Jello flavours that didn't make the cut

Grape and beef liver and cherry and beef kidney. Yum.

No, these were not for eating (to state the obvious). We were using them to practice biopsies and fine needle aspirates using ultrasound. I may have mentioned before that I'm terrified of ultrasound. Like, it might as well be alien technology (hm, maybe I should have stayed in my costume...). But that's no reason to avoid it. If anything that's more reason to work with it as much as possible.

I was lucky to get my name drawn to do the biopsy/FNA wetlab this afternoon. Of course, it's Halloween, so that meant quickly changing out of my 11th Doctor costume before running down to the radiology department. After a brief introduction to the equipment, the vet guided us one on one in taking a biopsy of a bovine kidney buried in grape jello. It was dark enough that you couldn't cheat by looking for the kidney, and I actually surprised myself with how kidney-ish the kidney looked on the screen. Granted, jello is an almost perfect medium for conducting ultrasound because there's nothing in it, and it's uniform densitty and it conducts the sound waves really well. But I could see the needle on the screen going into it and felt the "pop" when I hit the capsule, and managed to get a sample. Very cool. The vet compared it to playing video games. Always knew my Final Fantasy obsession would pay off. See, you're watching the screen. Your non-dominant hand (left for me) is holding the ultrasound probe, your dominant hand is holding the biopsy gun. (You could do it the other way, but I agreed with the vet when she said, "If I'm going to be stabbing an animal, I'd rather do it with the hand I have the most control with." Wise words.) Is it easy? Oh lord no. I found out my left hand likes to think for itself, because it kept wanting to drift around. Next thing I know, I can't find my needle on the screen because the probe is now an inch away from it. Stupid left hand.

Then it was on my own for fine needle aspirate. You're taking a smaller sample, so you just use a normal needle with a syringe. I'd been practicing pulling back a plunger with one hand, and figured I was getting pretty good at it. So I poke into the cherry jello, down into the kidney, and flick my thumb to pull back the plunger and take a sample. Yeah, you didn't really believe that, did you? The bloody plunger wouldn't budge. After trying it one handed (the correct way) for a few minutes, and therefore, looking like an idiot for a few minutes (luckily, just in front of my peers, not in front of the vet), I finally had to give up and adjust my grip to get a sample. Lesson learned, I have weak puny thumbs.

As a bonus, the vet told us we were welcome to use the jello for a few weeks while it was still good and we could come down after hours to use the portable ultrasound machine to practice. I plan on doing this. I also plan on embarking on an intense strength training program for my thumb.

Of course, that was completely intentional

Today we did physical exams of lab animals. Mostly mice and rats. More rats than mice, actually. Lab mice are hateful little buggers and will try to bite you at every available opportunity. Right up there with budgies. Rats are adorable little cuddle monsters though. At least the ones at school are. There isn't a lot to a physical exam on a rat. Temperature, respiration and heart rate are all pretty much impossible to take. A lot of it is palpation and visual inspection.

The rat pooped on my classmate who went first. It landed on the table, luckily. No big deal, it comes with the territory! But that doesn't mean it was fun, so I was glad the rat got it out of his system, litterally. I took my turn, scooping him up and talking baby talk to him while I looked at his eyes, nose, ears... "Oh you are so COOOT! Look at your little nose, I could just cuddle you all day!" I plunk his butt on the table so I can hold him under the front legs with one hand and palpate his abdomen with the other. My hands are small, and I can't quite do it without using the table as a stabilizer. This turned out to be lucky.

Thirty second later, I noticed a puddle on the table.

As I'm finishing up my exam, the vet/professor comes over to see how we're doing and if we have any questions. "Wow, you got a urine sample, that's awesome!" He's kind of dead pan at the best of times, so I'm not sure if he's mocking me, so I laugh it off and hand the rat off to another classmate and go to wash my hands. The vet comes rushing back with a syringe to draw up the urine off the table, and asks us if we think it's normal looking. After a little session of Rat Pee for Dummies, he says, "Good job on the urine." Again, not sure if he's kidding, I replied "Oh, yeah, I totally meant to do that" in my best sarcastic voice to show I'm completely joking. "No, really, it's good. Usually they just pee on you. Well done for not getting wet!"

Yep. Today I got an A+ in Not Getting Peed On 101. It's a required course in vet school. It's 5% reflexes, 10% knowing animal body language, and 85% luck.

WTF Moments and Mental Black Holes

It's guaranteed that at least once during an exam, I will have one of the above. There's an important difference between the two, but they're equally frustrating.

A "WTF moment" happens when you encounter a question about something you're positive you've never seen in your life. Maybe you zoned out in class, or maybe it was at the bottom of a page and you skipped over it, maybe your cat fell off a table and distracted you while you were reading it. In any case, it's there on the exam and it may as well be written in Ancient North Martian. WTF Moments require you to do nothing but full on guess. Maybe you can extrapolate an answer based on something else you know, but sometimes you just circle C. Yesterday, it was Diagnostic Imaging. I was flying through it confidently until I hit a brick wall. That wall had a sign on it that said: "At what point in gestation does fetal ossification happen in the dog?"

I think I actually heard crickets in my own head when I read that. My brain looked at it and said, "Okay hand, you're on your own. Just pick something." It was in our notes, I later found out. We have Powerpoints and Word documents, and usually they're pretty similar. Unfortunately, the Powerpoints totally failed to mention fetal ossification and I hadn't read the Word documents.... My bad. I picked C. It was wrong.

Mental Black Holes are a totally non-understood phenomenon. You read something. You reread something. You reread it a third, then a fourth time. Thirty seconds later, and... it's gone. It doesn't matter how many times you try to memorize some trivial little detail, you can't. There's no rhyme or reason to why it happens. This cropped up on Bacteriology last week. It was a matching question. I had it down to Burkholderia mallei and Burkholderia pseudomallei. One causes glanders in horses, one causes melioidosis in humans. I'd like to point out this is the second time I've learned these. I had them on another exam for a Medical Bacteriology course a few years ago. You'd think after getting it wrong back then, I'd get it right this time. No such luck. My brain refuses to accept that B. mallei causes glanders. "I reject your reality and substitute my own". In my brain's version of reality, B. mallei causes melioidosis, because M goes with M and that's nice and easy to remember. I even tried during the exam to say, "Okay, so it's the opposite of what I think it is." But then I managed to talk myself into thinking that I thought that B. mallei caused glanders, so therefore, it causes melioidosis.

I looked it up when I finished the exam. I won't pretend I didn't bang my head against my locker door a few times.

Stream of consciousness

With two midterms this week, one last week and two more next week, we're all just a little out to lunch lately. We're all sleep deprived and giddy. Here are just a few of the thoughts streaming through my head.

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Why in the hell do oysters need a whole virus family all to themselves?! Damn greedy oysters.

Why do we have this giant list of antiviral drugs, when they're barely used in vet med?

E coli is hot stripper pink on MacConkey agar.

Citrobacter rodentium causes EPEC like disease in mice and gerbils. Like laboratory mice. Their genes have been spliced. They're Pinky, they're Pinky and the Brain, Brain, Brain, Brain....

Why is my cat on my shoulder?

Everything causes mastitis. Never look at a cow funny, it'll get mastitis.

Everything causes cancer. Or diarrhea. Those are the options.

So, equine papillomavirus causes papillomas in horses. But equine papillomatosus is caused by bovine papillomavirus. But it's also caused equine sarcoids. Shouldn't equine papillomavirus cause equine papillomatosis? Who names these things?!

PWMS, PRRSV, FeLV, FeSV, CPV-1, CAV-2, ICH, ICTB, E-I-E-I-O....

HERPES! Thank god it's herpes! (This wasn't me, it was a classmate rejoicing at finally getting through the retrovirus section.)

Greasy pig disease... Sounds kinda tasty, actually. Like bacon.

Yersinia pestis is carried by- KUROMI! YOU ARE BLOCKING MY VIEW! GET BACK ON MY SHOULDER!

I'm starting to see a pattern in treatment... 99% of the time, you're either going to give it penicillin or kill it. 

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....So that pretty much sums up where I am these days. Of course, sometimes, if you're lucky, you find out your professors are more or less on the same page. Today, it was our bacteriology professor. I'll leave you with this gem: "Erysipelothrix rhusiopathiae... It really does just roll off the tongue. It's very calming to say, it's like bacterial valium. I can almost picture a yogi, sitting on a mountaintop, chanting it....and levitating."

Sometimes it's easier to just let them do what they want

Midterms have more or less consumed my life right now, so forgive me dear readers, if I'm a bit quiet. We wrote Diagnostic Imaging last week, Public Health this week, Virology and Bacteriology next week and Diagnostic Imaging and Systemic Pathology the week after that. October basically just sucks.

There's still bright spots though. Fridays are pretty relaxed for us right now. It starts with Diagnostic Imaging lab. We tried to radiograph a classmate's dog today. I was supposed to be holding her back legs so we could do a right lateral thoracic view. I make no bones about the fact that I'm, er, petite as my mother likes to say. "Good things come in small packages!" she used to tell me. For the most part, this isn't an issue except in trying to find extra small gloves and extra small coveralls. Every now and then though... I have tiny little hands with short little fingers to begin with, so getting my hands around legs for restraint is already a challenge. Then with the lead gloves on (which aren't so much gloves as oven mitt shaped) and a dog who'd already laid there for one round of radiographs... Yeah, the rads didn't actually get done. It wasn't just me losing grip though, the other guy was having a rough time too, and the dog just wasn't having any of it.

Then we have Systemic Pathology and Virology, then lunch. No biggie, though Virology is often right up there with watching paint dry. ("Go blue! Go! Dry! Dry like you mean it!" - Decline of Video Gaming)

After lunch, we have Clinical Orientation II. Playing with animals, yay! Today it was birds. Tiny birds. Tiny not-well-handled-before birds from a pet store. Budgies to be specific, and juvenile at that! Never one to back down from a challenge though, I dove in and grabbed a bird. First thing you need to know about not-well-handled-before budgies: They bite. A lot. They have very movable heads that they can get into all sorts of bizarre positions and if anything comes even vaguely within striking distance, they will bite it. It doesn't really hurt though. You're definitely aware they're biting you, don't get me wrong. But it doesn't hurt enough to cause any sort of screaming or blood loss. I think in the span of a 5 minute or so exam, I must have been bitten a good 23 times. If you can deal with the pain, it's actually a reasonably good distraction method. At one point I had to switch him from one hand to the other to check his wings. He happily clamped down on my finger, but hey, it was keeping him calm so he didn't fly off! And now I can add "budgie" to the long list of animals that have made me a chew toy.

On being a soother

Friday was another physical exam lab. In two hours, we did swine, sheep and neonatal calf. Sheep and swine were about what I expected. Swine is mostly about observation. Body condition, behaviour, mentation, discharge, cleanliness, things like that. There isn't a lot of hands on. Sheep are fairly similar to other species, with a couple of key sheep specific things to look for, like anemia and checking feet.

Then there were the calves. One was two weeks old, one was three weeks old.

I really can't put into words how freaking adorable these little guys were. Big wet noses, long lovely eyelashes, big floppy ears... Ooh, it's enough to melt your heart.

So two of my classmates and I set to work examining this little bull calf. I'd been a bit nervous about doing this. Baby animals can be extremely unpredictable. Kittens are tiny balls of love, fluff, claws and teeth. Puppies are love, fluff, teeth and urine. Foals are tornadoes of flying feet when you try to restrain them at that age. I find adult cattle hard enough to work with sometimes, let alone three week old babies, 

It quickly became obvious there was a foolproof way to restrain this little guy - just let him suck on you. Oh it didn't really matter what. A hand, a boot, a knee... As long as he could try to suckle something, he didn't really care what was happening to him. We checked his sclera, felt his joints, checked his umbilicus, felt for a pulse, took a heart rate and lung sounds, with him clamped on someone's hand the whole time. He had no teeth, so it didn't hurt. Mostly it was weird. He kept at if for the whole 20 or minutes we were working with him, just alternating between the three of us. Part of me wonders how long he would have kept trying before he realized there was no food. If nothing else, his persistence was admiral!

My coveralls went prompty into the laundry. Mostly for biosecurity and hygiene. But also just to get the calf slobber off.

Validation!

Vet students are, on the whole, neurotic. More than one of us admitted to getting a little giddy the first time we saw ourselves in our coats or coveralls with our stethoscopes around our necks. I don't understand much about traditionally girly things, but I'm guessing that's sort of what a bride feels like the first time she tries on her wedding dress.

I have been obsessing over coveralls lately. I own two pairs. One is actually a youth pair. Have I mentioned previously that I'm only 5'0" tall? Unfortunately, the youth pair has long sleeves (not great for rectal palpations!) and it's slightly too short in the torso meaning I get a slight wedgie when I wear them and bending at the waist isn't really an option. When I bought them, I didn't realize exactly how full a range of motion I'd need to do a physical exam on a cow or horse. It also lacks enough pockets. A fourth year on clinics recently came in to the laundry office to buy a new lab coat and proclaimed: "Remember this when you get to clinics. You will need a lab coat that's two sizes too big because it's got to fit you, and all the stuff you have to carry." For labs right now, I'm carrying a pen, a penlight, a thermometer, a pair of gloves, and a tube of handsantizer. Pockets are essential.

The other pair is short sleeved and has lots of pockets! It even has the slits on the sides so you can reach into your pants pockets underneath. Yes, they are proper coveralls. They're also men's, like just about every set of coveralls I've ever seen. They fit in the chest, and are a little big in the waist, fine in the hips... but the crotch comes halfway down my thighs. Oh good lord, I look like I'm off the set of MC Hammer Goes To Vet School (note: not a real movie).

I'm no idiot, I know that when I start rotations in fourth year, farmers probably won't take me seriously. I'm 5'0", 120 lbs, and I'm so baby faced that I look like I'm 12. Oh, and there's the almost inevitable sexism, but that's another post. In some attempt to look credible, I've been toying with shelling out the $77 to get women's coveralls from a Canadian company online. It's a ridiculous price, given that men's are usually about half that and can be bought in several different stores around here. Then I tried to convince myself I was just being stupid and shallow. Who cares what I looked like? I know my stuff, I'll prove myself that way! When did I get all conformist??

Then today, another fourth year stopped in to buy coveralls. Sifting through the racks, trying to find a pair that fit her, she said, "I'm just trying not to look like an idiot when my external rotation starts next week." Hallelujah! Sweet validation! It's not just me!

Unorthodox study methods

Let's face it - this path comes with a ton of information. I try really hard not to cram and then forget everything the day after the exam (or as a pharm professor put it: "purge and regurge"). I try to focus more on concepts and what's going to be useful for the NAVLE and for clinical rotations. But sometimes, you do what you have to.

This has led me to some interesting study habits. Oh, there's the usual stuff like flashcards, endless rewriting and rereading of notes and drawing diagrams. Study groups quickly got crossed off the list when I realized that my friends and I never seemed to get a ton of actual studying done. We get distracted by each other too easily and we end up spending most of the time joking and demonstrating physiological principles with candy from the Bulk Barn (yes, that did happen, I think a strawberry gummy became a heart, right up until someone ate it).

Then there's the more creative methods. In pharm tutorials, the prof had us play charades with pharmacokinetics terminology. My group is sure to get an Academy Award for our moving depiction of "ion trapping".

Then there's the time-honoured method of "Explaining things to your cat/dog/horse/cow/fish/rat/bird/etc". See, the rest of the population doesn't understand and, more importantly, probably really doesn't want to hear about the virulence factors of Corynebacterium pseudotuberculosis. Or the difference and the pathological significance of a firm lung versus a hard lung. But your pets? Well, they'll generally hang around as long as you're either petting them or feeding them and they don't talk back (unless you've got a bird or a Siamese cat) so they can't complain and tell you to shut up.If they do actually ever tell you to shut up, that's probably a sign you need to put down the book and go to bed.

Finally, there's methods you develop on the fly. A notable example: a not insignificant percentage of my class (yours truly included) spent some time on Sunday with a flashlight making shadow puppets. Why? Trying to understand magnification, subject film distance and focal film distance for our diagnostic imaging midterm on Monday. I used a shadow snake for mine.