Tattoo.

Ever since I learned that I could cover old tattoos with new ones that I like more when I got my leopard gecko over an old, faded rose on my foot back in May, I've been obsessed with covering the other old, faded rose on my back. It's a tiny little lower back tattoo, about the size of a silver dollar. It used to be very pretty, but now the colors are dull and the detail is blurry and I just really dislike it.

So I've been designing a rat to go over it. I used Shutterstock free images as my base, and then took bits and pieces from different ones to create the final image. I'd steal the whiskers from one, the hind leg from another, the tail from another, and then use Paint to piece them together and the drawing tool to fill in or erase parts. I'm very happy with the results!

The text will be more flowy and script-like. This is the closest font I could find to one I liked. And it will curve around the tail instead of being straight like that. The saying is the one that my closest friends and I chose to have on our necklaces that we made in 7th semester. It means, "I'll find a way or I'll make one." Not only does it have special meaning to me because of those girls, but also because I really identify with it. What Rossie wouldn't? We couldn't get into the state schools, so we went on an adventure instead and did what it took to become vets.

Now just to find a tattoo parlor in Chicago or Indy so I can get it done while I'm on externships. I think I'll email Nic, the guy who did my gecko in San Francisco and see if he knows anyone he trusts in those areas.

Horsies!!!

I'm on large animal emergency right now. I love it so far. The hours are a little annoying (7pm-midnight or later, usually). But I love the one-on-one time with the animals. It's quiet, the lights are dimmed, they're sleepy and cuddly. We do walk-bys every hour and any treatments that need done throughout the night. Last night I spent 10 minutes holding a hot pack against a sweet little Arabian mare's shoulder, and feeding her treats and scratching her neck.

While I was in Nashville camping with Don a few weeks ago, I picked up some apple molasses horse treats at a dog treat bakery there. I used to buy treats from them all the time for my rats. They were crazy for the peanut butter blueberry cookies and the cheese sticks. But these apple molasses treats smell *heavenly*. The other brands I've ever given to horses, although the horses love them, smell like Milk Bones. Just bland and uninteresting. These smell like oatmeal cookies fresh from grandma's kitchen. Every horse I've ever given one to has started nickering and bobbing their head enthusiastically.

I just love horses. The sweet, musky smell of a horse barn is one of my strongest olfactory triggers for a feeling of calm and well being. When I was working at Purdue, one of my responsibilities was husbandry for the horses. I'd clean out anywhere from 6-23 stalls every day. I got really comfortable shoving horses around in a cramped stall without fear. I had those horses trained well, too. They didn't get hay until they backed into the far corner of their stall. Anyone trying to crowd me or bump the hay out of my hands got the stall door closed in their face. I don't tolerate bratty behavior from an animal that can kill me with one kick. Most of them would move to the back corner if they saw me coming with hay. The rest would usually only take one, firm "Back!" and they'd move. Occasionally I got a butthead or two who needed work. Then, after I was done cleaning, everyone got a quick scratch and a cuddle before I moved to the next stall. And afterward, if there was time, I'd brush them out, pick their hooves, feed them treats and love on them. Those were my babies. They were research horses, usually a terminal study, so they were euthanized at the end of their time. But I did my best to make sure their remaining days were happy, and all of my coworkers did, too.

And I swear, if I'd had the money or the ability to board him, I'd have adopted Bo. He was undoubtedly *my* horse. Bit a few other people, because he was a stall sour jerk. But we had one day where he tried to bite me, and I yanked his head down by his halter and made it very clear that I was not afraid of him, and from that moment on that horse loved me. He'd poke his head out and follow my every move in the barn, and lean against me for cuddles while I cleaned his stall. I still miss him.

But I don't want to go into equine practice. I've seen enough of my classmates who started out with a strong equine focus and switched to small animal to know that I'd burn out fast if I even considered it. They all say the same thing; they love to ride, have loved horses all their lives, but equine medicine made them hate horses because all you ever see is horses close to death, in pain, aggressive or scared. So I'll stick to cuddles and kisses and treats.

Compassion fatigue.

It's something every vet student hears about, has lectures on, awareness raising on social media about it... Compassion fatigue is, if anything, overly-emphasized in vet med. And for good reason. Our profession has an alarmingly high burn out rate, and suicide rate. My own professor, when lecturing on the topic, brought up a vet who she went to Ross with who had committed suicide with Fatal Plus euthanasia solution and an injection pump machine from her own clinic.

Today, Dr. Wallace, my beloved large animal medicine professor, linked to this article on Facebook. I'll quote the portion that made my heart clench in empathy:

"Veterinarians are determined, driven, type A people. We as a species hate to give up, we loathe defeat, and we give until the bank is empty. Our ability to maintain a level of empathy for every client, every incident and every patient is unrealistic. How does a normal rational empathetic person put a pet that they have watched grow from infancy to geriatric to sleep in one room and then walk ten feet away to another patient who you are expected to be jubilant and clear headed to examine, diagnose, and treat? Somewhere along the way we learn to mask, shelter, or disregard our emotions. Somewhere it became expected, and we learned to push feelings aside and press on. It is a recipe for a psychopath and a schizophrenic. And we do it every single day."

She goes on to say that we need to take better care of ourselves. Pay attention, stay clued in to what our bodies and our minds are telling us. Look for patterns of substance abuse or coping mechanisms in our own behavior that are red flags. And set boundaries. Learn to say no to clients.

It reminds me of a conversation I had with a clinician when my septic, failure of passive transfer calf was dying. I was watching him lying on his die, struggling to breathe, groaning with every breath, and just clearly in abject misery. He was receiving excellent care. He was on pain medication. But he was still suffering, because he was just continuing to get worse with no hope of cure. We were playing catch-up with his suffering as he continued to plummet.

I asked the clinician, "Have you ever reached a point where you fired a client because they wanted to keep going, but for your own sake of mind and your personal, ethical considerations you felt it was wrong to do so?"

He said no. He said we can control suffering with pain medication, or even induced comas if necessary. He said the owner had to reach the conclusion to end life on their own.

I agree, to an extent. I understand his position. But I disagree on one basis, and that is the sake of my own mental health. Yes, ideally the owner should decide to euthanize without you pressuring them to do so. Saying, "Euthanize or find another vet." definitely falls under the realm of pressuring a client. But if I am treating a patient past my comfort level, and I am upset, and do not want to continue, and feel it is wrong to keep going, and I do this often enough, I feel that I will burn out.

I had this exact conversation again with the anesthesia technicians when we had a particularly nasty case come in and everyone in the room felt that elective surgery in an animal that old and that ill was probably not in the animal's best interest. The technicians agreed with me, and said that they would be more apt to work with a veterinarian who set firm personal boundaries regarding quality of life than one who kept going in the face of suffering.

It helped re-establish my gut feeling that I am not being selfish, or a bad person, or a bad doctor, if I establish boundaries with my clients regarding end of life decisions. I'm pretty confident in my decision now that I will reserve the right to gently, but firmly, show them the door if need be.

Go to sleep, little kitty!

I'm on anesthesia rotation right now. Ax scares the crap out of me. The drugs we use to induce and maintain anesthesia have some profound systemic effects. They slow the heart, drop blood pressure, make them stop breathing... It's scary. When you think about the fact that the Illinois teaching hospital is a referral hospital, and we don't get average, every day, healthy pets for the most part, but difficult, involved cases, often with multiple combined illnesses, it's terrifying.

Usually, an Ax protocol goes like this:

Premedication: This is to make the animal sedate and relieve anxiety before placing an IV catheter and and inducing anesthesia. Usually a combination of an alpha-2 agonist or benzodiazepine with an opioid.

Induction: After you've placed an IV catheter, you induce anesthesia with propofol, thiopental, alfaxalone, etc. These agents usually induce apnea (no breathing). You've got about a minute from the time you induce until you need to have an endotracheal tube in that animal so you can hook them up to oxygen and ventilate them if necessary. It can be very scary. Cats in particular are difficult to intubate, because their largyngeal muscles spasm with stimulation and can cause a dry choke where their airway closes and then you cannot get a tube in. We often use a lidocaine splash block on the arytenoids to desensitize them and then use a thin wire stylet to guide the ET tube to avoid that.

Maintenance: You can use a TIVA (total intravenous anesthesia) of a combination of drugs to maintain sedation, but more often we use inhalants. Inhalants like isofluorane are extremely cardiovascular depressive. They cause hypotension and bradycardia.

That's all pretty intense, in and of itself. If you also have a bunch of complications that make you have to be very selective in your choice of drugs, and have to add CRIs (constant rate infusions) intra-op to correct the things that the anesthetic causes (dopamine to improve blood pressure, diuretics to improve blood flow to the kidneys in renal failure patients, dextrose for hypoglycemic patients)... Shit gets complicated and intimidating.

Two of my anesthesias wound up being cancelled because it wasn't safe to anesthetize them. Both were very involved, with bad systemic illnesses, and I was scared. I'm glad they were cancelled, not just because it was very unsafe for them and likely could've killed them, but also because it was a relief that I didn't have to go through with it. I am very happy, though, that I spent a long time researching for each case, carefully putting together what I thought was the safest anesthetic protocol uniquely crafted to that patient, and each time the faculty or resident anesthesiologist barely altered it at all. And my protocols were REALLY involved. Each of them involved 2-4 premeds, a co-induction with propofol and fentanyl, and at least two intra-op CRIs. Both had hypotension concerns, so I needed to keep my inhalant down as low as possible while still keeping them under.

It's nice when a board-certified specialist looks at your work and says, "I'm happy with this. Tweak this a bit, lower the dose of that, and we're good to go." And those changes were based on experience with those drugs in the specific conditions my patients had that I don't possess yet. So I'm pretty pleased with my performance so far.

Long distance vet.

Recently a friend of mine in Australia messaged me about a lump on his cat's jaw. He had an appointment with his regular vet in a few days, but he wanted my take on it. The cat was older, and a few differentials popped into my mind, some of them not very good. I asked a few questions that would help me narrow it down:

Where exactly is it located?
Is it hard or soft?
Can you move it around in the tissue, or is it fairly fixed in place?
Is there pain associated with it?

The answers did narrow down the possibilities, unfortunately not in a direction I liked. I had to tell my friend that I was highly suspicious that this was an aggressive form of cancer seen in older cats, particularly in the location he was describing on the mandible, called squamous cell carcinoma. I told him I really hoped I was wrong, as I had not seen the cat myself, but given the description that if I were to work up this case SCC would be at the top of the list.

It's really, really hard delivering that kind of news. Particularly when someone isn't expecting it. I knew my friend well enough to know that he wouldn't want me to bullshit him. He'd want the facts, no matter how hard they were to hear. So I warned him that this does not have a good prognosis, as even with the most aggressive treatment (surgery to remove part of the jaw, chemotherapy, radiation therapy), most of the time the cancer has already metastasized by the time it's detected and the cat will die within a few months.

Turns out that SCC was confirmed with more tests. My friend opted for palliative therapy with pain killers and soft foods to make her comfortable for as long as possible, until the other day when he had her humanely euthanized at home. He's since written me a couple of times thanking me for my help and support. I was kind of taken away by his gratitude, because from my perspective I hadn't done much other than deliver some really bad news. His vet was the one deciding course of treatment and administering those treatments to make his old girl feel better.

It's a reminder that in this career your bedside manner, empathy, and a shoulder to cry on are equally if not more important as your skills as a diagnostician and clinician.

Graduation date.

For the last 3 years, we've all been looking forward to graduating in New York City. It seemed so glamorous, so romantic, so thrilling! We'd wear fancy clothes and pretend we're fancy New Yorkers for an evening. It made it more special somehow, for a lot of us.

Well, screw all that, because we're graduating in Florida. Hot, sweaty, sticky Florida. Graduation has been announced. We'll be graduating at the Bank United Center in Coral Gables, Florida on June 13th, 2014. No one in my class is happy, except perhaps the people who already live in Florida. The rest of us are bitching about frizzy hair, melting makeup, sweaty clothes, and the decidedly less glamorous location taking away from our romantic, multi-year-long fantasy of New York.

I'm happy to be graduating. I'm not happy about looking shiny in all of my graduation photos.

Amazeballs.

I'm sure at some point in vet school everyone has a case that just takes them on an emotional rollercoaster, makes them exhausted and grumpy at times, and elated and walking on clouds at others. I just had my first one.

On Tuesday at around 3:30pm we got a call that a 4-day-old downer calf was coming in. When he arrived he was "flat out" meaning on his side, unresponsive, kind of comatose but awake. The history I got from the owner was that the calf had been at the teat constantly, and crying through the night. It sounded like he wasn't getting enough to eat. My top differential was failure of passive transfer. Either mom wasn't producing enough milk or her teats were blocked or something was causing this calf to not get enough colostrum in his first day of life and he wound up immune compromised.

His serum total protein was 5.0g/dL, which was a good indicator of inadequate maternal immunity transfer. A value of 5.5 or above indicates adequate transfer. Normal serum total protein is around 7.0 with half being albumin and half being globulin (antibodies). 5.0 - 3.5 = 1.5. So he got something, just not enough. Unfortunately his blood glucose was 38 and he had a fever of 103.7. So that steered my differentials away from purely failure of passive transfer and into FPT and a secondary septicemia. He had an expiratory grunt and when I listened to his lung sounds they were harsh on expiration, leading me to believe he had a lung infection. We stuck an ultrasound probe on his chest and saw thickening of his pleural membranes and some consolidation.

So at that point my problem list was:
- Hypoproteinemia
- Hypoglycemia
- High lactate (4.9 yikes!)
- pleuritis
- dull mentation/weakness/ataxia

We gave him a fluid bolus of 1L of saline and then started him on an 8% dextrose drip to help with the lactate and hypoglycemia. We gave him some anti-inflammatories and antibiotics for the infection. And we gave him a unit of plasma for the low protein and lowered immunity.

Over the next two days he got a little bit better, started drinking from a bottle again. Then on Friday he crashed and burned. We'd corrected his lactate and his glucose, both were within normal range again. But his ataxia suddenly got worse, his mentation plummeted, and he started head pressing. So what had originally been our secondary neurological signs became suspected primary. We did a CSF tap and sent it to clinical pathology. I was sitting in the breakroom typing my SOAP when I saw the clin path people walking down the hallway toward the in house large animal ward and I thought, "Oh no..." Because clin path people don't belong down there. They stay in their offices and lab upstairs. If they came down for this, it's bad. I ran out the door to catch up with them.

Sure enough, Dr. Russell greeted me with a print out and he said, "This should make your skin crawl." The protein in his cerebrospinal fluid was 5.2g/dL. That's higher than in his blood. Normal CSF has a total protein of around 0.5g/dL. The total white cell count was 113,000/mL. Normal is 10-20/mL. Translation: Calf has an infection in his brain. The fluid was analyzed and showed high numbers of intracellular and free short, thick rods. So we added bacterial meningitis to the problem list.

We switched his antibiotic, since clearly the first one was not working, and over the next 48 hours changed his fluid rate, dextrose concentration, and fluid type half a dozen times based on seesawing blood work results. We added a nasogastric tube and feedings every 4 hours. And we also administered mannitol three times, which has to be given slowly over a period of hours and the patient has to be monitored the entire time for respiratory distress because if it's given too fast it can cause pulmonary edema. Basically, I lived at the clinic Friday and Saturday. And Saturday I was on call for ambulatory service and had to go on three farm calls as well as keeping up with his treatments. Thankfully another Rossie was on RAHMs with me who was helping me out with the calf when I was away on a call.

It was very touch and go, but then I got news that he had finally passed some feces. I came in and he was standing, alert, and hungry! He sucked down a bottle last night on his own and again three times for the overnight students. He ate very well this morning and is much more "with it" mentally. Things are looking very optimistic for him.

This is the first time I have personally been responsible for the care of a patient who has gone from completely unresponsive and mere hours from death, to making a full recovery (almost there, give it another couple of days). I did that. And it feels incredible. Pulling 12-14 hour days five days in a row, sitting in a stall with a comatose calf for hours at a time, not seeing sunlight because I'm there before it comes up and leave after it goes down.

When I was serving tables as a waitress, if I had a long night or a bad night, I hated the world. I was miserable. Even at my most exhausted and sore and disappointed this week, I was never in a foul mood. I guess that's how you know you're in the right field.

NAVLE.

My exam is scheduled. Tuesday, December 10th at 8am I'll be taking my veterinary licensing exam. I pretty much want to vomit.

Making a decision.

These past two weeks I've been on lab animal rotation. And I have to admit, I was bored stiff most of the time. The sad part is, I was following around an actual, board-certified vet the entire time, so it's not as though my experience wasn't an accurate reflection of what her day to day is like. And her day to day is spending most of her time behind a desk, or in meetings. Clinically, there was very little going on.

I think this has solidified in my mind what path I want my career to take. And it kind of breaks my heart a little. For the last four years, I've had my mind set on a career in lab animal medicine. And the primary drive for that was because I care deeply about rodents used in lab animal medicine, and want to make beneficial changes in their housing and care. And let's face it, there just aren't that many people who deeply, genuinely care about mice and rats. Being one of those people, I feel a responsibility to go into LAM.

Unfortunately, I no longer think it would make me very happy. I love the hands on stuff. Surgery, especially. And you just don't get to do that much surgery as a lab animal vet. Or many treatments, for that matter. The researcher does most of their own surgeries, and the technicians do most of the treatments. I would hate being stuck behind a mountain of paperwork, and in meetings, all day, every day, with very little practical work with the animals.

The thing that sucks is that while a boarded lab animal vet can hope to make anywhere from $90-120K, an average small animal vet makes about half of that. The hit in salary is a hard pill to swallow. Also, the knowledge that my professional life will be harder in private practice. Clients will get angry at me, they'll be heartbroken when I can't save their pet, I'll be heartbroken when I can't save their pet. Emotionally, the toll private practice will take on me will be much, much worse. The hours will be longer and less predictable. All in all, private practice is a less cushy, comfortable job than lab animal, any way you slice it.

But I can't ignore my gut. And these last two weeks my gut has been telling me, "This is awful. You'd be bored, frustrated, and miserable. You're itching to get your hands on an animal after two WEEKS. Imagine two years. Or twenty."

So I think I'm going to pursue small animal private practice. Which terrifies me, to be honest. Changing my plans in such a huge way, the financial hit, the unpredictability and drama of private practice. It scares me to be leaving my comfy lab animal bubble. And there's a part of me that feels like I'm betraying and turning my back on the rodents that need me to be their advocate, and that hurts a lot. But I think I'll be happier in the end.

Left my heart...

Lately I feel more and more like a child of two worlds.

The weather is getting cooler here in Illinois. Fall is almost here and I'm loving it. I grew up in the midwest, and autumn is absolutely my favorite season. I can't describe the perfection of a beautiful fall day to someone who grew up somewhere without a true autumn season. The sun is warm, but the breeze is crisp and cold and makes your cheeks pink. The sunlight filtering through leaves so brightly jewel-colored red, orange and yellow makes you feel like you're standing in a kaleidoscope. The air smells like woodsmoke and baking spices. It's been my own personal Nirvana since I was a kid.

Then I moved to St. Kitts. At first I hated the heat and humidity, but soon I grew accustomed to it. I fell in love with the coqui frogs at night, and the serenity I felt floating face down watching brightly colored fish darting around me. Now when someone still at Ross posts a photo of themselves on the beach, I feel a pang of longing to be there. I miss the ocean and eating barbecue chicken with my feet buried in the sand. I miss my friends. The island got under my skin in a big, bad way and I miss it so, so much at times.

Apologies.

I know I've been really lax in updating lately. It's a combination of being busy and tired and just not having too terribly much to say.

I finished my diagnostic medicine rotation last week. Necropsy was rough. Large animals like horses and cows are a serious work out to necropsy. I was so sore I could barely move some days. I went home with dried blood still on my elbows a couple of times. I'm not a fan, basically. It can be cool to see lesions and find the cause of death, but overall, it's a lot of bloody, nasty, hard work. But I got a good evaluation from the faculty, so that's nice.

I just finished my first week of my lab animal rotation this past Friday. So far it's been pretty slow. There were three first year students rotating through before they began classes last week. I mean, before they've had a single day of vet school yet they're on these rotations with fourth year students. It's kind of cool, I guess, for them, but I don't see that they get much out of it. The students on my rotation didn't seem all that enthusiastic. And it certainly bogs down the fourth years' experience. I don't really get it.

One really cool thing we did get to do on Thursday was head up to Chicago to get some experience with non-human primates used in animal research. I won't say much about that, because animal rights groups tend to go insane at the mention of research monkeys. I can assure you that all of the ones I saw were socially-housed, got lots of enrichment through music, toys, food, etc. and were in good health. Getting to pet monkeys for a day was pretty awesome.

It's finally getting cool here. Down in the 70s today. It was lovely. It's cool enough to sleep with my A/C off and the windows cracked tonight. I'm looking forward to my apartment smelling like the outdoors again.

I've been dieting, trying to lose some weight before graduation. I'm down six pounds so far!

Boo do doobie doo.

Not much to say. The Ross summer semester officially ended on Thursday, so I have officially completed one semester of clinics (OHMYGODholycrap!).

I'm on Diagnostic Medicine right now, which actually takes up two blocks for a total of four weeks. I'm spending the first two weeks on cytology, and the last two weeks on necropsy. I really enjoy pathology, it's another aspect of medicine that feels like a treasure hunt to find the answer. Unfortunately, I'm not as good at it as I feel I am with imaging. My eyes don't pick up things as easily when they're microscopic on a slide, or surrounded by a puddle of gelatinous blood on a necrotic piece of tissue. But so far my skills in ctyology seem comparable/slightly above those on rotation with me, so I don't feel too bad.

I do remember being much, much better at recognizing cells in 3rd semester during my Clinical Pathology class, though. However, we were looking at slides several times a day every week, so that likely has something to do with it. And I have gotten better over the course of the week. Yesterday I successfully diagnosed 11 out of the 21 cases we looked at, and of the 10 I missed I had recognized elements that were right but I didn't arrive at the correct conclusion (i.e. saw a pyogranulomatous inflammation, didn't find the fungal agent responsible).

Anywho... Not much going on. Castiel is getting bigger. He's been neutered, and he's flipping crazy. I miss my calm, sleepy kitten when he first came to me (anemic and with gastritis, yeah, I know). But hopefully he'll grow out of this uncontrollable phase of climbing curtains and destroying anything remotely resembling plastic.

Okay, not as cute as a cat, but still. I like giant millipedes.

I bought brand new brushes a few months ago, and hadn't had the opportunity to try out the eyeliner brush yet. I love it! Using the brush and gel eyeliner makes drawing vintage cateyes a la Audry Hepburn super simple!

Winner!

I actually really like reading radiographs most of the time. Sometimes it's tricky and frustrating, but most of the time it feels like a treasure hunt for me that ends in an animal going home less sick than it came in. And I'm kind of good at it, too.

Back in 5th semester (I'm ashamed to admit this) I really slacked off on my DI - that's Diagnostic Imaging - midterm. There was a Pharmacology midterm right before it, and we were leaving for Puerto Rico a day after it. So, yeah, I wasn't my most focused. I didn't study hardly at all. Of 20 powerpoints on the exam, I had reviewed 11 the night before the test. I woke up at 4am the morning of the exam and rushed through the remaining 9 just hours before the exam. I was so afraid I was going to fail the midterm and have to catch up on the final exam. I walked away from that midterm with a 95%! Something about radiology just clicks in my head. Maybe I'm a visual thinker, I don't know.

So I was pretty confident going into my Imaging rotation. What I wasn't expecting was to find out that the Univeristy of Illinois students hadn't ever had a class on imaging. They had gotten it in bits and pieces spread out throughout their various coursework, but never a class devoted to imaging.

Suffice to say, I'm doing well on this rotation, and we'll leave it at that.

Today I had a pretty awesome little moment of victory. We are assigned three cases: bone, thorax, and abdomen. We are asked to study the case based only on a brief signalment and history (Ex: 9-year-old, male rottweiler, vomiting for two days), and interpret what we see on radiographs, and present the case along with our differentials to the class.

My thorax case threw me because some of the findings were contradictory. On lateral view, there was a HUGE soft tissue opacity centered around the base of the heart and dorsally elevating the trachea. The mass was more visible in right lateral than left lateral, indicating it was in the left lung. But on ventrodorsal view, it wasn't there. My first thought was a mediastinal mass, probably the tracheobronchial lymph nodes given its location, that would explain those findings. But then, the mediastinum was deviated to the left. Masses in the chest deviate structures away from them, not toward them. It made me start second guessing my diagnosis. I considered atelectasis, but couldn't explain why I couldn't see a retracted lung lobe on VD or why I could still see blood vessels in the lung extending out to the periphery of the thorax if there was a collapsed lung lobe. I ended up sticking with my diagnosis of a mediastinal lung mass.

The clinician specifically said that it was a challenging and confusing case. He said that the deviation of the mediastinum was odd and made you second guess yourself. Basically, I was given a deliberately difficult assignment and knocked it out of the park!

The little things.

One thing I am very grateful for inheriting from my mother is her positivity. My mom is just a naturally happy person. There are people in this world who I just don't understand how they function being as angry and miserable as they constantly seem to be. People who say, "Ugh, I hate ____" every other sentence just confuse me and make me sad. That isn't a statement against clinically depressed people. I've been there twice in my life, and I know it's different than just being a moody jerk. Plus most of the clinically depressed people I know, you would never guess it talking to them. I'm talking about people who are just negative all the time and unpleasant to be around.

The great thing about being a positive person is you can be having the crappiest day ever, and it only takes something small to bring your spirits right back up again. A nice day, a good cup of tea, and suddenly all of the stress and negativity is gone. And I truly do love that I'm one of those people, because it makes life easier.

Today I had a really hard time getting out of bed. I've spent the last six days in and out of our small animal isolation ward caring for a very sick dog with Parvo. I was exhausted and sore and did not want to get up to go do 7am treatments. I went, and left school around 9am and decided to stop at the Market at the Square, Urbana's farmer's market, on my way home. The sun was warm, the breeze was cool, the sky was blue with big fluffy white clouds, and the air smelled like summer in the Midwest. After a few minutes of walking through isle after isle of fresh produce and baked goods, I was in my happy place. I bought apple butter, cheese, sweet corn, and shortbread cookies. Now I'm in bed, cuddling with Castiel, sipping a cup of mint tea, and completely and utterly content.

Here's some pics from the market. It's truly one of the biggest and best farmer's markets I've ever been to.

I love it when there's a vendor that does this! They basically take every fresh lettuce and herb in their garden and combine it to make a salad mix. It's seasonal, so it's always changing, and delicious. I love to have it  with goat cheese fritters, dried cranberries and sunflower seeds.

A shuck your own corn truck! My favorite of all the vendors there.

Money woes.

Sorry for the big gaps between posts. The wildlife and exotic rotation was crazy busy. I got to do a lot of really cool stuff, though, including two zoo visits where I anesthetized and did physical exams on zoo animals. There was also a big wildlife component, so I got to restrain owls, snip off some necrotic bone and sew up a goose's leg, and put a nasogastric tube in a box turtle.

Right now I'm on small animal critical care. There are three students on the rotation right now (three Rossies of different generations - HOLLA!) and so it's actually pretty laid back and we have a lot of time to round on cases, or common clinical presentations, topics like fluids or specific diseases... It's nice.

One thing I will say about the first clinical semester is that you blow through money fast. Between a deposit on your apartment, furnishing a new apartment from nothing (sofa, bed, dishes, silverware, cleaning supplies, etc.), my parking pass for Illinois was $660, the NAVLE was $570 for the national exam fee plus another $225 for state licensure, $230 for VetPrep NAVLE study materials, etc. almost every Rossie I know that just started clinics this semester is almost broke. Some of them have to live on less than $1,000 for the next month and a half, including rent. It's insane that in clinics we actually get about $2,000 less on our refund check than we did in semesters 1-7.

The good with the bad.

I had a hard day on Tuesday. I took over a patient staying in the ICU from another student when I started on the wildlife and exotic rotation. She was an intestinal resection and anastomosis post-op that wasn't doing well. She wasn't passing feces and had hard masses of impacted fecal material in her bowels that weren't moving. On Tuesday her owners came to visit and she passed away in the room with them. It wasn't a very pleasant situation, her owners were very upset, and I took the brunt of it.

Later that day I was drained and moody and just wanted to go home. My last appointment was a snake with a persistent respiratory infection that we'd been trying to treat for over two months. Even with a culture and sensitivity, the antibiotics weren't clearing it up. We resorted to an antibiotic that can have some serious side effects, but would get some of the nastier bugs that won't show up on culture and the antibiotics we'd tried previously did not cover. The owner was understandably upset and reluctant, and for some reason was having a personality conflict with the clinician. Things got heated and he refused the treatment. I asked the clinician if I could go try and talk to him, because I felt like we'd developed a rapport earlier and maybe I could get him to come around. We felt this was kind of our last shot at getting this snake better, so she told me I could try. I went up front and sat with him and told him I was sorry that things got so heated. I explained again why we wanted to proceed with this treatment, despite its risks. I told him it was ultimately up to him, and I'd understand if he still didn't want to, but that I didn't want him to walk out angry and to not at least try the treatment because of a personality conflict and tempers getting out of control.

Well, he agreed to the treatment. He also told me that he's working on a Master's in counseling, and that I am very good at conflict resolution and empathizing with people. It kind of made my whole day.

Second rotation down.

I just finished with my small animal ER rotation today. Basically, I don't like emergency medicine. It's just not my bag. I hate the heartbreak of it, I hate feeling helpless, and most of all, I hate having the money conversation. ER fees are hefty. Most 24-hour clinics charge a $100 exam fee, and that's just to get the animal seen, not including any diagnostics or treatments. After the emergency fee, bloodwork, radiographs, ultrasound, and ICU hospitalization fees, I was quoting owners $1,000-$2,000 routinely during this rotation. Many, many people don't have that kind of money these days. It was exhausting and sad and I really didn't enjoy it at all.

I am looking forward to tomorrow and the start of my exotic and wildlife rotation, though!

Hot dog.

An important message this time of year.

http://www.ebaumsworld.com/video/watch/82689781/

And just in case you're ever arguing with someone who thinks it's okay on a "cool" day: http://caninecollegemi.com/1758/pets-in-vehicles/temperature-inside-car-chart-2/

It only takes 20 minutes to reach 100 degrees in a parked car with the windows cracked on a 70 degree day. That's easily an, "I'm just going to run in and pick up a few things." amount of time.

Smoothie madness!

So this is one of those "kind of but not really related to vet school" posts.

Knowing that my hours were going to be crazy in clinics, I decided to invest in some supplements that could be added to a smoothie so that I could have a liquid breakfast or lunch on days when things were too busy for me to eat.

First off, I went and bought a smoothie-specific blender. Reading through reviews, a lot of them about the choice I wound up going with were negative and mentioned leaking. But I liked the design so much, I bought it anyway. I went with the Oster My Blend, which is basically a giant Magic Bullet. I haven't had any leaks, and it tackles whole, frozen strawberries and big chunks of frozen pineapple like a champ. Basically, it's cheap, and it works really well, and it's kind of cute.

Next I went in search of powdered supplements. On a recommendation from a friend, I wound up going with Amazing Grass products. I bought their chocolate Green Superfood supplement to put in my breakfast smoothies. It's not really a protein powder, but it's packed with veggies (broccoli, spinach, wheat grass). I just add a half cup of plain Greek yogurt to up the protein level. For lunch I bought the vanilla chai flavored Amazing Meal powder. This is more of a whole meal substitute similar to Slim Fast, but also has the super veggie mix in it. If I had it to do over again, I'd get the chocolate flavor of this as well, because the vanilla is a little too sweet for me.

Anyway, I just wanted to share. On the clinics side of things, I started my first night of small animal ER last night. It was not a fun night. We had one euthanasia that the owners weren't expecting (the referring vet diagnosed pneumonia, but the dog had vertical nystagmus so... definitely not).  And another crashing dog that had no PLRs and went into respiratory and cardiac arrest while we were trying to place a catheter. His glucose was so low it wouldn't even register on the glucometer (which means it's less than 20). We performed CPR on him for awhile, because the owner asked us to try and get him back, but after 15 minutes and no response to epinephrine or anything we were trying to do the owner gave us permission to let him go. It was kind of a heart-breaking night, actually.

Kitten stuff.

Castiel is doing much better. He's eating, he's more active, he just looks better and more hydrated instead of the sunken, lethargic thing he was. But he's still super affectionate and cuddly, and gets really upset if he can't be laying on me. He even lays on my feet when I wash dishes. I've always wanted a "Velcro kitty" that wants to be touching you all the time. Now I have mine. :)

Slowly, but surely, Mama is warming up to him.

He's just so gosh darn cute!

Clinics are still awesome.

My mid-rotation evaluation on Friday was all good things. They didn't even give me anything I needed to work on, just basically said I was doing great and that they loved my enthusiasm.

Today I started the ambulatory half of my RAHM rotation. It was a pretty slow day, with only two appointments. One of which was a pig euthanasia with captive bolt. That was upsetting to watch. Clinically, I know the pig isn't aware of what's going on after it's been bolted. But all the blood and bone/brain tissue, and watching it seize violently, it's not fun. I was a little shaken up for awhile afterward. Luckily my next appointment was a bunch of mares with foals, and I got to pet adorable, sweet babies with their velvety noses to cheer me up.

Clinics are just awesome. After two and a half years of intense study, I was beginning to flag and burn out. My energy and passion were just sapped out of me. Clinics has rejuvenated my enthusiasm and love of medicine. I'm excited about what I do again.

One small aside to the happy post, I had to take Cas into the ER small animal clinic at school today. He had gone 48 hours without eating and threw up several times. He was getting lethargic and sleeping constantly, so this morning I dropped him off in ER with permission to spend up to $200 on diagnostics before checking with me to order any further tests. They called me about an hour later with blood work and radiograph results that everything was normal except for some mild dehydration. They started him on metaclopramide (an anti-emetic and GI motility enhancer) and gave him some subcutaneous fluids. He threw up twice more, even with the metaclopramide on board, and still wouldn't eat. Then when I showed up at 4:30 to pick him up, he immediately went to his food bowl and started chowing down. He kept that down and ate again about 30 minutes ago and got his second dose of metaclopramide. So far, that's staying down, too. So it seems like he just had a really bad case of indigestion and got into a self-reinforcing loop of nausea, not eating, acid in the stomach making him more nauseated so he didn't eat, and it kept going on like that. Hopefully we broke the cycle and now he'll be fine.

New kitten!

Not a foster, this one I'm keeping.

I've been on the hunt for a kitten for awhile now. Mama went from being totally accepting of any new cat that I brought home, to hissing and hiding from any adult cat I brought home. I think the change happened right after Luna. But she accepted MJ after Luna because he was still a kitten.

Right now, in clinics, I have 12+ hour days on a typical week. I leave around 6:30am and get home past 6pm. When I get home, Mama is all over me, needing attention that I'm too tired to give. She's become increasingly restless and frustrated with me being gone or asleep all the time. So I knew I had to get her a companion.

I've been looking at kittens for a few weeks now, and just not bonding with any of them. The one time I did have a connection he had already been adopted. So I resorted to something I never do: Craigslist. *shudder* I know, I know. The person in me who has worked as rescue volunteer and foster for nearly 10 years feels so ashamed. But I really wanted to get this done quickly, and none of the shelter kittens I looked at seemed the least bit interested in me. I won't adopt unless I feel that special instantaneous connection.

I had a lady come over last night who was advertising a litter of kittens for adoption for a "small rehoming fee." He was the last of the litter, and at 10 weeks was starting to lose the tiny kitten adorableness. She was pretty desperate to get rid of him. I immediately started a mini physical exam on him the moment I got my hands on him. He reeked of cigarette smoke and had flea dirt all over him. And he went completely boneless in my arms and started purring, and I felt that tug of instant bonding I hadn't felt with the other kittens I'd looked at. Of course the fact that I had no intention of sending him home with this woman to get even more parasites and inhale chain smoking was also a big factor. I know she'll keep breeding. I know I haven't actually contributed to the well being of her animals. Trust me, I know, because it's the lecture I give everyone.

So I paid her to go away, immediately gave him a bath with dishsoap to kill the fleas I could, and then shoved him in the bathroom to run to Meijer (it was after 9pm, and Petsmart was closed) to buy kitten food and Frontline Plus.

Last night he slept cuddled up against me the whole night. He won't leave my side, and has to be touching me. Mama's cautious about him, but not hiding, so that's good. I feel confident she'll get over herself soon. I'm trying to squeeze him in at a clinic today to get FIV/Felv tested, a kitten vaccine, and dewormed.

Without further ado, everyone meet Castiel!

Clinics: day two.

In pre-clinics on St. Kitts, we were always told that Ross students did very well in clinics and that Ross grads had great reputations. And you really don't know how much of it is true and how much is bragging. Well now I know, it's absolutely true.

I was terrified about starting clinics. Scared I wouldn't know anyone, and all of the UofI students would already know and have relationships with the clinicians, and that I'd look stupid or incompetent. My first day was yesterday and I jumped right in with being assigned seven pigs for blood draws for pseudorabies testing and ear tattoos. Later that day I correctly diagnosed cecal dilation that most of the other students on the rotation were calling abomasal dilation. (Very, very close to one another, and it can be ambiguous, but the cecum extends farther back. I nailed it.) I also correctly identified lung consolidation on ultrasound.

Today I performed my first band castration, administered my first epidural, and manually reduced a rectal prolapse and put in my first purse string suture.

A lot of these things I'm doing for the first time. It makes me nervous, so I break out my notes before each appointment and do a really quick cram session. Each time I've done that I've been able to go into the appointment knowing enough to answer questions the clinician asks me, and have a general idea of what's going on. I won't know until I get my mid-rotation evaluation on Friday, but so far I feel like things are going really, really well.

And I've had one UofI student specifically approach me and ask for my help with a case because she feels I know what I'm doing. Two people have told me that Ross students on their rotations always appear to be the brightest in the group.

Ross did an amazing job preparing us for clinics. If you paid attention and worked hard in semesters 1-7, clinics will be an amazing, fun, and rewarding experience. You'll be exhausted, your feet will hurt, your back will hurt, and you'll feel like you're paying rent on an apartment for occasional naps (if you're lucky). But it's so worth it for that feeling of, "I know this! I actually KNOW THIS!"

Clinics: round one!

I'm all moved into my apartment in Urbana, Illinois. It's a nice one bedroom in a pretty nice complex. I have a pool just outside of my building (not that I'll have time to use it). Of course my bedroom is as pink, orange and yellow as it was in St. Kitts.

It helps in feeling like home. It certainly calmed Mama down when she was so anxious at the noise and bustle of move in day when I pulled out her blankets.

Urbana is that mix of small town and metropolitan city that I'm used to in college towns. And I've got a Meijer again! If you're not from the midwest, you won't know what that is. Imagine if you combined Wal-Mart low prices with Target quality, and the best produce section ever.

Today I'm just running some last minute errands, doing laundry, and tinkering around the apartment. Monday I start my first rotation - Rural Animal Health Management, also called "Farms" by the students. I'll be randomly assigned to ambulatory (farm calls) or in house on Monday, and then dive right in! I've been told to brush up on right and left displaced abomasum surgery, and respiratory diseases of large animals. So that's what I'll be doing all day tomorrow.

I'm a mixture of excited and terrified. But the people here are super nice, and we were basically told in orientation that if you volunteer to do things, answer questions when the clinician quizzes the group during rounds, and basically just try your best and have a good attitude, you will pass all of your rotations. Even gross medical errors, as long as you acknowledge them and work toward fixing them, probably won't fail you unless you try to hide it or make excuses. So hearing that helped a lot with the fear.

I'll definitely update when I can about clinics, but it's a busy time. I've already been told we basically live on campus from 6am until well past dinnertime most days. I already predicted that and bought a lot of protein powder to make smoothies to bring with me for liquid meals.

Pretty flowers.

If you've known me since childhood, you probably know that I love lilacs. A lot. I had a lilac bush in my backyard as a child, and I swear to you that thing was my best friend. Which may sound sad, but I spent hours playing around that bush. I hid things in its branches and made up games, and pretended all sorts of things, many of them I can't even remember because when you're a child there's this whole other world going on inside of your head that you can't tap into as an adult.

One thing I do remember is that when I went through my Xena obsession stage, and started "training" with a quarter staff in my backyard, no tree or bush was safe except for my lilac. I beat the shit out of every other thing in our backyard except that.

So when I found out that there was an entire garden of lilac bushes in Manito Park here in Spokane, I became a giddy little girl again. I was eagerly waiting for when they would come into bloom, and today was the day. I caught them at the perfect time, when the trees are half budded and half bloomed out. It smelled like heaven and I took, um, a lot of pictures. Like over fifty. I LIKE LILACS, SHUT UP! Here are some of my favorites...

Sore all over, but happy!

We just got back from a weekend in San Francisco last night, which means I'll be feeling the effects of walking miles up and down hills for a few days. It was a great time, we met up with old friends, and had some amazing food. If anyone reading this is ever in SF, I highly recommend eating at Pesce. Some of the best food I've had at a restaurant in a long time. I could eat their swordfish until I pop!

While walking on Pier 39, we saw a tattoo parlor with big picture windows where you could watch the artists at work. I have an 11-year-old rose on my right foot that is badly faded and in need of a touch up. It looked like this...

 
So we stopped in. They had a digital portfolio for each artist, and I began flipping through, and wound up lingering on one artist, Chris's page. He'd done a couple of pieces with dew drops that looked startlingly 3D. As though if you touched them you'd get your finger wet. I mentioned to my husband that if I decided to have anything done, that was the guy I wanted.

Well, as it turned out, he happened to be standing right there when I said it. He introduced himself and said that he specializes in photo realism, and asked what I wanted done. I showed him my tattoo and he grimaced and said with something so faded, he would just cover it instead of touching it up. That's when he said, "We could do another rose, a different flower, or you could choose something else." That really piqued my interest! I had never considered getting something else over the old tattoo. Because, let's be honest, I got it when I was 18 years old and had no real personalty or interest in anything, so I got a flower because it was pretty. Nowadays, I don't really resonate with red roses anymore. So I told him, "I want a gecko!"

We flipped through photos online until we found a few that I liked, and then worked on the stencil to combine features here and there until we had the perfect tattoo. I have to say, I am thrilled with the result. It's so pretty!

Eeeeeee! I LOVE IT!

And I have to throw an additional photo in, because while I love reptiles, my mother hates snakes. HI MOM!

Me with Pascal, a ball python in the reptile collection at my husband's museum.

Home sweet home.

All settled in back in Spokane, WA. This last week has been relaxing. It's fantastic waking up to my husband on one side of me and Mama on the other. It's lovely having both of them in one place and not having to worry about or miss one of them.

Spokane's weather has been gorgeous. 50s-60s since I arrived. Cold enough for sweaters and jeans, warm enough not to need a coat. I've been on lots of long walks and one jog since being home. The park a block from my apartment is perfect for jogging. Lots of trees and natural rock formations.

Mama and Roosevelt are getting along "okay" at the moment. Mama's stopped growling and hissing at him, but she's not ready to be best friends yet. Roosevelt really wants to play and keeps chasing her, but she runs and hides from him. Hopefully they'll get it worked out while we're away in San Francisco this weekend and all they have for company is each other.

Puffy Mama barely tolerating Roosevelt's presence.

Otherwise, I've just been doing a lot of cooking and baking. Don told me that I could pick anything to cook and he'd pay for the ingredients. Two things I've always wanted to cook but I've been kind of intimidated by is risotto and seared scallops. Neither are difficult, but they require a level of precision and if you don't get them just right they're both very easy to screw up. Well, I did it! And it turned out delicious!

This morning I made blueberry muffins from scratch. They also turned out wonderfully.

Americanized, once more.

Right now I'm sitting in my hotel room in Atlanta, Georgia (sidenote: If you're ever staying in the Atlanta area, Hotel Indigo is absolutely fantabulous) eating breakfast and preparing to make the rest of my journey home to Spokane.

We went to Lobsterfest on Friday night. It was the perfect way to have an island send off. Rum punch, lobster, bbq ribs, rice and beans, plantains, pumpkin fritters... Proper St. Kitts food done right. Vanessa and I studiously ignored each other for the last hour we were there because we wanted to avoid saying goodbye and crying as long as possible.

My flight out of St. Kitts was stressful. To all incoming students with pets, just know that when you try to leave the island with your pet you can expect a struggle. They overbook the pet spots on the flight, and that's just the ones that actually make reservations. There are plenty of students who don't make reservations and get there early to check their pets in before the students with reservations show up. It's a nightmare. Delta called me as I was on my way to the airport to try and tell me that I couldn't have Mama with me on the flight. I remained calm and didn't yell, but spoke in a very firm and businesslike tone that I made the reservation and double checked it just last month, and that she would be traveling with me in cabin, and that was final. The Delta rep at RLB airport called corporate, and everything worked out fine. But still, that's a heart attack I didn't need yesterday. And now my Kittitian kitty is an American citizen!

Flying over the ocean yesterday, and realizing that it will be years before I can swim in tropical waters again, was heart breaking for me. I had the crazy urge to jump out of the plane when we'd fly over an island where I could see the water turn from blue to turquoise to green over a stretch of reef. Salt life has become such a part of me now, it feels like something is being taken away from me that I'm not ready for.

As sad and painful as parting is, I'm excited to begin this next phase. I'm happy to be seeing my husband and my family and friends back home. I'm not the same person I was when I left them. I'm more patient, less easily stressed, and more laid back and understanding. I don't judge as harshly as I used to. St. Kitts, Ross, and my classmates changed me into someone who is going to make a better doctor than the person who arrived there 2.5 years ago.

Back to America!

Grades were just posted. Not only did I pass 7th semester, I did much better than I thought I did. I didn't receive less than a B on any of my final exams.

The major motivation for starting this blog was that when I was researching Ross, there were no blogs that went all the way through all seven semesters of school here. Most just ended somewhere in 3rd or 4th semester with no explanation. I wanted to provide a blog that documented the experience throughout all seven semesters as honestly as possible. I hope I've done that.

It's so hard to believe that two and a half years have passed so quickly. I'm full of mixed emotions about leaving. I'm definitely going to miss this place. I'm going to miss my friends so much. It's going to take at least a few weeks before the expectation that I'll see them in the morning, or the urge to say, "I can't wait to tell Vanessa..." goes away.

Transition ceremony.

When you get to Ross as a 1st semester, there is a White Coat Ceremony that marks your beginning as a student of veterinary medicine. At the end of 7th semester, there is a Transition Ceremony, that marks your move from didactic learning into the clinical portion of your education. Our transition ceremony was last Thursday. We all expected more tears, although there were a few, but mostly from professors. It was a joyous, upbeat, positive ceremony.

Again, it was emphasized that our semester has been a special one. They tell every incoming semester that by the end you'll all be family, but our semester has really taken that to a whole other level. We've been told numerous times that there's just something about us that is closer, warmer, and our bond is stronger, than most others that have come through Ross. Dr. Dascanio, before our final exam on Monday, told us that there has only ever been one other class with which he's felt as close. I'm going to miss these people terribly, but I haven't cried yet. That will probably happen at Lobsterfest tomorrow evening, when I'm saying my last goodbyes to everyone.

98 names. Our class started with 137 students. Only 50 out of this 98 were a part of our incoming class in January 2011. You hear things about the rate of attrition at Ross. This is proof.

My personalized instrument pack.

Bandage scissors with my initials on them.

Dr. Kenyon. His parting words to us were, "Milk clean, dry teats!"

Dr. Fuentealba! She's been our biggest cheerleader since 1st semester. She calls us her "Greenie babies."

Dr. Nibblett. She is always such a snazzy dresser!

The last remaining four of our original orientation group. There were seven of us when we started first semester.

Vanessa, Laura, Michelle and me. I *loved* Michelle's dress.

Laura wanted to strike a "Mad Men pose."

Elly's really light!

Jess, Laura, Vanessa, me and Elly with Dr. Wallace.

Ladies and gentlemen, I give you the RUSVM class of May 2014!