Second semester – go!

Performing exams in northern MN with SIRVS.

Greetings, friends! A month or so ago a friend remarked to another friend: “Tell Brett to update his blog.” Right – my bad. My last post? October 2011. As you can see, once vet school got rolling, a lot of things fell by the wayside. And so here I am, starting semester two tomorrow.

First, the brief retrospective. What did I think of first semester vet school? It’s a combination of fairly intense feelings: it’s tremendously interesting, a lot of fun, and a terrifying amount of work and stress. I have never felt such chronic fatigue in my life – I was tired after about the second week and never did really feel rested until the semester ended. Some of that was the nature of vet school, some of that was me needing to adjust to it. I’m pretty optimistic for second semester because I think I can do a better job of staying on top of classes now that I know generally what to expect.

My favorite class? Equine Neonatology, hands down. It was an easy class (that’s not why I liked it) because it was simply 7-8 online lectures with a highly abbreviated quiz following each (just to ensure you actually watched the lecture). We did have a couple in-class sessions that were largely case reviews. What made it my favorite class was that it  was straight-up practical medicine: here’s the neonate, here’s the type of problems, here’s how we deal with it. In your early didactic training you don’t get a lot of that (most classes are basic science classes), so it was a breath of fresh air every time I sat down to listen to a new neonate lecture. While other classes felt like ‘work’, neonate felt like ‘fun work’.

I’ll try and say more about first semester soon. But since second semester starts tomorrow, here’s the low down on classes. The pressure ramps up a bit, with more core required classes and a higher credit load (27 credits). We’re taking:

• Critical Scientific Reading (2 cr)
• Professional Development II: Communication (1 cr)
• Organology (3 cr)
• Veterinary Neurobiology (2 cr)
• Veterinary Physiology (6 cr) (6?? Gulp.)
• Veterinary Pharmacology (2 cr)
• Host Defenses (2 cr)
• Virology (3 cr)
• Applied Veterinary Genetics (1 cr)
• Basic Pathology (2 cr)
• Clinical Skills II (1 cr)
• Behavior Core (2 cr)

My wife, Kelly, getting to experience the inside of a cow's stomach firsthand.

Oh, but that’s not really all: we have the second half of our GOALE course (more or less an orientation/introduction course designed to acclimate new students to the school and profession), and more large-animal clerk duty to fulfill the requirements of first semester Clinical Skills I (we all automatically got a grade of ‘Incomplete’ until we finish our clerk duty this semester). Also, I have an ‘Incomplete’ in Equine Neonatology because we don’t technically finish the class until foaling teams conclude this spring. So a few first-semester classes are still in play.

As well, I’ll have monthly VeTouch clinics in Minneapolis (more about that later, but in short it’s a free clinic put on in downtown Minneapolis that utilizes vet and vet tech students to provide a free well-animal care clinic once per month), another SIRVS trip to northern Minnesota in March, and a RAVS trip to South Dakota right at the end of the semester. I’m flying to Florida this Thursday to the VBMA conference (I am the president-elect of our local chapter.) and also will stay a couple extra days to attend NAVC, one of the largest veterinary conferences in the United States. Along with other club activities and trying to nail down a job or research opportunity for summer, this semester promises to be every bit as busy as the last.

SIRVSing in northern MN

Last weekend I had the opportunity to travel to northern MN with a University of Minnesota group called SIRVS: Student Initiative for Reservation Veterinary Services. We set up shop just outside the White Earth community in a town called Naytahwaush. Our purpose there was to provide free basic clinical care. Generally, we performed exams, administered vaccines, and made recommendations for longer-term care or more advanced care than we could deliver in two days. It’s a win-win situation: the clients, who often don’t have the economic wherewithal to afford veterinary care (or simply don’t have a veterinarian nearby), get basic health care for their animals and the students get experience examining animals, delivering care, and interacting with clients.

I’ve participated in vaccine clinics before, but I would say this was somewhat more advanced. While we were still quite limited, we had rudimentary diagnostic capabilities and a very limited pharmacy in order to diagnose and treat some problems. In vaccine clinics it’s been my experience that more often than not the exam is perfunctory – it’s point is simply to ensure the animal is sufficiently healthy to handle the vaccines – and there is no attempt to treat other issues.

Saturday morning started with a man with six dogs. Given the amount of paperwork we need to do, along with the relatively slow pace of a student exam compared to a longtime practicing veterinarian, that took my team quite a while. A few clients later, one of the supervising vets approached and asked if I wanted to help with a critical care case. After taking the history it became apparent that the dog was a likely candidate for parvovirus: the 5-month-old puppy was listless and uninterested in his surroundings, had just had a bout of hematochezia (bloody diarrhea) on our floor, and had a reported history of recent vomiting.

Unfortunately, successful treatment normally requires hospitalization, and we did not have the capability to provide 24-hour care. We were limited to administering fluids to combat dehydration along with antibiotics to ward off secondary infection and subsequent sepsis. We did provide this both Saturday all afternoon and Sunday all morning, so I suppose we gave the puppy a somewhat better chance than it had to begin with. Better care would have involved an antiemetic to reduce nausea along with different fluids than the LRS (Lactated Ringer’s Solution) that we had. Even with our efforts, the prognosis (assuming our presumptive diagnosis was correct) was not good; parvovirus is a particularly nasty, contagious, hardy killer of puppies. Fortunately, there is a vaccine available. Unfortunately, this puppy hadn’t gotten it. The rest of my Saturday was taken up with this dog due to his need for constant care. Also, the particularly contagious nature of parvovirus would have made it foolish for me to return to providing exams for other (probably non-vaccinated) dogs.

Sunday was full of little interesting details on examination: a dog that had gotten its head caught in a car door and damaged an eye, another with a large squishy mass under its cheek that defied aspiration no matter who tried, a chihuahua that lived up to its reputation by trying to eat my arm off, a mutt with a broken leg that was well on its way to healing, and a really cute puppy. Puppies are always nice.

This little patient on Sunday made my day.

The entire weekend was an interesting education experience when it came to clients. Just like clinics I’ve been in, they came in all stripes: some compliant, some not so much. Some with financial resources to provide our recommended additional care (like heartworm protection), some without. Some trusting of the vet care we were providing, and some not. For example, one client absolutely refused rabies vaccination for his animal because of concern that his animal and he might contract rabies from it. No attempt to educate or convince him on my part was going to have any impact, and, believe it or not, I understand his point of view: here’s some technology he doesn’t really understand but if there’s one thing he does know, it’s that rabies virus is a pretty horrible thing, so staying an arm’s length away from anything involving it probably seemed smart to him. He was wrong, of course; there’s zero chance of contracting rabies from the vaccination, but he didn’t know that or believe me. (Incidentally, I just read that the first MN canine rabies case of 2011 cropped up in western MN recently. Please vaccinate your pets.) There were also some cultural differences, and they made it a bit challenging to provide the best care possible. For example, down here in Minneapolis most animals are largely indoor pets. They may go to the dog park, or go outside to play during the day, but at night they’re inside. The animals we saw this weekend were, more often than not, the reverse: mostly or exclusively outdoor animals with only a few that spent the majority of the time inside. During one exam I asked a client what they fed their dog; the client looked at me and said “Feed? It hunts.” That’s not something you’ll encounter here in Minneapolis. Incidentally, that particular ‘hunting’ dog had the best body and coat condition of any I saw; I suspect strongly a neighbor feeds the dog without the client’s knowledge.

Our hosts were fantastic. In particular, a local conservation officer made food available to us all weekend. She also fried up fresh walleye filets on Sunday afternoon that had been locally netted a day or two ahead of our trip. I was struck by the level of effort that took, and the consideration that it demonstrated. I knew they were going to feed us, but frankly, I anticipated the bare minimum. I never expected to sit down to a meal of fry bread, corn on the cob, fresh walleye filets, a wild rice mixture, milk, and juice. It was humbling.

SIRVS intends to return, I believe, in the spring for a spay/neuter clinic along with a day of exams and vaccinations. I thought I heard talk of a winter trip for exams as well. I’m hopeful I’ll be able to participate in all of the future trips!

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3 weeks down, forever to go…..

So that first week – the one where they let us play with horses and cows while lulling us into a false sense of security – ended. And then the other shoe fell.

Physiology? Light-speed. Radiology? Light-speed. Anatomy? Faster-than-light. Everyone gives you the “drinking from the fire hose” analogy, but I guess you don’t really understand until you’re trying to take sips and the water keeps banging your head against the wall behind you. It’s like we were test driving a Porsche around the parking lot for the first week, and then suddenly jumped to a no-speed-limit highway.

I had a couple (dim) light bulb moments last week. The first was “Oh my, I’m 3/16ths of the way through my first semester of vet school, and I’m pretty sure I don’t actually know anything yet except how to tie a few knots.” That wasn’t a glorious-feeling moment. The second was “I can barely remember what classes I’m already taking, and a few of them haven’t even started yet.” (That would be 4 of them, to be exact. I counted, later.) To give you a bit of an idea; we have four quizzes in our first-semester radiology class, plus a final. They’re pretty flexible – you have about a week to take them once they’re available and you can do it on your computer whenever you want – but the first one opens this Wednesday. We’ve had, I think, two radiology lectures so far. We have two more before Wednesday, but it’s basically four classes and then a test. Radiology is easily the class I look forward to the most, just because I think non-invasive imaging in general is a really awesome technology and it excites me. But it feels frightening to be taking a test after only a couple classes.

So vet school is a bit like frenetically treading water in the middle of some rushing rapids. You stay afloat, the river takes you basically where you need to go, and you just do your best to avoid drowning and getting smashed against the rocks.

As stinky as anatomy lab is, you get used to it, and it’s awfully cool to be able to take apart a dog and cat and see exactly how it all works. My appreciation for what’s going on underneath the skin has leapt forward. One of my (living) dogs doesn’t particularly like it so much because she’s tired of me trying to separate out the muscles in her limbs, but … you know … she gets a free massage out of the deal. I don’t know where the university gets their carcasses, but part of me wishes I could thank the former owners for donating them; it’s an invaluable experience. In our program we share one carcass per three people, and each group of three people is grouped into a row of two other groups of three. Each row has three animals, a male dog, female dog, and cat. Every week you switch tables within your row, so each group works on each animal as we progress through the carcasses. In an ideal world, I’d have an animal all to myself – I’ve found I learn really well on the days I dissect and not so well on the days my partners do – but there’s just not enough room for that.

Physiological chemistry – biochemistry – is baffling. The lectures seem a bit like a Jackson Pollock art: all complex, confusing, colors and lines and shapes with some supposed connection. But it’s far more than anyone could realistically memorize, and it’s not clear how deep to go with the material. So that one’s a bit of a puzzler. It’s a bit disappointing, because it’s actually really interesting material, but you’re left with the conclusion that you just have to skim off the top layer, grasp the basic concepts, and keep moving.

We’re also working through Histology, Animal Populations, Clinical Skills (final exam is Wednesday for the lecture and next Monday for the practical portion!), Foundations of Interprofessional Communication and Collaboration (where we go meet with dental, human medical, nursing, and other programs in some sort of effort to promote interprofessional efforts), Professional Development, a few classes I’ve forgotten, and then – oh yeah – those four that haven’t started.

Phew. Back to studying. I’ve got anatomy to learn.

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