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.

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

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 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?

It’s a shame you were able to find the one veterinarian willing to bash the profession, especially as someone who makes a living writing about and for the $50 billion pet industry. Your article evaluates the veterinary profession from only one side, so let me proffer the flip side:

There are people who fly their animals to the University of California at Davis School of Veterinary Medicine for dialysis or a kidney transplant. A couple offered Texas A&M millions of dollars to clone their beloved pet dog. Should a veterinarian not offer the best possible medicine just so those who are unwilling or unable to give their animal the total hip replacement or MRI will not feel guilty or inadequate? Are we to practice a medicine that is a step below human medicine simply because there’s a V in our MD?

Would those pet owners in your article be more comfortable with the archaic “vaccin-arian” who sees a dog or cat once a year simply to look it over and boost the rabies vaccine–which must be boosted, even in people, contrary to what your article might imply, because that immunity does not last forever (like a tetanus booster). As a veterinary student, I’ve had my rabies vaccination series and anticipate getting boosters for the rest of my life to keep up my immunity and protect myself from those patients who do not live with an owner responsible enough to follow legal guidelines. Being a veterinarian is about being the pet’s advocate, and having the tough conversations with the owners who want to take their aging, pained pet home to waste away about palliative therapy or even euthanasia. When our patients can’t speak, we have to practice the art of medicine to help them, heal them, but before that, to even diagnose them. A veterinarian runs diagnostics, like blood-work or imaging, to examine our patients who can’t tell us where it hurts or if they’ve had a decreased appetite lately or if they just don’t feel themselves lately. The last time I was at the doctor, I had basic blood tests run, and I’m a healthy 22-year-old! The biggest complaint you seemed to find was the cost which, until veterinary medicine inevitably goes the way of human medicine, is not determined by insurance and protocol.
And you did mention the protocol company, if not by name, by a calling card anyone well-acquainted with veterinary medicine would recognize. Do not be so foolish as to think that all veterinarians give Giardia and Corona vaccines to all dogs annually or run Lyme’s tests just to earn money.

But, while on the subject of money, why is it so wrong for a veterinarian to earn some money? Should they be forced into poverty simply because they care for your pets? If a lawyer, private practice doctor and accountant can charge what they do to “keep the lights on,” then surely you will not begrudge the veterinarian the same. Your veterinarian is not trying to gouge you when she tells you that your dog needs pain management after an operation, nor are they trying to take you to the cleaners by providing the highest quality surgical techniques. Do not be so cynical as to think that any veterinarian got into the business for the annual income.

Veterinarians understand that medicine is to be practiced individually, with each case managed on a personal level. Just as no veterinarian would ever attempt to diagnose a child’s heart murmur, so should no doctor or lay-person attempt to extrapolate that benign diagnosis to a cat. As my three board-certified veterinary cardiologists have taught me, a cat with a heart murmur has a severe pathology until proven otherwise. I enter my field with an open mind and a passion for medicine and for my patients, knowing the obstacles and the opportunities that my profession provides. We are one of the most respected professions in America, a respect that we neither take for granted nor, as your article insinuates, abuse. I am pleased to be entering a profession that manages to stay on the cutting-edge of technology without leaving the patient behind, as we veterinarians truly are the pet’s advocate. I plan on offering my clients the best possible medicine for their pet and finding a necessary compromise that suits the owners while giving the pet the best possible options.
I would recommend to your readership listen carefully to their options and know that we have everyone’s best interest at heart, and we leave the judgmentalism to Slate.

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. 

I began to write this entry the day after I made my very first medical mistake.  It was one so odd that I don’t think I could repeat it, causing my patient’s necessary surgery to be delayed and me to imagine all the possible career paths that would not directly involve patient care.  But my patient pulled through, thanks to the skill of the doctors and technicians here, and is now at home and doing wonderfully, and through the sage advice of all around me, I was reminded that this is a necessary part of our profession, and that so long as I learn from my mistake, it will not have been in vain. 

But what about our patients?  Are they to settle for a mere 99% change that we’ll treat them well?  A recent survey of British veterinary graduates admitted that 78% made mistakes their first year out.  That’s a startling statistic to me, but I suppose less so when i really think about it.

At the school I attend, we have one year–12 months–to learn practical clinical skills before being sent out into the world.  While the days of immediately post-DVM going back to your hometown and setting up shop on your own are quickly abating, the idea that with every passing day I and my classmates move closer and closer to being the sole party responsible for the treatment of an animal is terrifyingly real.  A large movement in the field of equine and small animal veterinary medicine is to do a one-year post-graduation internship.  This allows for 12 more high-paced clinical months with which to gain our footing, but it certainly doesn’t eliminate the risk.  Overall, I think it does give us a better chance at learning from them.

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…

Slentrol causes an elevation in liver enzymes in humans. What exactly does that mean? Well, it could mean nothing, but believe me, if Pfizer even thought that they could safely market this drug to humans, they would, so, though far be it from me to speculate on human medicine, I’d be a bit worried about taking this drug myself.

While at the Pfizer facilities, my classmates and I were able to visit with scientists in the both the research and development phase of the drug. As soon-to-be veterinarians, not only did we have questions about the indications for this drug, but we were also concerned about keeping our patients’ pills in our patients (and not their owners). Slentrol can be used in a biphasic weight loss plan in your dog (dogs only; Slentrol has definitely not been approved for use in cats) to take the weight off slowly and then keep the weight off. It’s a great addition to the arsenal vets have to fight canine obesity, along with low-fat high fiber diets and exercise… hmmm… sounds familiar.

Anyway, why this Slentrol-centric post? Well because the Colbert Report (one of my favorite shows) featured this dog drug on its segment “Cheating Death.” Colbert even references the dangers of humans taking veterinary drugs

Enjoy!

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.

It was a unique opportunity for me (since the other five people on my rotation didn’t have the chance) to get to do this cryptorchid castration.  My little patient had a retained left testicle, floating around in the inguinal canal… and you know the strategy for extracting the little bugger?  Just find it and cut… or as my junior surgery professor told us “No nut, don’t cut.”  He also was the professor who made it known to us that dogs are quite “scrotally conscious,” which is the reason why most canine castrations are done the way they are–by only incising above the scrotum and popping the soon-to-be-no-longer testes.  (Believe me, next to lancing an abscess, it’s one of the most satisfying feelings a veterinarian can experience.)

A hard-fought but exciting experience finding the restless testis!

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.

On Tuesday we go to a nearby town’s Humane Society shelter to do anywhere from 12-18 spays/neuters.  The drive out there is about 2 hours, so we had to be at school at 6:30am–that was rough–but we stopped for a small breakfast along the way.  I did my first canine neuter and another canine spay that morning, shoved down my lunch and was anesthetist for a feline spay and neuter.  We stopped for dinner on the way home, and started to really get to know our clinician and technician, as well as our classmates.  With a pretty large vet school class, you can make it through three years without necessarily getting to meet each and everyone, so this year will be an interesting experience. 

On Wednesday, we had another three patients, so the anesthetists from Monday swapped with their partners, and my friend K served as the anesthetist for my 77-pound female Weimereiner who had been used as a breeding bitch before being adopted by some great clients, the people who brought her in that morning.  The procedure was long and mildly frustrating as I had to make a pretty long incision comparative to my classmates with a tiny dachshund and a cat to spay, due to the turgidity of the reproductive tract and our worry about possible complications.  Luckily there were none, but my classmates both finished before I did, and my clinician, I felt, was being a bit unfair by hurrying me along as I was suturing the body wall.  My friend K could tell I was frustrated and helped to calm me down and the procedure was great, but it took a long time for the dog to recover after being under anesthesia for so long, so we had to sit with her until her temperature returned to normal. [It's difficult for animals to thermoregulate while under anesthesia due to the depression in their consciousness.]  When we extubated her, we saw that she had some mucus in the lungs, so we started her on antibiotics to combat the upper respiratory tract infection.  I had to track down a clinician to sign the prescription (since ours had gone home for the day… at 3pm) and then pill my patient.  The only thing that kept me from losing my temper (something I absolutely cannot do on clinics!) was the fact that I knew that the next day I would be getting on a plane to go on perhaps the most frivolous but most necessary journey of my life!

My boyfriend lives far far away across the pond, so visiting him is a luxury that I am rarely afforded.  I’ve only been there once–last May-June–and I know I won’t be able to go again until I graduate, so I had been scheming about surprising him in our “week” break between third and fourth year until he told me about two formal events (apparently people in England get dressed up a lot fancier a lot more often than we Americans do) in May that I had gone to the year before when I was living there with him but wouldn’t be able to attend this year.  I began scheming about surprising him for one of the events, but do you know how hard it is to book a secret flight, some how finagle tickets to an extremely exclusive party and manage to get time off clinics all at once?  It’s pretty f-ing hard, so when we were on Spring Break in Turkey, I told him, and we began arranging the trip together.  He, being the amazing guy he is, split the plane ticket with me, and we began making arrangements.  Due to some sort of luck, the now-Drs./then-4vms were graduating on Thursday, May 8, so our rotation had nothing scheduled on that day, so I could leave Thursday morning after I checked out my patient.  That Thursday, I managed to finish packing, show up at school by 7:45am, check on my patient, medicate my patient, check out my patient (after a few laughs with her owners about the possibility of a veterinary tummy tuck to correct all that pendulous mammary tissue that comes with being a mommy), go home and take my own dog for a walk, go to the dermatologist at 10am, get three moles removed, get a pedicure, go home to eat lunch, collect my things and get to the teeny tiny airport we have locally to stand in line for 30 minutes watching an idiot check his dog.

Now, you can check a dog… or any pet animal for that matter, but it’s something that takes some knowledge and some time, and this poor boy had neither of those.  The flight was at 12:50pm, and I arrived at 12:15, and I know that’s cutting it close, but this airport doesn’t even open security until 30 minutes before boarding time, so being there the requisite hour early is pretty much a waste of your time.  There were 5 other people ahead of me in line, all checking in on American Airlines, all for the same flight (since there are only three flights out a day, each separated by a convenient 6 hours).  The boy standing at the counter with the dog crate had to be prompted for the veterinary certificate [Pets need a health certificate to fly; airlines are pretty good about letting you know what you need, and your vet should be, too.], the food instructions, the food and then finally, the pet, as it turned out that his girlfriend was sitting about 20 feet away with the small chocolate lab puppy.  It’s amazing I hadn’t noticed her earlier, as she was constantly nagging about this and that, none of which should have been left to be dealt with 20 minutes before the plane was scheduled to take off.  Needless to say, there were some stressed people in line around me, and I can only thank my lucky stars that our airport is small enough to ensure that our plane didn’t leave without us.  I had a long lay-over before my flight to London, and when I arrived in England, it was Friday morning, and I’d barely gotten any rest, but I soldiered through it, and made it to Oxford where I met my boyfriend.  We thoroughly enjoyed our Friday together by stopping in at the Oxford Botanical Gardens to see Lyra and Will’s bench, as described in Philip Pullman’s The Amber Spyglass.  We enjoyed two meals on North Parade–a baguette for lunch in the park and some Indian food (since I can’t get it where I live) that night for dinner.  Mmm… that cheese nan and lamb korma… that’s what I dream about when I think about moving to an actual city some day.  We swung by to pick up our “tickets” for the ball the next day, and called it a night after streaming some great episodes of The Office (US, not UK).

The next day we walked around in a field for a while (not kidding) after a great Turkish breakfast, and then got ready for the big event!  There would be a lot to talk about regarding this event,–like how wunderbar everyone looked and how great it was to see everyone again–but I think most of it’s already been said, so suffice it to say that those Scholars certainly know how to push an agenda, and even when it’s one with which I agree, I’m not very agreeable when the rum runs out.

On Sunday I went home.  Flying home from England is, after all, an all-day affair.

Monday morning bright and early I had great intentions to ride my bike to school, but as usual with the weather the way it’s been, I was forced to drive (with gas at $3.62/gallon).  I was hoping that our schedule would turn out the way that it had last week, and I could kind of sit Monday out (as anesthetist) but no such luck.  Instead, I found myself as the only student on the rotation with a patient coming, so I got to spay a cat with all my colleagues in the room, watching.  Not really watching, actually, but waiting with baited breath for me to finish my 1 hr 25 minute spay as we were doing a declaw (onychectomy) after I finished the spay, and each of us would get the opportunity to participate.  The day was short, though, as felines tend to wake up from their ketamine and inhalant anesthesia much more quickly than canines from propofol and inhalants, so we were home early once again, and I was able to unpack and sleep.

Tuesday found us once again on the road to the Humane Society, where I spayed two TINY dogs (pediatric spays are astonishingly different from mature spays).  Wednesday was boring, with once again only one case coming in.  Since I was leading the group with spays, I just sat and watched, but Thursday and Friday were full days! 

Thursday was another shelter animal day–this time the local shelter–where they seemed to have a plethora of adorable pups needing neutering.  I got to do a cryptorchid surgery and a canine castration and canine spay. 

Friday we were doing surgery on the feral cats caught around the area by our feral cat alliance.  I did my very first cat neuter and decided that I’m going to open a clinic for big friendly dogs neuters and already-anesthetized cat castrations.    Our clinician had rounds with us and told us that we were one of her “most favoritest” groups in the last five years she’s been doing this, and that she hopes the rest of our class lives up to us.

I hope I live up to that kind of praise on the rest of my rotations!

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.

In this blog, I would like to share what I’m up to, including many achievements and many more frustrations that accompany life in the world of veterinary education.  I’ll have pictures when appropriate and funny stories when at all possible, and it is my sincere hope that this blog will bring others as much enjoyment to read it as it brings me to write it.

So before we finish this, a final disclaimer–
It is not my design to be purposefully vague about the institution I attend or my personal life, but I feel with the world the way it is–hiring and firing and the like–it’s best to not be so specific, especially with an email (subject:  Violation of Ethical Standards) ike the following being held over our school’s students, faculty and staff by our Dean:

This is an important reminder about the impropriety of exposing college related/medical/patient material on the internet or other media resources. It is imperative to exercise good professional judgement when making a decision to post a college-related photograph on the internet/other media, including Facebook and MySpace and other personal exposure tracks. Such additions can constitute violation of professional veterinary medical ethics.  

    Two specific types of circumstances are especially disconcerting.

1.  It is unethical to publish any information that could be used to identify a clinical case that has been a patient in the Veterinary Medical Teaching Hospital.  This is especially true of photographs wherein the patient or owner can be identified.  Patient information, including photographs, is never appropriate to make public without the specific written authorization from the owner; and students do not have the authority to seek such permission.

2.  Remember that you also must use exceptional professionaljudgement before sharing any photographs from college-related activities that would/might be considered graphic by the generalpublic.  Surgical incisions, animals under anesthesia, diagnostic procedures  et al are necessary, everyday occurrences for our profession.  However, these very same scenes may be offensive and/or easily taken out of context by the public; such medicalscenes and activities can be very disturbing to others. And they reflect negatively on this college and university, irrespective of how innocuous or trivial they may seem to college members.

   You must think carefully about potential consequences before posting any photographs involving clinical or research material. A good rule to follow is….if there is any question at all, do not do it! You carry an essential expectation of professional and ethical conduct.

Yikes, I know.  We’ll try to keep the violations to a minimum here

So here’s my adventure into fourth year and the realm of blogging!