, a smooth squishy cylinder. You secure the tube in place by what is known as the Chinese finger trap suture, not even kidding.

Oesophagostomy: Since we had the foresight to prop open our dog's mouth, we were able to attempt stomach tubes. There are a few methods, like through the nose or through the oesophagus. The latter is useful because it can be a semi-permanent way to bypass the mouth or provide/force nutrition easily. The way it works is you make a cut on their neck, into the oesophagus, and stick the tube in from the outside. You have to fiddle around, grabbing the tube from the inside and fussing with it until it's in the direction you need, and apparently this is next to impossible in a dead dog. But because, as we've already established, I am awesome, I totally got ours into place.

Exploratory laparotomy and experimental surgery: Towards the end of the first day, we had to gut the dogs so they wouldn't become too smelly and horrid over the week. But there's no sense in just gutting them, so we explored their abdomens first. We checked out all the organs, took biopsies of everything (which involve a number of bizarre stabby instruments), did pretend surgery on the intestines, and generally poked, prodded, and sliced anything we could get our hands on. The pretend intestine surgery is fun, because you cut out a piece, tie it back together, then turn it into a water balloon to see if your seal was water-tight--that is, hold it off and inject it with water. We even castrated our dead dog, and put in a urinary catheter such that we could see when it got to the bladder.

"If you get bored": As if we didn't have enough to do, they had tons of extra equipment to make extra sure we didn't run into any down time. There were otoscopes, slides for looking at our samples, nail clippers, syringe and needles for lymph node aspirates, you name it. Unfortunately, because our dogs arrived an hour later than they were supposed to, we ended up quite tight for time.

Fuzzy Scalpels Continued

So I have been pondering the name of this blog lately, which mostly came about through picking two cool sounding vet-related words and putting them together. Both "fuzzy" and "scalpel" have their own aesthetic appeal to me.

I mentioned before that the image that came to mind was from using scalpels in anatomy lab. While humorous, dissecting cadavres in anatomy lab is so first year.

Since I would like to continue this blog into my clinical years, I thought of a few other [not strictly-first-year-vet-school] instances where you could get fuzzy scalpels (i.e. no surgical prep):

• Necropsy <-- this is the big one I thought of
• Skin scrapes and biopsies
• Emergency tracheotomy

Er, I guess I can't think of as many as I'd hoped. There must be more! I'll keep you posted.

Commence Week of Awesome

So after suffering through what was pretty much the most horrible stretch of vet school to date, I seem to have been given my reward.

You see, the past two weeks, we had a "block course." Straight lectures all day long, with a few workshops in the afternoon. Normally I don't mind lectures too much, because, you know, we learn vet stuff. However last week was a mind numbing escapade through public health and the legislation of animal welfare, that left me alternately terrified to eat anything, and so bored my brain was melting out of my ears. Who knew there was so much to say about meat processing.

I'm going to leave it at that, more because I don't want to relive it, than the fact that it would make a stupidly boring story.

This week, however, things are going to be different! We started off today with a simple orientation from 9-10am, explaining the week and the two assignments. That was it for the day! Well, sort of. Then I went home and studied for hours.

Normally this wouldn't happen, especially on a Monday, and especially on a week where most days start at 9 or 10. But guess what this week is! No, don't, you'll never get it.

The roster I'm on right now is called "small animal clinical procedures" and is compulsory for small animal trackers like myself. We spend the week getting hands-on practise with clinical techniques like CSF taps, joint taps, eye surgery, bone marrow aspirates, dentistry, chest tubes, orthopaedic surgery, and a dozen other things. We get special tutoring with veterinary surgeons, ophthalmologists, and dentists during this time. It's hands-on, laid back, and we even get a catered lunch on friday.

Even the assignments are kind of awesome. We did one today that involved going out to a store (different groups went to either a pet store, supermarket, or pharmacy) and assessing the available pet products. It's actually a great idea--what can clients go and get over the counter? What potential dangers are there with the products there, or the way the products are displayed/presented? How much information is available on the nutrition of the pet foods? And, after all that, we bought a bunch of truffles before going home.

So bring it on. For a change, the stuff I spent three hours studying today is all stuff I'm going to do tomorrow. Like actually, properly, do myself. Vet school is finally paying off.

My Dog Got Dog Shamed

My mom is taking care of my two dogs (shelties) while I'm in vet school. They also own a little fluffy white dog, named Bella. Yesterday, my mom emailed me a series of photos...

Just Another Day in Class

This week, we have a block of lectures. It's a full day of back-to-back lectures and very tiring.

A person in the front row today pulled out a chopping board, a knife, a tomato, and a wheel of cheese. She quite casually got to slicing and making up crackers. In the middle of lecture.

Another interesting thing that happened was a catered lunch. Goodness it was delicious. Coincidentally, we received our "fifth year packs" today, which mainly include paperwork, but we also got our stamps. Yes, our stamps!

Your Name
BVSc

People were pretty enthused about this. As in, stamped blank pages, stamped each other, stamped the free food. Everyone had stamps on their hands and arms. I'm not kidding about stamping the food: I found an apple slice with someone's name stamped on it.

An End to Anaesthesia

Anaesthesia was both awesome and terrifying. Most of the terrifying part was due to the first day, and after that I slowly but surely gained confidence in what I was doing.

Rounds helped a lot: every day we had quite a thorough discussion on aspects of anaesthesia, and what to do when things go wrong. It made the days super long, though.

Our roster leader was an amazingly nice, friendly, smiley vet, who had unending patience for our complete inexperience in the hospital and working with real patients. We got to do lots of hands-on stuff, which is a huge change from fourth year. Probably the coolest part about the roster was that we made up our own drug protocols. She would give us the cases, and we would pick which drugs we wanted to use, at what dose, and what fluids to give, and so on. Every time, we were encouraged to use either a premed we hadn't tried before, or an induction agent we hadn't used, so we could see the differences in their effects. For instance, I tried a propofol/ketamine combination for induction, and that did not go so well: my dog twitched all during the surgery and recovery, due to the drug reaction on the muscles (we think). My roster-mate tried medetomidine for a premed, and her dog, who happened to be massive, ended up so zonked it turned into quite the ordeal to get it down to anaesthesia for induction.

We had a few really crazy cases. I did this one dog that had liver damage, so there were tons of potential anaesthetic complications. It turned out to have a local peritonitis around the bile ducts, and any time the surgeons tugged on it, the heart rate and blood pressure went through the roof. As soon as they let go, everything plummeted! This stressed everyone out. Except me, who had no clue what was going on because it was day 2, and was just diligently writing down everything they told me to into the anaesthetic record. It involved lots of fiddling with constant rate infusions of drugs; increase the dose of dopamine, now decrease it, now stop it, now increase it, now increase the fentanyl, on and on.

By the end of the week, though, I knew what I was doing. I knew how to set up all the machines, and what to do about every reading (though sometimes the answer is "get the anaesthesiologist"). The roster leader said that she would be comfortable with any of us anaesthetising her own pet, which, if sincere, is just extravagantly generous of a compliment!

Another fun thing about the roster was that we'd run into the other "teams" in the hospital. The students on surgery would be gowned up on the other side of the table. Several times, patients had to be anaesthetised for imaging, so we would march in their and handle that stuff, while our classmates on the imaging roster worked around us to take the xrays. The awkward part about that was when you're in the middle of taking your set of readings, and everyone has to keep clearing the room for the xray. Come back in, get a blood pressure while they readjust the positioning, everyone out again. It got a bit silly.

It was a full-on week, but very rewarding. The same thing that made it off the deep end overwhelming on day one is what made it so fun and exciting on day 5: responsibility.

The main thing I didn't like was the lack of contact with the patient. Well, the awake patient. I got to tap their eyelids and push their jaws up and down a thousand times, but I didn't get to see the happy little animal in the consult room. Also, a lot of the time, I had a very limited understanding of what was happening medically or surgically. So while it was a very exciting and enjoyable roster, I don't think I need to become an anaesthesiologist.

Roster Leader Reads Minds

While waiting around for a patient to get a CT scan, I got to chatting with our roster leader. At one point, she asked me if I want to specialise. I said I don't know, because residencies are a lot of work.

She told me she could see me in internal medicine.

Guess what my favourite and best class was for fourth year? Medicine.

I asked her what gave it away, and all she said was "You're a thinker. I can see you thinking through things." She then went on to explain that during her residency, she got to see all the other residents and what personality types they tended to attract. For instance, some students you just know are going to be surgeons.

Apparently she does this regularly. She told a student last year that she could really picture that student doing a nutrition residency (of all things??). The student's response? "You know, I've always considered doing that!"

Responsibility Time

Today was the first day of my first roster of fifth year. I am one of three unlucky bastards whose first roster is anaesthesia.

Now, the first roster is bound to be pretty intimidating. Despite four years of wandering around the vet tower, we haven't actually been in the hospital part more than one or two times. We basically have no idea where anything is, what anything's called, or where anything goes. We also have no clue how to use the computer system. Oh, and we have next to no practical skills.

I thought the first day might ease us into it. Boy was I wrong.

The reason I thought that was because we didn't start until 8:30, and had an hour tutorial. Sounds like a cruisy morning, right? Well, I guess that part was. The tutorial was pretty much what I expected: here's a reference list for this and that, here's how to check the cuff on your ET tubes. Okay, I got this.

Then at 9:45 (because the tutorial went over time, of course), we get given a list of patients for the day. A list which spans 3 sticky notes, and has four patients circled for us to do as soon as possible. And by that I mean, the surgeons want the 3 dentals to be ready to go by 10:30. We're told to go "work up the cases." At this point I haven't really figured out what that means.

The tech says "Today is probably going to be a little stressful, we have a lot going on today." Isn't that a great thing to hear, when you have no clue what you're doing?

We then get sent to the wards to start "working up" our patients. We manage to locate one of the three animals, get a lead on him, and then stand around looking lost in the middle of the ICU. Techs are all around us, but they're rather busy doing ICU stuff. We know we're supposed to use the computer system to look up a bunch of history stuff, but we don't even know how to log in. We're capable enough to take the vital signs and listen to the lungs, but from there, well... there was a lot of "Can you help us?"

Eventually they figured out that we were floundering on our own, and proper people stuck with us to help us out. This wasn't until after we'd already floundered around with 2 animals. The morning was a bit of a blur, a lot of "we need this dog ready right away" and "here's the blood, go run a PCV/TP." It's not that PVC/TP is a difficult thing to do, it's just that it's a bit of an obstacle when you've only done one in your life, forgotten how to do it entirely, and also have no clue where the machines are in this place.

Once the cases were worked up, the proper anaesthesia started. Somehow I didn't quite have a case all to myself. The other two students got their animals induced and into surgery, and I had the delightfully stressful job of tag-teaming them out for lunch breaks. This involved getting thrown into a surgical theatre, given a rundown of the readings, and then left on my own to monitor. A live animal. Getting a real surgery on its knee. I'm still trying to remember what all the numbers mean, let alone what to do when one goes bad.

Fortunately they were super easy, and all I did was write down the numbers and Xs and Os on the chart for twenty minutes (you draw a little graph over time of the heart rate and respiratory rate and blood pressure). The stressful part was mainly in the "holy crap I'm just alone in front of all these machines, with complete responsibility for this patient."

In the afternoon, we had rounds. They're basically a tutorial, with the vet running the roster teaching us students. We went over all the classes of drugs and their side effects, all the monitoring equipment and appropriate values, and fluids. It was basically a crash course of everything we've learned about anaesthesia over the past few years, in the last 3 or so hours of the most hectic, overwhelming day of vet school.

When I finally got home, what better could have completed my day than to find out I got in trouble for writing a snarky comment on one of my exams. To be fair, even the course coordinator knows it was a stupid question.

Stories From First Year: Aviary

This one didn't actually happen in first year, I think it was all the way after second year, but I didn't want to mess up my nice title series! Theoretically I could have done it in first year...

For my three weeks of "other" practical work, I picked birds! I worked at the aviary in the Esplanade that summer, which has dozens of species kept in all kinds of enclosures. Two of the enclosures house native New Zealand ducks that they're breeding as part of a conservation program. There's everything from the little songbirds and parrots, to pheasants and peacocks.

My favourite was a sulfur-crested cockatoo that suffered an old gunshot injury, so now climbs and walks around rather than flying. He knows how to speak and would say "hello" to me, and followed me around the enclosure by climbing along the walls. My least favourite was his neighbours, two more sulfur-crested cockatoos that got upset at my presence and liked to attack. More than once, I heard some flapping only to turn around and find a giant white bird hurtling towards my face.

The bird-keeper was a pleasant old fellow, but boy did he move slowly. He'd pause regularly to chat, whether it was out in the enclosures, or just hanging out at his computer as he showed me about a thousand photos from his trip to Africa. He usually took a full half hour at both morning and afternoon tea breaks, as well as a lengthy lunch. During that time I learned all the rules to darts and also drank more tea than I had in my entire life. Even if I didn't make myself tea, someone else usually brought me one. We spent so much time fluffing around to fill up the day, that one day when he was absent and I had to do all the enclosures myself, I got everything cleaned and fed by lunchtime. I scratched my head for a bit wondering how two people could take twice as long, then went home.

I was surprised by the birds' diets, having not had much experience. Making up their food is kind of fun, because they eat so much human food. Apart from their seeds (different combos for each enclosure), they also got fresh and frozen vegetables including corn, carrots, and peas. They got lettuce and silverbeet, apples, and some of them also got cheese, dried fruits, or honey water. To be honest, it sounded like a pretty delicious picnic some days.

At one point, we de-wormed all the budgies, which involved sticking tubes down their throats on two separate occasions--and there were 70 budgies. This was great handling experience, but I might mention that budgies bite hard.

My absolute favourite part was the Monster. I believe it was actually a Kea or some such bird, but I had to take bird-guy's word for it, because I never saw it. It had a huge enclosure with big bushes and a big house with concrete cylinders and other structures. I'd come in every day and drop off new lettuce, and find the previous day's three-quarters-eaten veggies strewn about. The apples would disappear. The water would decrease. But no bird. Ever. I decided it was actually a creature out of some horror movie, shrouded in mystery--the Kea thing is just a ruse.

Stories From First Year: Sheep and Beef

This one was in New Zealand, and again all I did was odds and sods. I put up some electric fences sometimes, but mostly I rode shotgun in the tractor, jumping out to open gates. Fortunately the old farmer I was with was very fun to talked to and loves making friends with international students (he introduced me to some other international students).

He also let me drive the tractor once. I am totally into that. I even parked it perfectly. Little me, up in this massive tractor, roaring down the farm track at like... 10kph. Well maybe it was faster than that. I don't remember. It was an automatic transmission so I didn't have to do much work at all, but it's something to cross off the bucket list.

The other thing I really liked was watching the farm dogs work, because they are so beautiful and well trained.

The most annoying day for me was sorting wool. Good god. It wasn't even shearing time, it was just crutching--taking the wool off around their bums so they don't get covered in poo--so it was way less wool than I would have had to face at shearing time. Still, that was one unpleasant day. From eight in the morning until I left at five in the evening, we were in the wool shed, with an endless stream of sheep, just me and the socially awkward shearer. I had a sort of stick thing that I used to sweep the wool off the platform, which sometimes involved sneaky maneuvers around his feet or behind him. Then, since it had just rained of course, I had to lay out anything super wet to dry, because apparently if you pile up wet wool it explodes. 

My skin is sensitive to wool, so by the end of the day, not only did I have a cramp from wielding my wool-stick, and not only were my hands covered in wool grease, they were also all red and itchy. It was also a bit of an adventure trying to get all the wool into the wool compressor thing. At first it went well, but around lunchtime the bin was pretty full, and there wasn't anywhere else for me to put the wool. So after that point I had to periodically climb up into the bin and jump up and down and stomp around on top of the wool until I made enough room to fit more in. Then of course when I did that, I got behind, because the shearer just kept on going, so the wool on the platform would amass and I'd have to frantically try to sort it out before it built up into some sort of wool ocean.

The worst part was that we didn't quite finish, and I had to come back and do more the next day. Ugh my hands were prickly needly greasy itchy sore globs of death.

Stories From First Year: Equine

A horse stables was the second of my practical experiences, and similarly involved a lot of new understanding about how horses are kept and what to do around them. It's pretty dull to talk about--I shoveled out stalls, fed the horses, groomed some horses, routine stuff like that. I did get a fair amount of responsibility with the horses, which was very lucky because apparently plenty of my classmates got stuck with some really boring equine time. Some places don't want you touching horses at all if you have no experience, so my friends got to do nothing but shovel stalls for three weeks straight.

One thing that amuses me is that horses require snow shoes so they don't skate around all over the ice, or get it packed up into their hooves. It was slightly terrifying to be leading this massive beast and have it slip on the ice and get a fright. I think I panicked more than the horses. They also got snow jackets, which I had to put on in the morning before they went out, then take off in the evening. The horses were surprisingly docile and pleasant to work with, which isn't my experience with horses in general.

I got to be mini-vet when one of the horses got kicked by another horse, and it became my duty to clean the wound and dress it every day.

The best part was all the other animals. In other stalls they had two ponies, two alpacas, a llama, and a donkey. Roaming free they had a goat, a tiny ugly pig, and a super fat sheep, and also a very handsome dog and a bazillion cats. And a domesticated raccoon that is the fattest raccoon I've ever seen.

The alpacas were skittish, but made adorable little mewling noises. The goat had some serious personality, and constantly sat on things that I needed and chewed on stuff and got into things. The ponies were fun to be around, but I'm not sure why. The llama was the best--I got to lead it out to pasture just like the horses, and it's just... llamas are really hilarious. They look funny and move funny and act funny. I think it got free at one point and the people who worked there had to go chase it back. The raccoon was cute, but had crazy sharp teeth and claws. It constantly chowed down on the cat food, which is how it got so fat, and it would come up and beg around people (which was not fun considering how sharp its claws are when it's grabbing at your leg or your sleeve).

Stories From First Year: Dairy

Ever since I started this blog, I've had "prac work" on my list of topics to write about. It would have been fun to see my original impressions of everything, but maybe the reason I never got around to it is that I couldn't think of any particularly exciting stories to tell. Now that I've finished all of them, I think I can cobble together an interesting assortment of notes from my experiences. We had to do 16 weeks on various farms during our breaks and summers, and I'll talk about them one at a time.

The first one I did was on a dairy farm in the states. As someone with no large animal experience, I didn't have a clue about working around cows or what a dairy farm was like at all. I remember being quite surprised at how all the cows had electronic collars, and the milking machine registered it and recorded their individual milk production and sent it to the computer, where you could look at it in charts and graphs. I also was impressed by the gigantic automatic pooper-scooper that moves slowly back and forth across the floor.

The most fun was on days when the vet came. I followed him around and talked to him heaps, and he let me help on a few surgeries. It was my first year out of vet school, so it was the first time I was ever treated as a vet student. I remember feeling excited but also super confused at all the vet-lingo he fired at me, as he explained the surgery. At this point I didn't even know cow anatomy, so my thoughts were along the lines of "I don't know what he's talking about but it sounds so professional and cool!"

The other distinct memory I have is following him while he was doing pregnancy scanning, and this one cow followed us the whole time. She kept rubbing up against me and pushing her head into me and sort of knocking me around. Cows are really cute!

Unfortunately, the farm I was on was well run and had everything covered. They didn't need a student to do anything, so apart from the odd job here and there, there really wasn't anything for me to do. The one time I tried to help out in the calf barn, I got myself completely soaked from trying to carry the big water buckets. Most of the work was done by a handful of Guatemalans. I ended up spending most of my time helping out with milking, and the Guatemalans flirted with me and tried to teach me Spanish.

As it turns out, that farm was a barn-based system, and in New Zealand it's largely pastoral farming, so when I got back to school I still was clueless about what we were learning. I spent the next two years trying to sort it all out in my head. Pasture-based farming is really different, but more fascinating I think.

Class-quake

Apparently there was an earthquake while we were in class. The bizarre thing is that I didn't feel it, though other people in the same classroom say they did. Maybe it was subtle because we were on the top floor.

We were just going along with lecture, when all of a sudden the projector image started wobbling a bit, and then went crazy. I was just sitting there, not feeling anything, while the projector image was bouncing all over the place. It was really bizarre!

What did you do today?

Standard warning: potentially unpleasant graphic concepts

Thursdays are lab days. Sometimes they're long, or a bit dull, or kind of cool. And then sometimes they're like today.

In the morning is the small animal lab, either medicine or surgery. Today we did dentistry. If you've ever had your pet get a dental from your vet, that's what we practised, and it's actually not very different from when you go to the dentist yourself. We use all the same tools, including the ultrasonic scaler which is the thing that makes the noise and uses the water spray while it scrapes against the teeth. So that was pretty neat, checking out all the teeth and cleaning off the tartar--the noise isn't quite so bad when you're on the other end of it.

The part about this lab that made it a rather unique experience is something you may have already thought of: what, exactly, were we practising on? Dogs. Dog heads, of course. Severed dog heads. We show up to lab and there is a huge pile of dog heads, and I go over and pick one out for me and my partner and carry it back to our table. So we just have this dog head (a pretty cute dog to be honest), that we are lifting up and rolling around as needed, prying open the jaws and cleaning its dead teeth. I have to say, that is a bit bizarre--cleaning a dead dog's teeth.

The other thing we did was practise extractions, which is a bit more of an ordeal than in people, because dog teeth have massive roots. It's more of a surgery, where you have to slice into the gums and make a flap, so you can get your tools way down to the end of the root. This involved some fun instruments like the drill (just like in people, if you've ever had a cavity done), and a lot of prying and leveraging to try and shove the tooth out. Like my human dentist once told me, it's not about strength, it's all about technique--you have to push in the right way, and the right direction. And it's actually pushing, not pulling.

That was in the morning. In the afternoon we have a large animal lab, either cows or sheep. Today it was sheep.

We've been learning about investigating ill-thrift in sheep, and there is a farm that is working with the university to investigate a problem in their flock. They have a whole bunch of very skinny sad looking ewes, and we the fourth years are going to be the ones helping to find out what's wrong.

Our labs are divided into half the class, so we have 50 people, and we were working in pairs. That means 25 sheep or so waiting for us in lab, and the first thing we did was the Great Sheep Massacre. We queued up, each pair with their sheep, and had a rather rapid-fire, bloody, sheep killing spree. We used captive bolts, which fires a bolt into their brain to destroy their pain perception and render them unconscious instantly, and then cut their throats to make certain they were dead (though theoretically the captive bolt kills them).

I partnered up with a very very quiet girl in my class. I did the captive bolt, which is a deceptively heavy item to wield. That involved putting the thing on the right spot on the sheep's head, then pressing the button. BANG, sheep collapses. My partner cut the throat, which involves twisting the sheep's neck around your boot and hacking through all the muscles and trachea until you get a massive fountain/lake of blood, and I have to say for such a quiet meek seeming girl, my partner had absolutely no trouble with this. Once the deed was done (which only took a few seconds), we quickly got out of the way and handed off the tools to the next group. We dragged off our sheep to an open spot in the floor, adding to the dozen bloody trails along the floor. I can't imagine what it must have looked like if some random person from the public had shown up. Dead sheep all across the floor, wide bloody trails behind them, a sea of blood at the centres of two ritualistic sheep-killing death spots, students queued up with sheep at each.

Once that was all over we proceeded to the post-mortems. As these are all very sickly, emaciated sheep, we went through our protocol of checking out each organ system in the hopes of finding a consistent culprit. Common boring ones include teeth and feet. I call these boring because you don't even have to open your dead sheep in order to get a diagnosis. Apart from those things, we had to check out liver, lungs, and intestines, looking for typical lesions of the diseases we've studied. The aim is that every pair writes up their final diagnosis on a board, and we'll get sent all the results. We'll analyse them, see if there's a common cause, and then write up a report about it.

Our particular sheep turned out to not be very exciting. I thought we had some lung lesions, but it turned out they weren't significant enough to call it pneumonia. We ended up not finding any lesions, which suggests either malnutrition, or maybe parasites. Which brings me to the next part.

We did something called a "worm count." When animals have parasites in their intestines, you can count the eggs released in their poop, but it's much more accurate to count the worms themselves. You take out parts of the intestinal tract, and then go through a fancy procedure to wash out all the contents into a bucket, dilute the worms, and put them onto a white tray to count them. It's winter here, and cold outside, and we had cold water, and I did not have a fun time. I spent forever running meters upon meters of intestine through my fingers in a bucket of cold water, to help get the worms off and into the water. By the end of the lab I could hardly feel my hands. I was trying to pick up microscopic worms and put them onto a slide, and my goodness my fingers could barely move. In the end, our sheep didn't have any parasites. After all that.

So our sheep ended up with a diagnosis of "unknown," and we attributed the emaciation to malnourishment just as the default. Once we get everybody's results, we'll see if any particular disease emerged as statistically significant. A few people did have some knobbly livers and diseased intestines, so it will be interesting to see the final results. I believe this is an actual investigation, and the professors are going to relay the information to the farmer, so it's pretty cool to be a part of that.

I Am Not Going To Be An Equine Vet

Today we had a short, easy practical exam on horses. 10 minutes on a written paper (label diagrams sort of thing) and 10 minutes with a horse and examiner.

It did not go well. I am so bad at horses that my person almost made me cry.

Considering everything about equine class screams "you don't want to be a horse vet!" I think it has been confirmed a hundred times over. From the pedantic need to know the difference between osteochondrosis of the fetlock and the tarsus and the femoropatellar and femorotibial joints (eg what is the prognosis of OCD of the distal intermediate trochlear ridge of the tibia versus anywhere else??) , to the fact that horses get sick and die if you sneeze at them and you have to be a crazy qualified specialist to be doing surgery on them, to the ever present danger of either the horse killing you, or the owner killing you, or maybe the horse killing the owner. Not a fan of the racing industry, either.

But I don't think I have to worry about these things, since it is apparently the limit of my skill to even get a halter on.

Professors: Viruses

Our virology professor was this sweet, tall, Polish woman. I probably liked her lectures 10x more just because of her accent.

My classmates didn't really like virology, because it was basically learning a long list of viruses. We went through a bunch of families, learning a bunch of details about one virus after another. It was also in this horrible room where the desk is slanted and there's not much space between it and the seats. This means that  not only do all your pens and papers slide off the desk, you can't really bend down to get it. If you try, the only option is basically planting your face in your neighbour's lap.

The best part about virology was that she regularly showed us videos in class. I say it's the best part, because it was interesting and a good way to learn, but it was also terrifying. Early on, when we were doing the more routine viruses, they were more simple videos about diagnosis and transmission etc. Then, as we got to the horrible, deadly, zoonotic viruses, we got to see documentaries about how scary and bad such viruses are. For instance there was an emerging virus in Australia that killed some horses... and then the vet who did the post mortem. And the horse's trainer. This was a brand new virus that no one knew about, and now they've done a lot of science and figured out it's in the same family as other wonderful diseases such as canine distemper and rinderpest. Then there was that virus's friend, in pigs in Malasia, that everyone thought was something else transmitted by mosquitoes. So they gave all the pig workers lots of mosquito protection, but a bunch of people died anyway, and they had to quarantine the pig farms and destroy the pigs. Both of those viruses are actually transmitted by fruit bats, particularly their faeces.

Then, of course, there are the fun videos about rabies, documenting not only rabid animals, but rabid people, including interviewing the one girl who is the only person ever to survive it. It kills a significant number of people every year, largely in Africa I believe. That girl had been bitten by a bat (I think she lived in the US), and didn't think to take any precautions. When she came down with the symptoms later, they went through great heroics, and eventually saved her by inducing a coma and keeping the virus from replicating in her nervous system.

Somehow, these things didn't seem to phase our professor. She was as excited about viruses as I think people can get. When she showed us a frightening video about ebola, she was saying how that sort of crazy, big-deal virus that everyone hears about was what got her interested in the discipline initially. You know, the ones that kill practically everybody that catches them. I agree that they are fascinating but I don't think I would be able to sleep at night if I studied them.

I think the thing I learned most from that class was never, ever touch a bat. And it is probably also a good idea to never, ever visit Africa either.

How Not to Give Insulin

When we were learning about insulin treatment, our professor shared this story.

One of her diabetic patients was very poorly controlled. They had tried adjusting the dose, the timing, and nothing was working. The insulin was stored in the correct place and not out of date, and the owners described their procedure of drawing it up correctly.

With nothing left to try, the vet asked them to bring everything in and show her how they were injecting.

It turns out, in the initial consult, they had been taught how to inject the insulin using an orange to practice on. So the owners had gone home and were injecting the insulin into an orange, and feeding the orange to their dog.

Cow Mittens

In every vet student's life, there comes the day when you finally put your hand up a cow's arse.

This is, in fact, one of the more exciting events in third year--partly because it's a big milestone, and partly because the lab that week is only one hour instead of two or three. By the end, they pretty much have to kick us out, but it can only be an hour because it starts irritating the cows, so they get all oedematous and you can't feel anything anymore. It also kills your arm.

The first step is to get a plastic apron. For us, these are on hooks that are quite a bit above my head, and they are also aprons made for giants, so I have an awkward time getting one down. Then you tie it around yourself to create a plastic wall that goes straight to the floor for an average height woman, and shuffle across the room with it. The next step is to don the plastic gloves, or rather, the plastic sleeves. They're usually yellow or orange and there are a few difficulties in getting them on. The plastic sticks together, so everyone is blowing down their sleeves like balloons to try and get them to puff out, and trying to peel apart the fingers and wedge their hands in. You pull the sleeve up over your shoulder and hope that it stays there, but they are such a weird size and shape this doesn't work for everyone.

Then, as some students bring in the cows and direct them into holding area, the rest of us line up. There are big containers of lube that you upturn onto your hands, and I always manage to spill a bunch on the floor doing so, and you rub it all over the plastic sleeves. The last thing to do is pick a cow, and maybe listen to whatever the professor says.

The very first time, he gave us a quick rundown of all the things we could palpate per rectum before we moved on to the reproductive tract (which is the main point of doing this in a cow). He started off pointing out the aorta up top and how you can feel it beat, as well as the bifurcation as it splits off towards the legs, and I got so distracted looking for it and then being excited about it that I totally missed the rest of the "quick rundown." I remember the left kidney and the rumen but I'm not sure what else he said.

The rest of the time of that lab, and every other attempt after it, was spent trying to find the stupid uterus. Supposedly the cervix is the easy part to feel, and you use that to pull up the uterine horns and ovaries. My classmates were always like, "I can feel a corpus luteum!" or "I think there's a follicle on the left ovary," and I have no idea how they managed that so quickly. Sometimes I could quickly find the cervix, but when I tried to pull up the uterus I could never find the bifurcation. Other times, I felt a hard ball that certainly must have been an ovary, but there was no cervix to be found (and as soon as I let go, I couldn't find it again, of course). It got even more difficult later in the year when the cows were pregnant--I really have no idea how to tell what is going on inside those cows. Pregnant? Not sure. How far along? Definitely no clue.

The ridiculous part of doing this is the peristalsis on the part of the cow. In the middle of you rummaging around in there trying to find stuff, occasionally there is a sudden increase in pressure that squeezes all the way down your arm. The first few times, I wasn't expecting it, and it pushed me right out of the damn cow. Then I learned you just have to let go, relax your arm, and wait for it to pass. There is literally nothing I can do until the wave is done--you would not believe how strong it is! This is part of the reason your arm gets tired.

Finally, the lab we had at the beginning of this year, I could consistently find the uterus and ovaries. Finally. Still not so sure about pregnant cows.

Try it Five Times Fast

Having recently completed the mid-year exam for small animal medicine and surgery, I thought I would share some of the words that are amazingly fun. I actually understand all these.

Cholecystoduodenostomy
Hypergammaglobulinaemia
Oesophagogastroduodenoscopy
Parasympathomimetic
Pseudohyperparathyroidism

There are, of course, many more where that came from.

I would also like to add, what is not fun is not having a good way to shorten "apocrine gland adenocarcinoma of anal sac origin" and having to write that every time a professor talks about. (Note: I recently learned I could use AGASACA and it made my entire week)

Retrospection on Fledgling Doctor Me

In second year, we had a class called Mechanisms of Disease.

I have only just now, after reviewing this post, noticed I actually made a post on that class before. I just forgot to delete it from my notes so I wrote another one, but what I talked about there was totally different anyway.

It was explained as a way of getting our feet wet with clinical thinking. Even though we had no knowledge of diseases, pathology, or treatment, we were given weekly cases, a lab relevant to the case, and sort of guided through it. It didn't work super well, because every case was presented by a different clinician--some were really helpful, others had completely forgotten what it is like to know absolutely nothing about medicine.

We were divided up into groups, and every group was assigned one case. You didn't have any knowledge of what it would be about until the week of, and then you put together a presentation on the diagnosis for the Friday. They were big groups so this totally sucked. Some people had ten thousand words on their slides, some people repeated what other people said, the formatting was completely crazy on the powerpoints, and there was no coherence to what anyone was trying to say. Then of course when it is your turn, it is absolutely impossible to get 10-ish people to do their research and pool it together into a reasonable form by the end of the week. In our case, the professor in charge of us did a really unhelpful intro lecture, and to guide us in our presentation he told each person to pick what most interested us about the topic and talk about that. That is a good idea, but it results in a less-than-comprehensive discussion of the disease or diagnostic process, and a lot of inane details. Overall, I think the student presentations deserved an A for effort but were useless for learning.

In retrospect, we learned way more in that class than I thought we did at the time, and it was mostly because of the labs. That class was basically mini-medicine class. For instance, that class was the first time we ever read an ECG or looked at a urine dipstick. Now, in fourth year, our level of learning is that we would be expected to diagnose and work up the same sort of cases all by ourselves from start to finish--so it's interesting to think back and compare my mindset. We were so clueless back then!

I remember the first case reasonably well. It was a dog with hair loss, pot belly, and drinking and urinating excessively. The professor asked us what disease this was most likely to be and I had no clue. There was the one person who timidly asked, "Cushing's?" and the rest of us are wondering what Cushing's even is. If someone asked our class that now, it would be too easy. It's like the free points question.

More importantly, back then we especially had no clue on what to do to figure anything out. So I didn't know the specific disease name, but I also got stuck there. What do you even do? I guess bloods--doctors always take bloods for stuff. For the longest time, "bloods" was such a vague, I-know-we-should-do-this-but-not-why answer (then... enter the mysterious world of clin path).

Throughout third year, we had a class called Clinical Studies, and it was the next step up. We didn't have cases or anything like that, but it was essentially almost-medicine class. That's where we started learning things like how to do a physical exam. They hammered in clinical thinking techniques. Along with pathology, we were getting an idea of what diseases are out there, but I'd say we were still completely useless at medicine in general. What is the first thing you do? Take a history! Perfect. Problem is, there's no "Take A History" button, you have to actually think of the questions that you want answers to. Similar to "take bloods", the "take a history" response is more of a reflex than anything else.

Now we kind of sort of know medicine. The process to get from there to here was something like putting thousands of pages into a blender, opening up your brain, and pouring it in. It is coming out of our ears and we have a lot more to go!

Vet School Requires Costumes

Naturally, to keep ourselves from going insane, vet students like to party. Some more than others, but in general we get so little opportunity to let loose that the events we do have are a little ridiculous.

I don't know what it's like for other people, but we have an enormous amount of costume parties. The Happy Hours always have a theme, and some people go really all-out in the costumes. I mentioned the mentor-mentee happy hour already, where everyone comes in pairs as famous duos. Usually, they have a broader theme.

There are the classics like...
- Cowboys and Indians
- Ninjas and Pirates
- Traffic Lights

I guess normal people know this, but apparently for the traffic light one (I don't recall if that's what it's called), you don't actually dress up as traffic lights. You wear green if you're single, orange if you're "it's complicated," and red if you're in a relationship.

There are the fun but not unusual ones like...
- Black Light
- Around the World
- Harry Potter vs Lord of the Rings
- Jungle Fever

Then there are the silly ones like...
- Dream Job if I Wasn't a Vet

Where everyone wore their overalls or their lab coats and came up with something to fit. I guess most of us are a "mechanic" at heart.

Budgerigar-ing

In third year clinical studies, one of our labs was about bird handling and the avian clinical exam. They brought in four or five travel cages full of budgies from the local aviary.

After a briefing, we were sent off to grab a budgie each and start practicing. Since they are tiny, we wanted to be careful, but they also turn into little flapping panicking escape-machines when you try to get them out of the cage. We had to reach in through the hand-sized flap on the side of the box, isolate a bird, and sort of (gently) squash it against a wall or floor so you could get a grip on it. Then, hopefully, the bird didn't wriggle out while you tried to one-handedly extract it from the cage.

Birds don't have diaphragms; the only way they can breathe is by using the motion of their chests. That means if you just grip them like a soda can then they will quietly die on you while you're not looking. The way you actually hold birds is by putting your hand around the back of their heads and squeezing their mandibles. This image from google sort of gives you the idea.

Since they are tiny, they have really fast hearts. I believe the normal is around 350bpm and they can get up to 600bpm. When you put your stethoscope on them, they are so little that the bell pretty much covers up the entire thorax. The prof told us to listen to both sides of their lungs, but it was really more like sliding it 2mm towards the other side. It's so fast, it sounds like a machine--bdrrrrrrrrrrrrrrrrrrrrrrrrr.

If you lose your grip, which is easy to do because it is a weird grip, they will bite you. I did a lot of this while I was working at the aviary, and for something so tiny their bite hurts. Those beaks are perfectly suited for clamping down on things. 

One of the girls in my lab group was rather notorious for being timid around the animals and messing up. She also giggled a lot at inappropriate things. Therefore it wasn't too unexpected when I heard some shrieking, and turn to see that her bird had twisted its head and bitten her. Her response? She reflexively chucks the budgie. Then giggles. Fortunately, her friend was a bit more on top of things and clamped her free hand over the bird before it could go flying off, and the budgie was returned to the original girl without any fuss (apart from more shrieking and giggling, that is). One of my friends in the class below me has told me that a similar incident happened in their class the next year, only that time the bird actually did get away and started flapping around the room. She said they had to quickly shut all the doors, the prof grabbed the long net, and had to run around the room trying to catch it.

Mentor-Mentee - My Turn!

Last year, as third years, it was our turn to be mentors to the incoming first years. I was pretty keen--my mentor was absolutely useless and never talked to me after the original mentor-mentee happy hour. I was going to hang out and be friends with a first year, and tell them all about vet school, and give them lots of notes and tips and resources.

I was Rudolph and my mentee was Santa.

Here's me. I did have a red nose, but I had long since given up trying to keep it on. My favourite part of this costume is not shown - I made a super cute fluffy deer tail out of ribbon and sewed it on the back. The necklace of bells and the antlers each took a really long time, even though I don't look like I spent any time on it.

I found my mentee and bought her a drink, as is the custom. I talked to her a bit, but she seemed like she would rather be left to talk to her friends so I did. I talked to heaps of the first years while I was there, which was really fun. It was their first week and they had no idea what they were getting into, and so many of them were shy.

I realised that we, as third years, knew everyone in our class. We could look at any person and know instantly if they were first or third year. The first years, on the other hand, hardly even knew each other. I think that's why they tended to cluster in little friend groups--they only knew a handful of familiar faces, and didn't know who else was in their class! After all, that's what it was like for us when we were first years.

Since then, my mentee contacted me a few times, and we are facebook friends. I gave her some files on a flash drive, in a very secretive exchange of moving the flash drive around between our mailboxes. We seem like pretty different people, though, so we never hung out.

What Cell Would You Be?

In clin path, when we were learning about eosinophils, our professor mentioned that the pathologists had once had a discussion about what cell you would be, or what cell describes your personality. (Because pathologists are the biggest nerds out of all of us)

She brought it up because she really loves horse eosinophils. They look sort of like raspberries.

There are a lot of cells I like, and some that I'm more partial to than others. My friend and I once talked about this in parasites--there were certain ones that spoke to us so we never got them wrong if they came up on a test. One of mine was Ancylostoma caninum, a hookworm in dogs.

Another was Toxocara canis because it is the same sort of worm as Dune sandworms.

But back to the topic, there are some nice cells to choose from. I quite like neutrophils because they stand out so clean and nicely on a blood smear.

They can be a little ragged, however. My favourite is one that is much more pristine--very smooth and fine: the spherocyte. Even the name has a nice roundness!

These are cells formed by partial phagocytosis--a macrophage takes a chomp out of a red blood cell, so the RBC stretches its membrane over the defect and gets smaller and more compact. They're present in immune-mediated haemolytic anaemia.

An Update From Study-Land

So as it turns out, vet school is hard. Vet school is really, really hard.

I pretty much spend the entire day in lectures, then come home and spend whatever time is left trying to catch up in textbook readings. It is finals week right now, and I literally spent more than 12 hours straight yesterday preparing for the small animal and surgery exam we had this morning. So you can see why I very quickly stopped updating the blog.

1. No time to write anything
2. No energy left
3. Not much to say! "Today, I studied."

Fortunately I did make notes on things even back in second year that I never got around to typing up. There are a few drafts I left behind, and I'll probably be sneaky and change the date on those when I finish them so I can pretend I posted them back then :P You won't get my naive outlook on it all, since it will be retrospective, but hopefully I can remember some good stories!

A big reason I wanted to keep blogging is that I want to keep some sort of diary of silly clients and bizarre cases. I thought, "Maybe I can blog them or something... oh wait, I already have a blog." So here's hoping for the future!

What, you aren't a qualified surgeon?

In third year, we had a class called Clinical Studies, which was a hodgepodge of stuff that's important as a real-world vet, like how to do clinical exams, anaesthesia, and imaging. A large section of the course was dedicated to "introductory" surgery, like the basic principles of tissue handling. That was the aim, but the surgeons live in their own little surgery universe, and in order to pass the exam, you basically had to be a surgeon already.

Our class had to come together in a collaborative effort to answer the questions from past exams, even with all of our books and notes at hand. We made a massive google document full of every colour imaginable, with highlighted answers and multi-coloured discussions and arguments about which one was correct. Lots of spots have something in red or caps, asking "Can someone explain this??" Here's the top of the page when you open it:

I would just like to say good work everyone on all the question answering I think we can all say these questions are worded terribly and information is very inconsistent but GOOD LUCK FOR TOMORROW :) This will not be a very pleasant experience ...i resent this test and the people that prepared it

Here are a few examples of our attempts to answer the questions in the study guide (SG):

18. C because it SHOULDN’T be designed to enhance traffic flow through clean areas? (agreed) (p70 of SG confirms this)

19. A apparently can someone explain this? :)

Disinfectants are used to sanitize surfaces / Antiseptics are used to cleanse wounds / Autoclaves are used to sterilize instruments. Hope this helps

20. B

21. C (Isn’t this B...? The image is the same as the one in the lec slides) Yep pretty sure its B

22. C

23. C

24. G/D (lettering is not ideal on this question!) not sure bout this either, thoughts peeps. I agree theres a table on page 1062 of fossum that says it is.

                               

FROM FOSSUM - Allogeneic cancellous bone grafts provide limited mechanical support and are osteoconductive, but not osteoinductive because the matrix is mineralized.  Therefore, answer is NOT G/D. where is this? because according to the table cancellous allografts are osteoinductive..

Thus is the answer E????????    I thought none of the grafts were good at osteogenesis. If the graft was rendered inert it would have no more protein therefore cannot be osteogenic unless a protein source was added

yeah i think its E (the last option...E2).. the questions is asking for which one is true..

But it gets worse.

j)  An advancement flap in the shape of a U is created, in order to not compromise its vascularity, the ratio of the length to the width should not be greater than:

                                   

i)  1to1.        ??       

ii)  1.5 to 1.               

iii)  2to1.        ??       

iv)  3to1.               

v)  4to1                        

ok so been trying to find this one... and found a few recent articles/studies saying that ratio isn’t even a factor …. “Therefore, the traditional concept of a width-to-length ratio does not dictate flap survival, rather perfusion pressure does.”    

anyways it carries on to say “ Classically, advancement flaps have a length-to-width ratio of 1:1 or 2:1” WHICH STILL DOESN’T HELP US!

The questions are ridiculously pedantic. Look at these. Seriously, the fuck?? WHY WOULD ANYONE KNOW THIS? Let alone in introductory surgery in third year, when you've barely even begun learning anything past anatomy, genetics, and microbiology.

When using Chlorhexidine solution (stock strength = 4%) to lavage a wound what is the maximum concentration that should be used?

                           

(a)  1 part in 10 of saline.                            

(b)  1 part in 20 of saline. p.27 has lavage concentration should be .05 = 1/20)??   

(c)  1 part in 30 of saline                            

(d)  1 part in 40 of saline.     Fossum says 1:40                       

(e)  1 part in 50 of saline. ← I thought it was 1ml to 80ml but....

       

you want to get Chlorhexidine down to 0.05% soln thus need to dilute it down 20 times

e.g. 10ml chlorhexidine diluted by 200ml saline = 0.05%

10/200 = 0.05%  actually idk    (I agree with B since that’s what the SG says.. eg 1/20=0.05)

You have to remember you are starting with a 4% solution......  So, you can’t just do 1/20.....  Besides 1/20 gives 5% not 0.05%

there was a something on the internet that had it as 1 part in 40 but I can’t find the link anymore..some textbook on google books...

ughhh me gad!

2. The maximum level of bacterial contamination required for successful wound closure in surgical wounds is generally considered to be:

a. 104 / g of tissue

b. 105 / g of tissue

c. 107 / g of tissue

d. 109 / g of tissue

Plus there's the questions like this one, about fistulas. We never talked about fistulas. Not once. I had no idea what a fistula was before I saw this question, let alone had any clue how to answer something about surgical management of one. Plus you'll notice this question goes from cow teats to foaling injuries. You may be beginning to see why vet school is so stressful.

18. Which of the following is a correct statement about a fistula?

(a) When closing a teat fistula in a cow the most important layer to make leak

proof is the mucosa.

(b) When closing a teat fistula in a cow the most important layer to make leak

proof is the skin.

(c) When closing a teat fistula in a cow preserving the epithelial tract will

accelerate healing. ← maybe this one but i really have no idea

(d) When repairing a foaling injury that has resulted in a rectovaginal fistula in

a mare a complete closure of the vaginal mucosa is more important than

the rectal mucosa. i know rectovaginal tears are not usually closed right away to allow for swelling to go down, but I think the vaginal mucosa is the most important thing to worry about (to reduce further infection from the rectum)...

(e) In time most fistulas will close as wound contraction is completed. 

Our whole document was 28 pages long. It was full of misery and stress and colour. Here's the best part, however:

Five minutes before the exam was about to start, as we were sitting at our computers ready to open the program, one of the high-up vet school coordinators appears. He only tends to appear to yell at us, so I immediately knew something was wrong.

It turns out that the surgeon had put the test online ahead of time over the weekend, because he was going to a concert or something. A few people in the class noticed it and accessed it. For some reason, the school decided to wait until that moment in time to let us know about the security breach and change the test. They had to throw out the multiple-choice test and throw something together for us. We would meet in a lecture room in half an hour, and would be taking a written test instead.

People cried.