Unexpected Sabbatical

I have about forty topics in queue for this blog, and somehow they’ve all been postponed due to the last few weeks.

Two weeks ago, on July 27, one of my most awe-inspiring classmates and best friends was senselessly killed in a car accident.
She had her two cats with her; only one made it.

Cassandra and her Gatsby

Being someone who has come to terms with my lack of belief in a greater  purpose, someone who does not believe in an omnipotent deity or an over-arching order in this world, I am simply devastated.

My heart goes out to her family and her fiance. 

The story of exactly what happened–the phone calls, the gathering of good friends round a table with more than one empty chair, the absolute heartbreak at such a loss, and the return to clinics after such a loss because it was what she would have wanted, the memorial service–these are all mere details.

The important things to note are her ever-present smile, a ray of sunshine in any day, and her inability to mask her emotions about anything.  How we never lacked her opinion on anything, and how she was never afraid to ask a question or five in class due to her insatiable curiosity and desire to be the best vet she could possibly be.

She has inspired more than just our class to strive for more, and as I walk the halls I can feel her absence.  She is forever a member of the Class of 2009 and forever one of the most inspiring people I’ve had the pleasure of working with. 

She was in my very first college class–8am genetics!–and a fiercely loyal friend for the last 3.5 years.  Many an hour we spent at our rec center working out, or at our local sandwich shop studying for countless exams.  Some hours we spent just sitting at her house watching TV (House and Grey’s Anatomy were favorites) or talking.  She was one of the most compassionate listeners I’ve met, and she was to become one of the most incredible veterinarians of our generation.  She will be sorely missed.

In her honor, our group of friends decided to start a memorial scholarship to continue to honor her contribution to our class, our school and our profession.  While it kind of breaks the rules of anonymity for my school I’ve kept on this blog, there are things more important.  Donations to the Cassandra Scott Memorial Scholarship can be made by check payable to The Texas A&M Foundation and in the memo section of the check, please write “Cassandra Scott Scholarship”.   
Checks should be mailed to: College of Veterinary Medicine, Office of the Dean, 4461 TAMU, College Station, TX 77843-4461

Cassandra J. Scott

 

DeBakey dies at 99

Michael E. DeBakey has died, at age 99. 
A pioneer of cardiac surgery, DeBakey’s name has been splashed across my university as a sponsor of education in veterinary cardiac surgery… and with good reason.

I had the distinct pleasure of hearing DeBakey speak when I was a young and budding scientist, and his humility and subtle genius struck me as quite genuine.  As one who funded the beautiful cardiac suite in which I’ve witnessed such amazing surgeries, DeBakey deserves the nod from this girl.

So here’s to you, “surgeon of the century.”

The Smegma Chronicles

Let’s get nasty.
On my first equine rotation, I had to take care of an animal with an “unruly penis.” [As a side note, this is perhaps my favorite diagnosis ever.]  He wouldn’t pee normally and seemed to have problems retracting his member after his colic surgery.  This went on for days with no improvement. 
As someone who’s never worked with horses before vet school save some riding while in Girl Scouts, I was unnerved by the accumulation of smegma in my patient.  Even after being told this was “normal,” being the compassionate future veterinarian that I am, I decided to take matters into my own hands… literally.

The Thick of It

Smegma is one of those amazingly onomatopoeic words that really describes the essence of its meaning… but it’s not the point of this.  The point of this post is to point out the glaringly present and tragically insufficient  depth and breadth of information present on the interwebs for owners of animals regarding veterinary health.

There’s so much to discuss when one starts (in the ironic setting of a blog) to address the amount of fallacious information propogated by websites that mostly mean well, but I’ll narrow it down to the omnipresent Wiki-empire, for fun’s sake.

When trying to explain to my nonveterinary friends the smegma chronicles, I found this website.  Oh how I laughed, especially at the first bullet under “Warnings,” but it also gave me pause.  Do people really rely on this information for medical or veterinary advice? 

In a world where so many self-diagnose or self-vet their animals, what’s all my education for if you’re just going to turn to wikipedia for all the answers anyway?

From the Archives: a vet student’s perspective on Slate’s “How to say no to your vet”

This is from the way-back archives.  Written last November in response to Emily Yoffe’s article “How to say no to your vet” in Slate, this article (and my response) still hit to the heart of the big disconnect between small animal (and even large animal) veterinarians and their clients.  The key I think that is missing?  Communication.  But we can communicate about that in another entry. 

Food for thought – my response to “But Doc, the Dog’s Already Dead!:  How to say no to your vet.”

a Note on Medical Mistakes

O, the humanity!

You turn to medicine to fix things that are out of your hand, and then something happens.
They’re why liability insurance exists, how eager Dateline or 20/20 reporters make a name for themselves–medical mistakes.

Certainly, in veterinary medicine, the stakes aren’t as high.  You’re not talking about someone’s child/spouse/parent, but the times, they are a changin’.  Entire courses are being taught in animal law.  Prior to now, the only remuneration you could get for your pet was its cost, but emotional damages are starting to be awarded in some states.  Now this entry certainly is not the blog entry when I would like to discuss the implications or argue the merits of this, but it is an important discussion my profession is currently having and that lawyers are having, but of course, not together.  Sigh.  A fight to fight another day.

What I hope to address here is the frightening aspect of medical mistakes, and how we all make them.  Every single person who works in a medical profession has made a mistake that has compromised, sometimes fatally, the life or treatment of a patient.  It’s frighteningly real, but it’s the consequence of our humanity.  We would all like to be perfect, but that is a devout wish we will never see realized. 

Dog Drugs in the Media

Last summer while spending time at Pfizer outside of Canterbury, Kent (birthplace of Viagra!), I was introduced to Slentrol, the first weight loss drug for dogs.

Now you may be wondering why on earth a pharmaceutical company would be willing to spend the money on licensing a veterinary drug, and your point would be valid. Slentrol (drug name dirlotapide) is a product of the quest for the Holy Grail of pharmaceuticals–a weight loss drug with benefits that outweigh the side effects. Many drugs have tried, and few have succeeded. Even Alli (orlistat), the new over the counter weight-loss drug, has a hefty list of side effects and doesn’t promise the effortless weight loss that most consumers desire. Alli works by decreasing fat absorption in the body by blocking the action of lipase, the enzyme that digests fat in the intestines.

Slentrol works via a more selective mechanism, blocking the transport of triglycerides into the blood stream (but not keeping the undigested fats in your intestinal track and thereby keeping those distasteful side effects to a minimum). Kudos to Pfizer because this mechanism is kind of genius, and it’d be a successful human drug, but…

Restless Testis

I kind of imagined this blog intertwining some of my medical knowledge with my experiences, and what better way to study for our North American Veterinary Licensing Exam than by blogging out my clinical experiences?!  This first one will be a ball, or rather a retained ball   Welcome to the land of one-hung-low!

Cryptorchid – crypt meaning hidden and orchid meaning testes

Cryptorchidism is a problem that plagues the animal kingdom.  It doesn’t so much amaze me how we get such things botched up, but rather, it boggles my mind that we get things right so often!

The testicles typically descend through the inguinal canal by six months in the canine, with actually most arriving in the scrotum by 10 days.  As many as 10% of male puppies can be cryptorchid, either unilaterally or bilaterally.  This means that either one testicle or both can be retained in the abdomen or in the inguinal canal (that fun area where your thigh meets your pelvis).  The majority of cryptorchids are unilateral, with the right testicle as the right kidney and testicle are further cranial in the body than the left–”Left is left behind.”

Most cryptorchid testes don’t produce sperm (since they’re maintained in the body at a temperature 1-2 degrees Centigrade higher than in the cool, low-hanging scrotum) so if your only reason for castration is sterilization, then I suppose you could leave it there.  If cancer and the ever-worrisome testosterone is your concern, however, you’d best take it out.  Testosterone is still produced, though at lower levels, putting the dog at a higher risk for such fun hormone-dependent tumors as perianal gland tumors (sounds great, right?) or benign prostatic hypertrophy (plague of both elder intact male dogs and humans alike).  Retained testicles also also 13x more likely to develop testicular neoplasia–especially Sertoli cell tumors.

My First Rotation: Doing Bob Barker Proud

I had planned on writing this as I went–updating the masses on what I was doing day in and day out–and perhaps that’s what I’ll fall into as my time becomes more scheduled, but for now, this post will serve as the synopsis of my first two week rotation:  General Surgery.

This rotation focuses on the basic surgical procedures of spaying and castrating dogs and cats and various other small procedures, like lumpectomies or feline declaws.  It’s a pretty self-contained service, with our students running the anesthesia and performing the surgeries, as well as dealing with the clients, etc., so it was a great place to start; got us all up to speed (as up to speed as we’ll be for a while) on the teaching hospital procedures and such.

We hit the ground running, too, with three patients in at 9:30am on Monday, May 5, after our short one-hour orientation.  Our rotation had six students, five from my class and one from another vet school doing his clinical year up with us, so we split into pairs with one student as the surgeon and one as the anesthetist.  Not quite awake or ready, or perhaps still too apprehensive, I chose to be anesthetist, allowing my very good friend K on this rotation to do her first feline ovariohysterectomy (cat spay).  It went smoothly, if slowly, and we soon realized that unless we started becoming flooded with patients, we’d have a pretty laid back first rotation.

Practice in Practice – My Fourth Year of Vet School

Years of school
Months of working in clinics
Weeks of hands-on labs
Hours of classroom instruction

And nothing really could properly prepare me for my fourth year of vet school.  Entirely clinical, this year will see me through 53 weeks (ah, the wonders of administration) of rotations–typically two weeks a piece–ranging from veterinary radiology to large animal emergency and criticalcare.  I’ll be doing my core rotations at my university, and the remainder are external elective rotations I’ve set up at the National Zoo, Chicago’s Lincoln Park Zoo and the San Diego Wild Animal Park.  One rotation takes me down to Tambopata, Peru, where I’ll be assisting in a macaw research project, and somehow, amidst all this, I’ll learn enough to pass the North American Veterinary Licensing Examination and become an actual veterinarian.

The prospect is mildly terrifying, but as we’ve been told by one of the most amazing vets I’ve ever met, “being a veterinarian is a lot about controlling your terror,” and I plan on doing just that as I wind my way through this maze of clinics, clinicians and clients, practicing the practice that will become my profession.