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!