Muscle of Inspiration

Sounds weird, right?

Yes, it did to me too, when I read it in anatomy lab. The scalenus is a muscle of inspiration. Er, well, it's a very nice muscle, but I'm not sure I really feel particularly inspired by it. My lab partners and I had a little laugh over it and then went on. The next muscle on the list was the serratus dorsalis cranialis. But this time, the wording was different. Something to the effect of "this muscle aids in inspiration".

Lightbulb turned on.

Ohhhh. Inspiration as in inhalation.


Bugger. That was dumb of me.

AVC Open House!

Yes, once a year the vet college throws open its doors to let the public see the parts of the hospital beyond the exam rooms. This is a massive undertaking. I think just about every single student and staff member helps out in some capacity. I was in radiology, explaining (to the best of my feeble first year abilities) radiographs to parents, kids and prospective students. I had a lovely chat (in between rushes of people) with a girl who wanted to know more about getting in to vet school.

I think the most common question I got was: "Are these pictures of dinosaurs?" Admittedly, having been a dinosaur-crazy kid at one point, it was actually a little heartbreaking to tell them no, they weren't. I wanted to point out that birds are sort of dinosaurs, but didn't think launching into the evolutionary history of avians was a good idea with a bunch of 7 year olds. Besides, after the eighth time a kid calls a radiograph of a crow a pterodactyl...

The parents had more trouble with the rads of the birds then the kids did though. At least the kids got it in the realm of "has two wings and flies". I had multiple parents though proudly point to the birds and proclaim, "Look sweetheart, it's a frog!" Yes, ma'am. That's the elusive Amazonian Long-Necked Beaked Frog. With Wings. 

Finally! Gross pathology rounds!

(And that isn't "gross" as in yucky, it's "gross" as in macroscopic or visible to the naked eye. Although some people would tell you that the first definition is just as appropriate.)

They're supposed to be every Thursday at 4:30, but sometimes, they just don't happen. I finally got to attend a session today though. The fourth years and the doctors present interesting cases that have come in for pathological analysis. To the unitiated, this is basically just looking at bloody bits of dead animal. And since I'm still woefully undereducated, that's what it seems like to me too. But I'm learning! Some cases are more interesting than others. Rabbit with a uterus full of cancer? Eh, pass. Goat brain with polioencephalomalacia that causes the brain to fluoresce under UV light?? Yes please! No one knows why it causes the brain to do this - there's theories that it might be related to break down of lipids, but nothing has been proven. You can see an example here: Polioencephalomalacia of ruminants

A day in the life

So, exactly what does a day in the life of a first year vet student look like?

This is a typical weekday for me:
7:00 - Wake up, shower, eat breakfast, collect various food for the day to take to school.
8:00 - Start job. Sort laundry, drop off for the service to pick up.
8:30 - Classes start. Class schedule varies by day.
12:30 - Lunch time. Depending on the day, I'm either working in the laundry room again (as I am now) or I'm attending club meetings.
1:30 - Classes (again).
4:30 - Classes end for the day. Find somewhere quiet to study or run errands or sometimes, there's extracurriculars (like Thursday is gross pathology rounds abd Fridays are physiology tutorials.
6:30 - Head to the gym.
7:30 - Leave the gym, come home, shower, eat supper.
8:30 - Study.
10:30 - Quit studying for the night, watch Doctor Who/Torchwood/anime/Daily Show/Colbert Report/Conan - depending on what strikes my fancy. Call parents/people back home.
12:30 - Bed.

Get up the next morning and do it all again! Weekends are usually tutorials, social events, extra curriculars (and sleep). And inevitiably, I end up spending almost as much time on weekends at school as I do on weekdays.

And now, a musical interlude

From our fellow prisoners (I mean, colleagues) at the University of Pennsylvania School of Veterinary Medicine. I give you... DYNAVET! Huge applause to these guys, this is just freaking awesome.

I had good intentions

So we didn't have class this morning. I was all prepared to pop into the anatomy lab and review some muscles and tendons and insertions. My body had distinct other ideas. Yeah, I gave in and rolled over and went back to sleep. I was dead tired. In my defense, I'm going on Saturday after the Histology tutorial. And next Tuesday is Anatomy jeopardy and I will be going to that!

Unfortunately, I missed clinical pathology rounds today. I had a doctor's appointment that ran long, so my options were eat lunch or go to rounds and well... Pizza won. What can I say? I'm weak. I will be hitting up gross pathology rounds after Anatomy lab tomorrow though! I like the clinical aspect, even though I don't want to be a clinician. But I'm a problem solver by nature, so seeing Antomy, Physiology, Histology, Immunology, etc integrated into real world cases is really helpful.

It's probably why I like Integration of Structure and Function (or Struck and Fuck, as my buddy called it in her notes...). That class is both exhilirating and mentally exhausting. It's okay, up until you get to the flow chart. We have to take each sign/symptom and draw them back through the anatomical and physiological mechanisms that caused them, tracing them back to the ultimate diagnosis. Unfortunately, we don't always know what we're doing. We're learning, but it's a lot to take in. A lot of consultation with Drs Google and Wikipedia (though I do not condone using them to diagnose in every day life, especially when used by people with no medical background at all). For example, we'll know that the spleen is involved in red blood cell recycling, but not quite HOW (because we haven't learned yet!). Our professors rightfully say we look panic stricken. Of course, panic stricken is how I'm approaching most of vet school. Most days I'm reminded of the saying, "If you can remain calm while everyone around you is losing their head, it's just possible you haven't grasped the situation."

In other news, I have a job! The Society for Atlantic Veterinary Students runs a laundry service. Students drop off dirty/smelly scrubs, coveralls and lab coats and they get sent out and washed and returned. They hire two students to staff the office for 5-6 hours a week and handle intake and handing out of clean clothes. I applied and got it! Not much, but it's easy to work around my schedule (mostly just means giving up part of lunch time and getting to school a half hour earlier or something) and it'll cover my grocery bills and then some. Plus it looks good on resumes and scholarship applications!

There's an old joke

It's a one-liner stating: The number one cause of death is living.

Sometimes, vet med feels that way. Especially as a new student without a lot of working knowledge. As vet students, we come in with some basic science and whatever practical knowledge we scraped up in our work experience and volunteering. So especially during this first year, sometimes, it feels like we're fumbling around in the dark.

The course that's supposed to teach us to think like clinicians is Structure and Function. We're given hypothetical cases (based on real cases) and slowly given the information needed to work through them. The format is thus:
1) Basic pieces of data.
2) Record data.
3) Record known problems - what body systems are involved and what might be affecting them (infection, trauma, degeneration, etc)?
4) What further testing and information is needed?
We get more information, add the new data in with the old, and then we can start eliminating things off our initial list of hypothesis. Now, this is problem solving, and I love it. What I don't love is when your initial list of problems consists of nothing but "lethargy" and "inappetance", as it did with this week's case. Do you have ANY idea how frigging long the list of possible causes for "lethargy" and "inappetance" is?? It goes on forever! It more or less includes everything that could ever possibly go wrong.

Eventually, it was immune-mediated hemolytic anemia. We think. No one's confirmed it for us, but after getting CBC values and a decent physical exam, that's what we came up with. My point, dear reader, is that your vet is not magical. When they say they need to run Test X, they mean it. There's a lot of symptoms that present with a lot of diseases. It's really hard to tell them apart with vague symptoms though.

The Buddy System

Remember when you were in second grade and you'd go on field trips? The teacher would put everyone in buddies, to make sure no one got lost.

I'm now 24 and in vet school, and the buddy system still applies. At least at AVC it does. Each incoming first year is assigned a 2nd, 3rd, 4th year student, a faculty member and maybe a staff member. It's fantastic! You essentially have a built in support system of people who have been there and done that. It's also tradition to pass on your notes to your buddy. Today, I got my "buddy binder" from my 2nd year buddy (who is a sweetheart, and left me chocolate and Sharpie highlighters during my first week; I will be returning the favour soon!). Except it's not a binder. It's a box. A box containing three massive binders full of everything she did last year, and helpful notes about how certain professors test, where pictures are helpful, etc.

I went to a histology tutorial this morning. Dr Singh (who must really love to teach) was offering it. I've been having little coniption fits in histology lab, because I know exactly what I should be looking for, I just can't ever seem to find them. Example: Intercalated discs. I know what they are, what they look like and where they're found. But I couldn't find one on the slide. So today, I asked Dr Singh if he could point one out to me. He couldn't find any either. The slides are all of the same tissue, all taken at the same time, but all are slightly different sections. Think of a slice of raisin bread. It was baked at the same time with the same ingredients as the rest of the loaf, but might have more or less raisins then other pieces. Likewise, not all features are evident on all slides of the same tissue. But I can breathe easy, because I do know what this stuff looks like, and Dr Singh said that for the exam, we'll all have the exact same image on a powerpoint slide on the board, and the features will be hugely evident. One tiny thing for me to stop worrying about!

The Elusive 77% Candidate

If you are a potential vet student, one of the first things you want to know is "How high do my marks have to be to get in?" There is no answer to that. Your grades are only one part of your application. Depending on the school you're applying to, and the rest of your application, they can be more or less important. We were told yesterday that our class average coming in was about an 87%. But remember - that's an average of 63 students, all with different backgrounds.

At all the information sessions I attended when I applied, the above question came up. All the admissions coordinator would say was "It's usually around an 85% for the class average." But he did often say that the lowest average they ever accepted was a 77% from a student who had the rest of her application be more or less perfect.

Yes, we got to meet the elusive 77%. She's just come back to teach large animal surgery at AVC. She graduated 10 years ago, and is now a diplomate of the ACVS. How cool is that? Being a waitlister, I've felt a bit like I was a second string pick, and I'm not good enough to be there. She gives me hope.

A Curriculum Run-down

So they went over with us in a little more detail about exactly what the next four years will look like for us at AVC. Each vet school in North America produces competent grads, but the individual paths vary a little. I'm here to elucidate what an education at AVC is like.

The first two years are what they call "foundation years". A lot of Semester 1 is spent getting everyone on the same page. We all have the same 20 pre-requisites, but those can vary within them. Plus most of us are coming in with more than those 20 courses, so we have extra background knowledge. So some of us are breezing through Physiology, while others are falling asleep in Immunology. Some people have zero experience with farm animals, while others come from a farming and 4-H background (the question "What's a feedlot?" came up at one point; I will emphatically state that it wasn't me who asked it!). We're all trying to fill in the gaps in our own knowledge. I have more of a cell biology/microbiology background, so Immunology and Histology are no big deal. I am pouring a lot of time into Physiology and Anatomy though. My housemate has more of a background in Physiology though, but less knowledge on Immunology. To future first year vet students: Don't panic. We all struggle with something, we're all strong in somethings.

Semester 2 continues more normal Physiology, Anatomy and Histology, while starting to introduce some diseases - Parasitology and General Pathology. We also get into some hands-on stuff in Semester 2 with Clinical Orientation I where we learn restraint and physical exams. In other words, Semester 1 and 2 are mostly about learning what's normal. Semesters 3 and 4 get into more diseases - in other words, learning what's not normal and what causes it. These are also the two semesters of "ologies" - Virology, Bacteriology, Systemic Pathology, Pharmacology. Semesters 5 and 6 are in year three. I'm told this is a seriously intense year. You start surgeries, you're finally learning the medicine, and you're *gulp* planning your fourth year rotations. Rotations are very important. There's a core of certain rotations you have to take, but the majority are up to you. Obviously it's very important to your future career which ones you pick. We were told today that most third years freak out about picking their rotations. We were also told that they worry needlessly and most people get what they want.

So you jump right from third year into fourth year rotations - no summer off that year! In November/December of your fourth year, you take the North American Veterinary Licensing Exam. You have 2 tries to pass and get your license (the Americans get 5 tries - unfair!). If you fail both, you have to take the Part C which is a hands on practical, but there's a huge waiting list to take it, and it costs upwards of $6000. The good news is that AVC has a 2 time pass rate of 98% on the NAVLE.

I plan on passing it the first time around.

In lighter news, tomorrow is our first field trip. Yay! We're going to a combined sheep/cow/poultry farm. And there's a conference on welfare in dairy cattle coming up at the end of the month (free for students). Dr Singh, the Super Smart Former Histology Professor (and current admissions committee guy) is doing tutorials in Histology on Saturday mornings. I will say this for AVC - the opportunities to learn are there if you want them! Histology is a funny subject for me. I get the theory, I've done it a few times before now. I second guess myself a lot when I'm actually at the microscope though. So guess where I'll be Saturday morning?? Definitely at the tutorial. I just need someone with me at the scope for awhile to point everything out ("That's a Perkinje fibre, that's a nerve bundle, that's a blood vessel, that's an intercalated disc") and I'll be fine after that. A lot of my classmates feel the same way though. A typical conversation in Histology lab goes like this:

Classmate A: Are you guys looking at the guinea pig skeletal sample?
Me: Yep.
Classmate A: What's the blue stuff?
Me: Which blue stuff? The blue stuff next to the blotchy red and purple stuff?
Classmate A: No, the other blue stuff.
Classmate B: I think it's.. collagen? Didn't he say collagen stains blue?
Me: Yeah, but only with certain stains, right? What's the blotchy stuff?
Classmate C: Muscle fibres... in cross section?

That's about it. We speak in vague colour and texture descriptions. We're really happy when we figure it out. Today, there were three "quiz" slides set up at the front. Not really quizzes, just for fun - fake case descriptions alongside the slides and we got to "diagnose" them. Which led to this scenario:
Me: The second one about the cow... We're just supposed to notice the huge increase in white cells, right?
Prof: Exactly.
Me: *feeling a tad smug* And they're monocytes, right?
Prof: No, lymphocytes, actually.
Me: *no longer feeling smug* Oh. So, is it an infection of some sort? The description said swollen lymph nodes, tired, inappetance...
Prof: They're lymphocytes. Bessie has leukemia.
Me:...