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.

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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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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Vet school day one was both exciting and a bit of a yawner all at once. It was a gentle introduction to vet school; the kind of thing where if you peek around the edges of the lectures, and under the corner of your study carrel, and in the cabinets of the anatomy lab, you can see that vet school is going to be incredibly intense – just not for these first few days. So as exciting as it was to finally be starting, and as hectic as it was (It made a day of undergrad feel like a day in the recliner at home.), it was really more frenetic than actually challenging. The most difficult decision I had to make today was “Should I wear scrubs and a lab coat to anatomy, or should I just wing it in my jeans since all the specimens are dry?” The rest of the week looks to be somewhat similar to today. Right about this point next week I’ll be looking back fondly at how easy this week was, wishing I hadn’t mocked it.

I totally ripped this off of Facebook from one of my classmates.

We spent the morning in lectures: an overview of horses (that included a series of humorous “This is a horse; this is not a horse” slides like the one included here – honest!) covering basic breed differences, handling, behavior, that sort of thing. We then covered equine limb anatomy. It was a bit of a My First Anatomy lecture: all very big-picture stuff like knowing there are two rows of carpal bones, proximal and distal, but not bothering to learn which ones are which. After another lecture on large animal isolation protocol in the hospital (presumably to get us up to speed for when clerk duty starts in a few weeks), we grabbed lunch.

After that, we spent a few hours in the anatomy lab reviewing what we covered in lecture. I have to give the teachers props for the way they set it up. Not only did they have table after table of specimens to examine, but they also took the time to throw up a bunch of radiographic images as well. I really appreciated that they gave us a multifaceted way to learn the material. It really wasn’t that complex; we were ready to take the lab test after about an hour. (Yes, that’s right, a test on our first day of school.) Once we finished that up we headed to the large animal hospital for a hands-on introduction to safely handling horses. I learned that it does indeed hurt a bit when a horse steps on your foot. Beasts.

And then we were done. Some lecture time, some anatomy lab time, some pet-a-horse time. All in all, an awesome way to start.

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Tomorrow is orientation, followed by an overnight camping retreat Thursday/Friday. Then next Tuesday we start a full week of large-animal clinical skill class. I like how they start you out with clinical training. For starters, it sounds more fun than sitting in a lecture hall all day (but who knows, maybe it’s not). It gives you a week to calm your nerves and get used to things before the grind begins. The school has a bit of an ulterior motive, I think – they require students to do overnight clerk duty in the large-animal hospital, and this is your training. So the school wins, the students (probably) win … all in all a good deal.

Then the second week is when it gets ugly. I’ll let you know how it goes.

See you at Christmas.

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But if your dog does get heartworm disease there is only one heartworm adulticide (immiticide) in the U.S., and it’s now largely unavailable because the sole manufacturer, Merial, can’t obtain one of the critical ingredients (either that or they are having manufacturing difficulties; the industry news is a bit confused on what’s causing the actual shortage).

Bottom line: if your dog has heartworm, your veterinarian may not be able to treat it as well as they’d like. There is another treatment; the American Heartworm Society (Really? You didn’t know they exist?) has a recommended non-adulticide protocol, and it appears to be reasonably effective, but it takes far longer (possibly up to a year or more). During that entire period of time, your dog will be on an exercise restriction due to increased risk of a secondary problem, thromboembolism from fragments of dying worms. The same exercise restriction is in place with the adulticide treatment, but the duration is much shorter because the worms are killed so quickly.

Don’t skimp on your pet’s heartworm preventative. It really is necessary, and you don’t want to be one of the vet clients with a heartworm dog.

As an aside, while cats do get heartworm infections, they are much more resistant than dogs and, in any case, immiticide cannot be used as treatment in cats.

Part of the debt ceiling resolution involved the cutting of graduate student subsidized loans. Right now, qualified students can borrow up to $8,500 per year from the federal government, and the government picks up the tab on the interest on the loan(s) until after the student graduates. So for a few years while you’re in school, essentially, your loan doesn’t accrue interest (it does, you just don’t pay it). That’s the subsidized part. There are also unsubsidized loans, where you start paying interest immediately. Those make up the bulk of the rest of graduate student loan packages.

Currently, the plan with the debt ceiling bill is to nix subsidized loans. The argument is that it will save some $22B over the next decade. Of course, ‘save’ really means that graduate educations will cost students $22B more over the next decade (in addition to tuition hikes), which means deeper debt for graduate students, which means less taxable income, which means lower tax revenues. It potentially also means fewer people pursuing graduate school, which means fewer high-income earners, which also means lower tax revenues. Either way, it translates to lower tax revenue.

I’m frustrated at how politicians have chosen to frame this issue. They’ve correctly noted a lack of available money for Pell Grants (grants are not repaid and are awarded to, primarily, undergraduate students demonstrating need). So they’ve painted it as an either/or: you can have Pell Grants OR subsidized loans, but shucks, sorry, we don’t have money for both.

Now. Pell Grants are a good thing. If it truly were an either/or situation, I’d agree that Pell Grants should get the money because they generally are awarded to people who wouldn’t otherwise be able to obtain a bachelor’s degree. Given the well-documented average income increase to people with bachelor’s degree compared to those without, it’s money well spent because it generates tax revenue down the road that provides a good return on investment. In other words, the money spent educating people benefits us all.

But, as one of my upperclassmen pointed out, it shouldn’t be either/or. We’re talking about $22B over ten years. $2.2B/year. That amount of money can – and ought to – be cut out of the military budget and kept for Pell Grants AND subsidized loans. Money spent on the military does virtually nothing to repay itself; it’s money down the drain. Money spent on education more than repays itself in the form of increased tax revenue through higher earnings.

Either way, when we invest in education as a country, we get our money back – and then some.

I guess school starts in 4 weeks. I’ve bought the books that I want. I’ve got the white coats and barn overalls and scrubs. New laptop? Check. Myers-Briggs? Er… actually, that’s still on the todo list. I think they need a personality type for “hates personality tests and puts them off until the last minute.” Eh. It’s not due for a few days.

(By the way; I like how the MB people try to tell you that none of the Myers-Briggs categories are better or worse, but the second you come out an I(ntrovert) people look at you suspiciously and try not to sit with their back to you.)

Anyway, school. I’ve got the ID card, figured out parking/carpooling, decided on electives, grilled for a bunch of my classmates, received my vaccinations, joined the (S)AVMA and MVMA, have a plan for health care, have politely started disengaging from various activities I won’t be able to keep up, and am ready. And nervous as H, E, double hockey sticks. The back and forth of whether this is a good idea has made me just a little bipolar about school; on the one hand, I am really, really excited. I’m fascinated with medicine, and eager to be at the intersection of people, animals, and health care. On the other hand, it’d be awfully easy to stick with my comfortable job, raise the kids, retire on schedule (as opposed to ‘never’), and coast through life.

But that’s not really me.

Speaking of kids, this arm belongs to my 7-year-old son:

Kelly posted that picture on Facebook a bit ago, and I concluded that I’d better stop rough-housing with him before he realizes that actually, he can beat dad up. Maybe this gymnastics thing is a bad idea; he’s turning into the Hulk.

In other news, Clay also starts school in a few weeks. He’s attending a new charter school based on a Classical method of teaching. He’s excited and nervous; very appropriate emotions. The school sounds amazing, though, and we can’t wait to see how well he adjusts. The downside? Long days. He has to be at school at 8 and they’re done at 3. Then he has gymnastics three days a week from 5-8. So those three days are going to be brutally long for a young guy. But, he really loves gymnastics and wants to tough it out and, if anyone can do it, he can.

Little to report on Tirza. She loves playing with her new little brother, torturing her older brother, and she’s backed off from dressing like a walking visual cacophony. Instead of making sure she mixes vertical stripes, horizontal stripes, and polka dots, she just settles for ensuring she has pink all over. Not much to say about Ian, either – he’s so easy-going that it’s been fantastic. He cries like any baby, but as soon as you pick him up he settles down. He’s just a social little smiler that all he really cares about is making sure he doesn’t get left behind.

Kelly may be returning to school soon (or maybe in a year or two) as well, which would be really exciting. So it’s possible that at some point in the near future we’ll have me, Kelly, Clay, and Tirza all in school at the same time. Instead of evening bedtime books or games, we’ll have nightly study session. Since Clay will be learning Latin, he ought to be able to help me.

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Good point. So, in more important news than bunnies…..

The university sent the incoming class information out to all of us, along with a few paperwork ‘assignments’ (class registration, photo waiver, id card, parking lottery, all that kind of jazz). On the one hand, it’s all very tedious and, frankly, the university’s web presence is quite disorganized with some parts that are just plain non-functional. On the other hand, every large school has some level of slow-moving bureaucracy, so I imagine it’s par for the course. More importantly, it’s pretty exciting to see things starting to happen. Even though it’s all boring pre-semester paperwork, it reminds me that it’s starting soon. (Just a bit more than two months!)

Part of the paperwork is letting the administration folks (who handle our registration for us – thank you!) know which electives we want to take. There are 10 required classes (21.5 credits) in the first semester along with three (2.5 credits worth) elective courses. You can take as many (or few) of the electives as you wish, so the first semester runs 21.5-24 credits. The required classes are:

• GOALE (GOALE is short for Gopher Orientation and Leadership Experience: I believe it’s designed to introduce professional skills, accomplish class team-building, etc.)
• Foundations of Interprofessional Communication and Collaboration
• Professional Development
• Overview of Animal Populations
• Veterinary Anatomy
• Normal Radiographic Anatomy
• Veterinary Physiological Chemistry
• Histology
• Nutrition
• Clinical Skills I

The elective courses are:

• International and Cultural Immersion
• Neonatology
• Introduction to Non-Domestic Veterinary Medicine

Of the electives, I plan to skip non-domestic vet med. I really would love to take it just because it sounds interesting. But I’m nigh positive I won’t be heading into zoo or wildlife medicine, so even though it might be pretty darn neat … I’ll save a bit of time and pass. I will take neonatology; it’s primarily equine, but will still have value. The downside to neonatology is that you participate with the foaling teams in the spring, which potentially means some not-so-fun nights (though I suppose there’s some clinical skill value even in those). I’m riding the fence on the international/cultural class: it’s required if you want to apply for travel funds, which may be useful. I’m told the commitment level is pretty low: show up for a lunch-hour meeting every other week. At the moment I went ahead and signed up for it, but I may change my mind.

I did have one ‘age’ gaff that amused me. The university has contracted out the role of collecting vaccination information. Along with all public schools in the state, they require two doses of MMR in your lifetime and a recent Td for anyone born after 1956. I had one MMR dose as a child (so I did have to go get another), but when I went to input the information the drop-down menu to select the year of the vaccination only went back to 1971. My MMR was in 1970.

Oops! I already knew I was old; the university didn’t have to rub salt in the wound.

ETA 7/29: I originally wrote that by not taking an elective or two I would save money. That was incorrect; our tuition is capped at a certain level, and that level is met by the core curriculum. So electives don’t add to your tuition cost.

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Investigating, I discovered that a rabbit had built a nest down into the rocks. One foot off the walkway and four feet from the front door. The door that two starving (just ask them) dogs go in and out of at least four or five times a day to go to the bathroom. You’d think the rabbit would notice the scent (if nothing else, of the large amounts of urine deposited by the dogs in the nearby lawn).

Tonight I was letting the dogs out before bed and, as I opened the door, I said to my wife “I bet we’ll see momma rabbit out there sometime; they come back to the nests at night.” I looked outside and sure enough, there’s the mother rabbit sitting on our walkway. Unfortunately, my Aussie/Chow also saw the rabbit. I didn’t do much when I heard her yipe, though, because the storm door was still closed and I didn’t think the Aussie would go through it in pursuit of a rabbit.

I now know better. With her typical bulldozer mentality (she’s really a moose trapped in a dog’s body) she shouldered her way through the door and tore off after the rabbit. On the plus side, Lucy has never been an accomplished hunter so I wasn’t too concerned about the rabbit’s chances (and sure enough, Lucy came back a few moments later sans rabbit snack).

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