Monday 24 June 2013

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.


Saturday 22 June 2013

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.

Thursday 20 June 2013

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.

Wednesday 19 June 2013

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)

Tuesday 18 June 2013

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!

Monday 17 June 2013

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.

Sunday 16 June 2013

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.

Saturday 15 June 2013

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.

Friday 14 June 2013

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!