One of my main problems that I come across is that I want to make notes (in whatever format, but writing stuff down helps me focus on it, and it seems to make it stick better) and then I end up with about ten different ways of storing them. I have a lot of my lecture slides in course folders, and all of my notes from those lectures are in books, but then I have a bunch of extra stuff that's saved in random places where I've tried to pigeonhole it into existing folders, or written notes based on a specific textbook, etc.
I've hit upon a more question-based approach which I think might help focus my information on what's useful and relevant, where I've split vet nursing in total up into seventeen categories which hopefully cover most things I'll need to know, and has the added benefit of being separate to courses and specific books and such, so I should be able to keep each section up to date and separate, without too much blending.
So far my list of topics is:
-Anaesthetics
-Anatomy
-Avian/Reptile
-Behaviour
-Clinical/Diagnostic
-Emergency
-Geriatric Care
-Laboratory
-Medical/Intensive Care
-Paediatric Care
-Pathology
-Pharmacology
-Preventative Care/Product Knowledge
-Radiology/Imaging
-Reception/Computer Skills
-Small Animal Care
-Surgery
As far as definitions go, I'm still working on wording them exactly right because most of them are still a bit iffy in my head. The categories look like they should be reasonably easy to define though, so it's the bones of a project I intend to work on for basically my entire vet nursing career.
The way I'm planning to set things up is that within each of the above categories, there'll be a bunch of questions which I'll think up whenever I find something I'm uncertain about or wish to learn more information on, which will be under each category. That way, when I want to do some learning, I can pick a section, and have definite questions to find an answer to, like "what do the atria and ventricles of the heart appear as on an ultrasound?" "what are some abnormal heart sounds and what do they signify?", as opposed to the slightly more vague "wanting to know more about the heart". The questions will all be stuff that's relevant (like in my external clinic the other day, we had a cat with saddle thrombus that had been there a few days, and I wasn't sure what that was, so the associated question would be something like "what is a saddle thrombus, how is it formed, and how does it affect the animal physiologically?" I've since found out that it's a clot in the aorta that often forms when there's associated cardiac problems causing uneven blood flow, which breaks off and then partially or completely blocks blood flow to the hind limbs, causing paralysis and tissue death, which may or may not be able to be reversed, and if it's not reversed within a few days then it's best to euthanize before gangrene sets in. Treatment being blood thinners, fluids, and hope. This cat unfortunately didn't make it (she died really suddenly when we were trying to feed her) but she didn't really have a positive prognosis either.
It's just things like this - specific diseases and such - that we haven't been taught much about yet that I come across and feel like I don't know enough about yet. From what everyone else is telling me, a lot of it is experience and I know that seeing an animal with saddle thrombus really drove it home more than words on a page will ever be able to, but I...basically want to know everything I can cram into my head about vet nursing and animal pathology and surgery and general care, and I need to know more about emergency situations and such. Really the only thing I can't focus on yet is reception, and that's only because each clinic I go to uses a different system and I don't spend enough time on reception anywhere to need a complete how-to guide. It's something I'm confident I'll pick up on my own once I start regularly using a single system.
Overall I'm hopeful for this system of organisation, but we'll have to wait and see how it goes.
Saturday 23 July 2011
Friday 22 July 2011
PHC Assessment and General End Of Semester Ramblings
I think I've officially impressed people (but at the same time I don't want to get complacent and stuff it up). I'm not entirely sure if I've talked about this before, but at the start of the year, one of my lecturers put my first-year case report in to a journal publication. There were some minor things to change, but they were mainly just a few clumsy sentences and removing specific times and such from the report. That came out about two weeks ago, and my report came out really nicely.
About a week ago, the same lecturer emailed me about an assessment that we need to do later on in the year, which is basically a preventative health clinic (PHC) where we look at people's pets that are either well and getting a yearly checkup, or their owners are just starting to notice that their animal's doing something kinda weird. What we need to do is take the history, examine the animal, talk with the vet, collect samples for diagnostics where appropriate (eg we'll do a blood draw but not a cystocentesis), analyze those samples, and then talk with the vet about the case, with some basic recommendations about what we need to do to confirm or deny likely possibilities. We're not expected to diagnose the animal ourselves, and it is completely up to the veterinarian to say what gets done, but obviously the more knowledge you have, the better. After that we'll need to talk to the client, explain the findings and the recommendations, give them a sample bag of select goodies that are relevant to their case, and follow through with sending off lab samples etc if it's needed. This is all supposed to be done in September, and I think we also need to do a bunch of advertising and stuff on the clinic to drum up our customers.
Well, this lecturer's cat was starting to look a bit poorly NOW, as opposed to in September, and she also got the go-ahead to choose her very own student to do their PHC assessment early, on her cat. She chose me, which is rather flattering, and told me that she didn't think it'd affect my marks if I did the assessment early, but that it'd probably be easier to do it early as well, seeing as it'd just be me in the clinic, rather than me and twelve other people and twelve other clients and twelve other pets. There was also the plus that she'd be holding and I'd trust her to properly restrain just about anything. She also knows what I SHOULD be doing, but wouldn't construe things completely wrong, either. She sent me a marking schedule, and it all looked reasonably do-able, so I went for it. I was in VSG on Tuesday, at my external clinic on Wednesday, and then did the assessment, so I got to do a practice blood draw on a cat at my external clinic which was good, since before this, I'd only drawn blood from one dog (the total is now one dog and two cats and one nonproductive stab).
Basically I met my lecturer at the clinic, and examined her cat. I didn't take an awesome history (I got most of the basics, but did miss some important stuff) and my examination was also a bit more patchy than it should have been (I missed some bald patches from fur-pulling, a small sore in her mouth, a rather large heart murmur which was probably present when I listened, but may not have been as loud, and soreness in the hips and left forearm) which was a bit frustrating. I didn't have a sheet, so I was doing things completely from memory, but I should still have picked up on at least some of those. I did manage to do the blood pressure monitoring quite well, and figured out that the cat did better with her head covered so she didn't have to look. We gave her a few breaks because she was a really timid cat, and then came back to get blood samples and a urine sample if we could. It worked pretty well - her collar had rubbed a ring of fur off most of her neck, so I didn't have to clip, and her jugular was large and easy to find. I drew one sample pretty well but slightly fumbled the syringe and couldn't get all the volume out at once, so had a second try and didn't quite get it, so the vet drew up the remaining volume from the other jugular. Apparently the right side is usually larger, too. The lab tests went quite smoothly, though my blood smears were rather shabby. The cat had elevated ALT and creatinine, so we asked the lab to include a CBC in with the T4 test they were already doing( (we actually JUST missed the lab courier, which is annoying, but the forms did say to hold the other samples, so it should be fine - they'll just get told with the afternoon pickup.My explanation was okay (I did get some time to read through a five-minute consult book that gave information about each thing on the biochemistry test, and about what an increase paired with other increases meant, etc. ) and they actually started asking me harder questions as well, to see if I could answer them. We tried again for a cystocentesis sample but her bladder was still too small, so we weren't able to get a urine sample. The vet seemed to be impressed with me overall, and told me that the extra work I was putting in was really showing, which made me pretty happy. I'm glad to do the extra, and I enjoy learning about stuff, but it is nice to see that other people have noticed it too.
About a week ago, the same lecturer emailed me about an assessment that we need to do later on in the year, which is basically a preventative health clinic (PHC) where we look at people's pets that are either well and getting a yearly checkup, or their owners are just starting to notice that their animal's doing something kinda weird. What we need to do is take the history, examine the animal, talk with the vet, collect samples for diagnostics where appropriate (eg we'll do a blood draw but not a cystocentesis), analyze those samples, and then talk with the vet about the case, with some basic recommendations about what we need to do to confirm or deny likely possibilities. We're not expected to diagnose the animal ourselves, and it is completely up to the veterinarian to say what gets done, but obviously the more knowledge you have, the better. After that we'll need to talk to the client, explain the findings and the recommendations, give them a sample bag of select goodies that are relevant to their case, and follow through with sending off lab samples etc if it's needed. This is all supposed to be done in September, and I think we also need to do a bunch of advertising and stuff on the clinic to drum up our customers.
Well, this lecturer's cat was starting to look a bit poorly NOW, as opposed to in September, and she also got the go-ahead to choose her very own student to do their PHC assessment early, on her cat. She chose me, which is rather flattering, and told me that she didn't think it'd affect my marks if I did the assessment early, but that it'd probably be easier to do it early as well, seeing as it'd just be me in the clinic, rather than me and twelve other people and twelve other clients and twelve other pets. There was also the plus that she'd be holding and I'd trust her to properly restrain just about anything. She also knows what I SHOULD be doing, but wouldn't construe things completely wrong, either. She sent me a marking schedule, and it all looked reasonably do-able, so I went for it. I was in VSG on Tuesday, at my external clinic on Wednesday, and then did the assessment, so I got to do a practice blood draw on a cat at my external clinic which was good, since before this, I'd only drawn blood from one dog (the total is now one dog and two cats and one nonproductive stab).
Basically I met my lecturer at the clinic, and examined her cat. I didn't take an awesome history (I got most of the basics, but did miss some important stuff) and my examination was also a bit more patchy than it should have been (I missed some bald patches from fur-pulling, a small sore in her mouth, a rather large heart murmur which was probably present when I listened, but may not have been as loud, and soreness in the hips and left forearm) which was a bit frustrating. I didn't have a sheet, so I was doing things completely from memory, but I should still have picked up on at least some of those. I did manage to do the blood pressure monitoring quite well, and figured out that the cat did better with her head covered so she didn't have to look. We gave her a few breaks because she was a really timid cat, and then came back to get blood samples and a urine sample if we could. It worked pretty well - her collar had rubbed a ring of fur off most of her neck, so I didn't have to clip, and her jugular was large and easy to find. I drew one sample pretty well but slightly fumbled the syringe and couldn't get all the volume out at once, so had a second try and didn't quite get it, so the vet drew up the remaining volume from the other jugular. Apparently the right side is usually larger, too. The lab tests went quite smoothly, though my blood smears were rather shabby. The cat had elevated ALT and creatinine, so we asked the lab to include a CBC in with the T4 test they were already doing( (we actually JUST missed the lab courier, which is annoying, but the forms did say to hold the other samples, so it should be fine - they'll just get told with the afternoon pickup.My explanation was okay (I did get some time to read through a five-minute consult book that gave information about each thing on the biochemistry test, and about what an increase paired with other increases meant, etc. ) and they actually started asking me harder questions as well, to see if I could answer them. We tried again for a cystocentesis sample but her bladder was still too small, so we weren't able to get a urine sample. The vet seemed to be impressed with me overall, and told me that the extra work I was putting in was really showing, which made me pretty happy. I'm glad to do the extra, and I enjoy learning about stuff, but it is nice to see that other people have noticed it too.
Saturday 9 July 2011
Work Experience At The Zoo
Today I got to go to a nearby zoo & wildlife center with a friend from vet nursing (for transport) and spend 8 hours there to fulfil course requirements for my study. It. Was. AMAZING.
We started off at 6.30am, and drove down, getting lost on the way and ending up 20 minutes past where we needed to be - luckily we'd left in such good time that we weren't that late in the end. Filled out some forms, then went around on the morning monkey feeds, which included cotton top tamarins, lemurs, capuchin monkeys, a lone spider monkey, Barda, (who lived next to the main capuchin monkey cage), and others. One of the lemurs was feeling poorly, so we got quite a good look at her because she was comparatively still, and we also got to have quite a lot of time with Barda, as he was very attached to his keeper (who was showing us round) and would come right up to the bars to say hello. After that was some veggie chopping for the emus.
After that, we had morning tea, and went on the monkey/elephant talk, which involved a little more about the monkeys, then we went to see Mila, who is the ex-circus elephant that they rescued, and have been since rehabilitating with tremendous success. Mila's an African elephant who was wild-caught and then kept in zoos and circuses for thirty years, so it was amazing to see how far she'd come. She was genuinely caring with her main keeper, and they obviously had a very special relationship. Positive reinforcement really has done wonders for her - it's so cool to see her showing natural behaviours when she used to rock stereotypically for nearly 20 hours a day.
Then we got to go around all the red-eared slider (turtle) cages, and check all the turtles. They're hibernating over winter so they don't get fed, but we did pick them all up and checked their shells for scratches, chips, or other damage. Most of them only had a few bashed-up bits, but one did have a small sore on it leg. We iodined up any damage, and had a lot of fun with the turtles, as turning them on to their backs basically stopped them from attempting to leave, not that they were having much luck!
After cleaning up the turtles it was time for lunch, and one of the zoo cats made sure to get in all the cuddle time/food stealing he wanted, which was cute. There are three cats that roam around the zoo (which is somewhat bad in terms of healthcare, but the main keeper is a fully qualified vet with a second degree in nutrition, so she tests their feces regularly for things like toxoplasma gondii, which can reproduce inside any mammals or birds.
After lunch, we did an otter talk, then got to see Mila in her outside enclosure - there were a few more people, so this one wasn't held in the barn - and then got to see Ruby, the lioness, fed, as well as the bobcats. That was really neat, even if it did start raining quite heavily at times. Ruby was very friendly towards her keeper as well, rubbing up against the cage for (careful) scratches, and following her around - although that was probably just for the food benefit! We also got to hear Ruby roaring quite a bit as we were running slightly late, which was pretty cool, too.
After the talks, we helped the main keeper do a soak of a sick chicken's badly infected feet, which was kind of gross but necessary, and also got to see a fledgling woodpigeon which was being cared for. Then we stopped by Mila again to give her some browse, although we were quite preoccupied by the two zebras, which were shamelessly cadging food (we were given bags of duck/chicken/emu/zebra/deer/peacock/pigeon/sparrow food, which we scattered around with us through the day, more or less tripping over the animals in the process) and then sorted out some kea enrichment, which was us stuffing muesli bars, unbuttered popcorn, and sunflower seeds into a roll-along treat ball, and a length of bamboo with the divider portion in the middle of a ten-inch tube, which we then put in with the keas, and got to watch them having a go at getting the food out. They were actually really clever about it too - the male kea was dunking his muesli bar in the water bowl to soften it up, and he would pick the stick up and drop it a few times if he thought he could dislodge some more muesli from the inside. We didn't get to see them finding the treat ball though, because it was time to sort out some more monkey food.
One thing that really surprised me (although it makes sense looking back) is how much food that zoos go through in a day. The elephant would eat 110kg of leaves, branches (thick as my wrist branches too, not twigs) and fruits and veggies, the lion went through 3-5kg of meat per meal, the bobcats were a kilo between them, the monkey cages would have been about four large buckets stuffed with fruits, and the emus went through another bucket of carrots and muesli bars and the like, and that was just the feeds we saw - maybe half the diets. It was pretty cute though, because one of the other zoo cats (domestic ones) was meandering around the kitchen chasing the fledgling pigeons that have adopted the place, which was a spotted bengal named Spots, who was "not very clever". She was really talkative though, and friendly, and stood on my shoulders for a while when I picked her up.
We gave the capuchins and Barda some more fruit, and tried to have another look at the cut that Barda had on his hand. There were two main groups of capuchins - a big group of twelve that had two cages connected by a wire walkway over the path (Barda's cage had a walkway that mirrored theirs, and a second enclosure down the bottom) which were quite stable and harmonious, and a smaller group of three (two girls and a boy) who were the misfits of the capuchin world, with a low-rank female, a low-rank female with no monkey social skills, and a large but low-rank male. By putting them separately, it stopped them getting bullied by the other group members, and they're apparently really shining for it. They certainly seemed very content when we went to feed them, with Jungle coming right up to the front of the cage (she was raised mostly by humans though, so her behaviour isn't typical of capuchins).
Next was probably one of the most awesome parts of the day - we got to hand-feed mealworms to some cotton-top tamarins. That was singularly awesome, because they're so much more delicate up close. It was the coolest feeling ever to feel them grabbing stuff off my hand, and I don't think I'll forget how solemn and gray their faces were - a little incongruous with the wild hairdos though!
After feeding the tamarins, we also got to feed the center's ageing one-eyed otter, who was also a bit of an oddball, in that he was mostly blind, old, and small for his species, so it was very difficult to get him into a group. However, it does mean that he can be hand fed as well, which meant scooping up bits of mince, and holding them out for him to delicately grab with his mouth (doing very well for someone not able to see much).
The center really did have a bit of an odds-and-sods animal collection, but that's mostly because they don't really aim to be a popular zoo because they've got amazing animals, but because the animals they do have are all there on other reasons, and the education benefit comes second to the welfare of the animals. A lot of them are animals that didn't get along with others, they had a lot of ex-circus animals that needed extensive rehabilitation, or they're animals that just aren't wanted anywhere else. The fact that they put so much effort into keeping everything running, and that they still had constant improvements they were making, and wanting to make, and plans for future years - it's just stunning, the amount of work they put in for the animals. I have nothing but the highest esteem for the main keeper, because she obviously knew her stuff, but every action showed how much she cared about her animals. Not only that, but the fact that she lives on site, and wakes up whenever Mila needs a friend, no matter how little sleep she's had...it makes me feel very small, when I think about her dedication. What's more, on a day where she was short staffed, and had four other young students in for captive wildlife courses (either current or planned) she still made as much of an effort as possible to make our day interesting and fun, going out of her way to make sure that we got to do things like feed the cotton tops, and things like that.
One day just wasn't enough time there, which makes me really glad that we may be going back for another day there.
We started off at 6.30am, and drove down, getting lost on the way and ending up 20 minutes past where we needed to be - luckily we'd left in such good time that we weren't that late in the end. Filled out some forms, then went around on the morning monkey feeds, which included cotton top tamarins, lemurs, capuchin monkeys, a lone spider monkey, Barda, (who lived next to the main capuchin monkey cage), and others. One of the lemurs was feeling poorly, so we got quite a good look at her because she was comparatively still, and we also got to have quite a lot of time with Barda, as he was very attached to his keeper (who was showing us round) and would come right up to the bars to say hello. After that was some veggie chopping for the emus.
After that, we had morning tea, and went on the monkey/elephant talk, which involved a little more about the monkeys, then we went to see Mila, who is the ex-circus elephant that they rescued, and have been since rehabilitating with tremendous success. Mila's an African elephant who was wild-caught and then kept in zoos and circuses for thirty years, so it was amazing to see how far she'd come. She was genuinely caring with her main keeper, and they obviously had a very special relationship. Positive reinforcement really has done wonders for her - it's so cool to see her showing natural behaviours when she used to rock stereotypically for nearly 20 hours a day.
Then we got to go around all the red-eared slider (turtle) cages, and check all the turtles. They're hibernating over winter so they don't get fed, but we did pick them all up and checked their shells for scratches, chips, or other damage. Most of them only had a few bashed-up bits, but one did have a small sore on it leg. We iodined up any damage, and had a lot of fun with the turtles, as turning them on to their backs basically stopped them from attempting to leave, not that they were having much luck!
After cleaning up the turtles it was time for lunch, and one of the zoo cats made sure to get in all the cuddle time/food stealing he wanted, which was cute. There are three cats that roam around the zoo (which is somewhat bad in terms of healthcare, but the main keeper is a fully qualified vet with a second degree in nutrition, so she tests their feces regularly for things like toxoplasma gondii, which can reproduce inside any mammals or birds.
After lunch, we did an otter talk, then got to see Mila in her outside enclosure - there were a few more people, so this one wasn't held in the barn - and then got to see Ruby, the lioness, fed, as well as the bobcats. That was really neat, even if it did start raining quite heavily at times. Ruby was very friendly towards her keeper as well, rubbing up against the cage for (careful) scratches, and following her around - although that was probably just for the food benefit! We also got to hear Ruby roaring quite a bit as we were running slightly late, which was pretty cool, too.
After the talks, we helped the main keeper do a soak of a sick chicken's badly infected feet, which was kind of gross but necessary, and also got to see a fledgling woodpigeon which was being cared for. Then we stopped by Mila again to give her some browse, although we were quite preoccupied by the two zebras, which were shamelessly cadging food (we were given bags of duck/chicken/emu/zebra/deer/peacock/pigeon/sparrow food, which we scattered around with us through the day, more or less tripping over the animals in the process) and then sorted out some kea enrichment, which was us stuffing muesli bars, unbuttered popcorn, and sunflower seeds into a roll-along treat ball, and a length of bamboo with the divider portion in the middle of a ten-inch tube, which we then put in with the keas, and got to watch them having a go at getting the food out. They were actually really clever about it too - the male kea was dunking his muesli bar in the water bowl to soften it up, and he would pick the stick up and drop it a few times if he thought he could dislodge some more muesli from the inside. We didn't get to see them finding the treat ball though, because it was time to sort out some more monkey food.
One thing that really surprised me (although it makes sense looking back) is how much food that zoos go through in a day. The elephant would eat 110kg of leaves, branches (thick as my wrist branches too, not twigs) and fruits and veggies, the lion went through 3-5kg of meat per meal, the bobcats were a kilo between them, the monkey cages would have been about four large buckets stuffed with fruits, and the emus went through another bucket of carrots and muesli bars and the like, and that was just the feeds we saw - maybe half the diets. It was pretty cute though, because one of the other zoo cats (domestic ones) was meandering around the kitchen chasing the fledgling pigeons that have adopted the place, which was a spotted bengal named Spots, who was "not very clever". She was really talkative though, and friendly, and stood on my shoulders for a while when I picked her up.
We gave the capuchins and Barda some more fruit, and tried to have another look at the cut that Barda had on his hand. There were two main groups of capuchins - a big group of twelve that had two cages connected by a wire walkway over the path (Barda's cage had a walkway that mirrored theirs, and a second enclosure down the bottom) which were quite stable and harmonious, and a smaller group of three (two girls and a boy) who were the misfits of the capuchin world, with a low-rank female, a low-rank female with no monkey social skills, and a large but low-rank male. By putting them separately, it stopped them getting bullied by the other group members, and they're apparently really shining for it. They certainly seemed very content when we went to feed them, with Jungle coming right up to the front of the cage (she was raised mostly by humans though, so her behaviour isn't typical of capuchins).
Next was probably one of the most awesome parts of the day - we got to hand-feed mealworms to some cotton-top tamarins. That was singularly awesome, because they're so much more delicate up close. It was the coolest feeling ever to feel them grabbing stuff off my hand, and I don't think I'll forget how solemn and gray their faces were - a little incongruous with the wild hairdos though!
After feeding the tamarins, we also got to feed the center's ageing one-eyed otter, who was also a bit of an oddball, in that he was mostly blind, old, and small for his species, so it was very difficult to get him into a group. However, it does mean that he can be hand fed as well, which meant scooping up bits of mince, and holding them out for him to delicately grab with his mouth (doing very well for someone not able to see much).
The center really did have a bit of an odds-and-sods animal collection, but that's mostly because they don't really aim to be a popular zoo because they've got amazing animals, but because the animals they do have are all there on other reasons, and the education benefit comes second to the welfare of the animals. A lot of them are animals that didn't get along with others, they had a lot of ex-circus animals that needed extensive rehabilitation, or they're animals that just aren't wanted anywhere else. The fact that they put so much effort into keeping everything running, and that they still had constant improvements they were making, and wanting to make, and plans for future years - it's just stunning, the amount of work they put in for the animals. I have nothing but the highest esteem for the main keeper, because she obviously knew her stuff, but every action showed how much she cared about her animals. Not only that, but the fact that she lives on site, and wakes up whenever Mila needs a friend, no matter how little sleep she's had...it makes me feel very small, when I think about her dedication. What's more, on a day where she was short staffed, and had four other young students in for captive wildlife courses (either current or planned) she still made as much of an effort as possible to make our day interesting and fun, going out of her way to make sure that we got to do things like feed the cotton tops, and things like that.
One day just wasn't enough time there, which makes me really glad that we may be going back for another day there.
Friday 24 June 2011
So, turns out I'm really bad at this whole blog thing.
Sorry, future me.
So far I've been doing really well in vet nursing. I'm just about to finish my first semester of my second year (of two), with only exams to go. I've already passed two of my courses through internal marks alone (exams are worth 40%) and the one I haven't passed, I need to get something ridiculous like 5%, since that exam's worth 50%. My last course is assessed through the year via the blue books (we have specific tasks we must complete for each area of the specialist clinic, and it's graded at the end of each semester), and I've got all my tasks signed off within the allotted time (which is apparently uncommon). Furthermore, the specialist clinic liked me so much that they invited me back in for an extra day of one-on-one learning, which I jumped at, and I had that today.
I was actually really surprised at the...level of expectancy that the staff have of the students at the specialist clinic. See, I don't feel like I'm totally rad or anything, really - I feel more or less overwhelmed by all the stuff I don't know, and if I'm at all ahead of my peers, I feel as though it's because I realize how little our course really covers, and am making an effort to read around it and study what interests me outside of class. But the things that my classmates apparently get pulled up on are basic, BASIC things, like knowing how to scrub in. Keeping in mind that this is a surgical department, and surgery is what they do at a surgical department, some people still don't think to read through the information we were given to at least familiarise themselves with scrubbing in. (Surgeries at the specialist clinic are sterile.
I had really good vibes from everyone today though. The vet I was in surgery with remembered my name, which is a good sign, and all the vet nurses were really complimentary.
So far I've been doing really well in vet nursing. I'm just about to finish my first semester of my second year (of two), with only exams to go. I've already passed two of my courses through internal marks alone (exams are worth 40%) and the one I haven't passed, I need to get something ridiculous like 5%, since that exam's worth 50%. My last course is assessed through the year via the blue books (we have specific tasks we must complete for each area of the specialist clinic, and it's graded at the end of each semester), and I've got all my tasks signed off within the allotted time (which is apparently uncommon). Furthermore, the specialist clinic liked me so much that they invited me back in for an extra day of one-on-one learning, which I jumped at, and I had that today.
I was actually really surprised at the...level of expectancy that the staff have of the students at the specialist clinic. See, I don't feel like I'm totally rad or anything, really - I feel more or less overwhelmed by all the stuff I don't know, and if I'm at all ahead of my peers, I feel as though it's because I realize how little our course really covers, and am making an effort to read around it and study what interests me outside of class. But the things that my classmates apparently get pulled up on are basic, BASIC things, like knowing how to scrub in. Keeping in mind that this is a surgical department, and surgery is what they do at a surgical department, some people still don't think to read through the information we were given to at least familiarise themselves with scrubbing in. (Surgeries at the specialist clinic are sterile.
I had really good vibes from everyone today though. The vet I was in surgery with remembered my name, which is a good sign, and all the vet nurses were really complimentary.
Monday 28 March 2011
First day of Vet Hospital Refresher
Today we started our three-day refresher for the vet hospital attached to the course. We spent three weeks there over the course of last year, and we have a short three-day stay this year to refamiliarise ourselves with the routines, as we have to supervise first-year students later on in the year. Today was ridiculously busy - we had four scheduled surgeries, plus three emergency dropoffs, plus a full booking of consults in every available time, PLUS a few boarding patients, a euthanasia, and two stitch ups, only one of whom we could fir in. Luckily there are ten people in our groups, so there were enough students to get almost everything done, though we did stay from 8 until 6 and even went overtime by half an hour - and there were still two patients to finish up, plus the last of the cleaning to do.
Today I was acting as the Clinical nurse, who is the nurse that helps out in consults (holding the animal and such) reception, and general stuff around the clinic, like filling orders or restocking shelves. A friend of mine was acting as Receptionist, but we swapped back and forth a little since the rules for our refresher are reasonably loose. We'll be working together tomorrow as well, but as Hospital nurses - so we'll get to prep any surgery patients, and recover any patients undergoing anaesthesia. Then, on Wednesday, we'll be acting as Surgery nurses, and scrubbing in to any sterile surgeries, as well as helping clean instruments and assisting the anaesthetic nurses with their areas.
Some of the highlights of today were:
-the 12 week old Golden Retriever puppy that visited, who was absolutely adorable and well behaved.
-the red tipped Husky that had a dental, with really soft fur. She was a bit of a wimp (wanted to be back in her cage, wouldn't leave her owners, etc) but really unusual in colouring.
-the pair of 12 week old kittens that came in for vaccinations. Brother and sister pair, and purring like anything.
-the litter of kittens plus wild mother that one of the vet nurses had set up in the break room - didn't have much to do with them because the mum is quite feral, but had a peek from a distance, and the kittens are about palm-size, being around a week old.
-Holding a grumpy DSH for subcutaneous fluid therapy and NOT letting her bite anyone, not even when we had to rip off some of the tape holding in her catheter.
We also had a few not-so-fun cases today, like we usually do.
-The first one was one of our major surgeries, a leg and tail amputation. The cat in question had been found on its owner's doorsteps with a mostly severed back paw, and had had infection set in, which made amputation necessary. That was one of our major surgeries today, though apparently it was quite successful. They're a little worried about septicaemeia, but are hopeful that antibiotics will help counteract that.
-We also had a few remarkably unhelpful clients, who just didn't understand what we were trying to ask. One of the staff nurses was talking to them, and asking if their cat could walk - to hear that he wasn't right now. Asked if he HAD been walking - gingerly. Was he weight bearing on all legs? No, none. So he wasn't walking? Yes, he was. So he COULD put weight on all legs? Yes. Client also asked about rabies (not present in NZ) and asked if he HAD to bring his cat in (it hadn't been eating anything except gravy for three days). Another client was a backyard breeder who was deliberately trying to foist a puppy with a several thousand dollar urinary problem off for 'free' to people, knowing that the puppy had the issue. That's just plain irresponsible, especially since no one's really going to shell out several thousand dollars for a risky sugery that could lead to lifelong complications. The puppy should have been euthanised as soon as the issue was evident, and it's a little sad that the breeder didn't seem to get that. Nevertheless.
-Our last interesting case that I was involved in was a DSH whose owner rang up for a consult because his kitty wasn't breathing very well (huge respiratory effort), and had lost a lot of weight very recently. She'd been a small cat to start with, so the weight loss brought her down to a mere 2.3kg, and she was almost painfully thin to look at - you could feel her pelvis clearly just by stroking her back. The vet took her temperature and got a massive 41 degrees celsius, which is two degrees higher than normal, so we put the kitty on some ice packs covered by a towel to try and bring the temperature down while we got ready for some radiographs. She was a really sweet cat, but she did seem quite disoriented, and when I offered her some water, she took a few moments to orient herself, realize what I was offering, and remember what to do with it. Unfortunately, the radiographs showed that her lungs were filling with pus and fluid, which is a very expensive thing to fix, and has no guarantee that it would even work on a cat in her condition. The owner didn't have the money to install a chest drain, so unfortunately she had to be euthanised. I think it came as quite a shock to the owner, who sounded like he thought it was a case of "take these antibiotics and she'll be on her feet in no time", but instead it was more along the lines of "Sorry, there's nothing we can do". I was quite sad, because I'd been hoping she'd pull through, though I had a bit of a suspicion from how she looked that it wasn't going to be very positive news.
Regardless of the mixed bag we got today, I'm back in tomorrow in Hospital, so that should be interesting to see what we have happening - hopefully it will be slightly less busy than it was today.
Today I was acting as the Clinical nurse, who is the nurse that helps out in consults (holding the animal and such) reception, and general stuff around the clinic, like filling orders or restocking shelves. A friend of mine was acting as Receptionist, but we swapped back and forth a little since the rules for our refresher are reasonably loose. We'll be working together tomorrow as well, but as Hospital nurses - so we'll get to prep any surgery patients, and recover any patients undergoing anaesthesia. Then, on Wednesday, we'll be acting as Surgery nurses, and scrubbing in to any sterile surgeries, as well as helping clean instruments and assisting the anaesthetic nurses with their areas.
Some of the highlights of today were:
-the 12 week old Golden Retriever puppy that visited, who was absolutely adorable and well behaved.
-the red tipped Husky that had a dental, with really soft fur. She was a bit of a wimp (wanted to be back in her cage, wouldn't leave her owners, etc) but really unusual in colouring.
-the pair of 12 week old kittens that came in for vaccinations. Brother and sister pair, and purring like anything.
-the litter of kittens plus wild mother that one of the vet nurses had set up in the break room - didn't have much to do with them because the mum is quite feral, but had a peek from a distance, and the kittens are about palm-size, being around a week old.
-Holding a grumpy DSH for subcutaneous fluid therapy and NOT letting her bite anyone, not even when we had to rip off some of the tape holding in her catheter.
We also had a few not-so-fun cases today, like we usually do.
-The first one was one of our major surgeries, a leg and tail amputation. The cat in question had been found on its owner's doorsteps with a mostly severed back paw, and had had infection set in, which made amputation necessary. That was one of our major surgeries today, though apparently it was quite successful. They're a little worried about septicaemeia, but are hopeful that antibiotics will help counteract that.
-We also had a few remarkably unhelpful clients, who just didn't understand what we were trying to ask. One of the staff nurses was talking to them, and asking if their cat could walk - to hear that he wasn't right now. Asked if he HAD been walking - gingerly. Was he weight bearing on all legs? No, none. So he wasn't walking? Yes, he was. So he COULD put weight on all legs? Yes. Client also asked about rabies (not present in NZ) and asked if he HAD to bring his cat in (it hadn't been eating anything except gravy for three days). Another client was a backyard breeder who was deliberately trying to foist a puppy with a several thousand dollar urinary problem off for 'free' to people, knowing that the puppy had the issue. That's just plain irresponsible, especially since no one's really going to shell out several thousand dollars for a risky sugery that could lead to lifelong complications. The puppy should have been euthanised as soon as the issue was evident, and it's a little sad that the breeder didn't seem to get that. Nevertheless.
-Our last interesting case that I was involved in was a DSH whose owner rang up for a consult because his kitty wasn't breathing very well (huge respiratory effort), and had lost a lot of weight very recently. She'd been a small cat to start with, so the weight loss brought her down to a mere 2.3kg, and she was almost painfully thin to look at - you could feel her pelvis clearly just by stroking her back. The vet took her temperature and got a massive 41 degrees celsius, which is two degrees higher than normal, so we put the kitty on some ice packs covered by a towel to try and bring the temperature down while we got ready for some radiographs. She was a really sweet cat, but she did seem quite disoriented, and when I offered her some water, she took a few moments to orient herself, realize what I was offering, and remember what to do with it. Unfortunately, the radiographs showed that her lungs were filling with pus and fluid, which is a very expensive thing to fix, and has no guarantee that it would even work on a cat in her condition. The owner didn't have the money to install a chest drain, so unfortunately she had to be euthanised. I think it came as quite a shock to the owner, who sounded like he thought it was a case of "take these antibiotics and she'll be on her feet in no time", but instead it was more along the lines of "Sorry, there's nothing we can do". I was quite sad, because I'd been hoping she'd pull through, though I had a bit of a suspicion from how she looked that it wasn't going to be very positive news.
Regardless of the mixed bag we got today, I'm back in tomorrow in Hospital, so that should be interesting to see what we have happening - hopefully it will be slightly less busy than it was today.
Belated Specialist Clinic Day 3.
My bad for getting this out late, but I've been super busy with lectures and work. Since I've got another post to write about the vet clinic that I was in today, this one'll be quite brief.
The deal today was that we swapped over at lunchtime to a new group of students starting their half-week in the specialist clinic, which meant that we didn't get to do very much at all because most of our patients arrived at around 11/12. But, we did get to see the amount of progress that our motor neuron schnauzer had made - which was fantastic. I was first in, so I went to see her before I started, and was a bit concerned because she looked exhausted and was barely responding to me, but it turned out that she'd just returned from a walk - yep, a walk - under mostly her own steam all the way out to the grass at the front of the building (maybe 35-40m, but a big deal for a sick dog) with just a sling (rectangle of fabric with handles) behind her front legs and another sling in front of her back legs, which just allowed the nurses to help support her if she tripped or needed a bit of extra help. She was doing really well, and was slated to go home later that day when we left. Took her out for another walk before we went, and she got all the way out and back with only minimal help, and managed to urinate by herself as well - extra bonus. My entire group was so proud of her for recovering so nicely, and it was really good to be able to see the progression of her recovery, not to mention the esteem boost of having a successful nursing case.
We also had some bad news though. The Newfoundland that was in on the second day came back in to the after hours clinic, and was unfortunately euthanised. I have to admit that I think it was the right time for her to go, but it would have been very sad for her owners, and it was a little bit of a shock to us, seeing as it hadn't really been discussed the day before. I do feel for her owners, but I think that in the end they made the decision that was best for HER, not for them...and i commend them on having the courage to make the hard choice.
The deal today was that we swapped over at lunchtime to a new group of students starting their half-week in the specialist clinic, which meant that we didn't get to do very much at all because most of our patients arrived at around 11/12. But, we did get to see the amount of progress that our motor neuron schnauzer had made - which was fantastic. I was first in, so I went to see her before I started, and was a bit concerned because she looked exhausted and was barely responding to me, but it turned out that she'd just returned from a walk - yep, a walk - under mostly her own steam all the way out to the grass at the front of the building (maybe 35-40m, but a big deal for a sick dog) with just a sling (rectangle of fabric with handles) behind her front legs and another sling in front of her back legs, which just allowed the nurses to help support her if she tripped or needed a bit of extra help. She was doing really well, and was slated to go home later that day when we left. Took her out for another walk before we went, and she got all the way out and back with only minimal help, and managed to urinate by herself as well - extra bonus. My entire group was so proud of her for recovering so nicely, and it was really good to be able to see the progression of her recovery, not to mention the esteem boost of having a successful nursing case.
We also had some bad news though. The Newfoundland that was in on the second day came back in to the after hours clinic, and was unfortunately euthanised. I have to admit that I think it was the right time for her to go, but it would have been very sad for her owners, and it was a little bit of a shock to us, seeing as it hadn't really been discussed the day before. I do feel for her owners, but I think that in the end they made the decision that was best for HER, not for them...and i commend them on having the courage to make the hard choice.
Tuesday 22 March 2011
Specialist Clinic Day Two
So today was my second day in the Medicine department of my specialist clinic, and it also went pretty well. We had both the mini schnauzer with possible Addison's (which was confirmed today) and the motor neuron schnauzer with us again today, but the Westie from yesterday had gone home after his cardiac tests were done. In addition to those, we had a few other patients - a 12 year old Newfoundland, a DSH cat, a husky, and a mutt, in for various tests.
The most interesting things we did today were probably with the motor neuron schnauzer and the Newfoundland, as the others were mainly dealt with by the nurses, or by other departments. The schnauzer was looking much better than she had been yesterday, which had been an improvement on how she had been over the last half of last week - when we arrived this morning, she was in sternal recumbency (lying on her chest, fairly upright and centered) and was very bright and wagged her tail when she saw us. She also had a lot more energy, and seemed to be less withdrawn. She ate some food (shredded chicken and prescription dog food meatballs) and was able to urinate on her own, which was a big improvement from having to have her bladder expressed manually - it's not really pleasant for the animals, and dogs can get funny about urinating or defecating inside once they're toilet-trained. Since she was so much better, we started doing a bit of physiotherapy with her, so she doesn't lose too much muscle tone and to start getting her back on her feet, hopefully. (I'm not sure what was causing her problems, the last I heard of it was that it could have been a tumour, poisoning, or botulism, so it may or may not be something that can get better, per se)
Her therapy involved the use of a sling that fits into a rolling framework, with holes for all four legs. It can be set varying distances from the ground, but the sling supports most of the dog's weight while still allowing them to feel like they're walking by themselves. She seemed to really enjoy it, though she had a bit of trouble keeping her back legs under her and they kept slipping forwards in a sort of bunny-hop fashion. It was quite funny doing our circuit of the main area, since there were three students and two nurses all cheering and coaxing one staggery little dog around the corridor. She seemed to enjoy it though, likely because she'd been recumbent for nearly a week, and bed rest can't be all that interesting for a dog. We did another short journey with her in the afternoon, and found that if someone helped support the weight of her bum, she could use her back legs more easily. It's a pretty good step forward (so to speak) and she may be able to go home and be cared for in her home environment if it turns out that she can use a sling (around her lower belly, so that her owners can help support her weight) to get around.
Our other interesting client was the Newfoundland, though this was one of the...less appealing sides to nursing. She's 12, which is very old for a giant dog, and she has a variety of health problems, including very weak back legs, a heart block, spinal pain in the neck and hip regions, and more or less complete urinary incontinence. She can get up on her own, but has a sling that is generally used to help her up and down, so that she doesn't strain herself too much. The urinary incontinence was one of the worse problems when it comes to quality of life, since she basically just trickled urine about half the time. This meant that her bedding was damp all the time, the floors where she lay down would be wet when she got up even a few minutes later, and she was getting some very severe pus-filled nodules/skin tags/lumps around the urethral opening due to the urine scald - more or less nappy rash - caused by the incontinence and more or less constant dampness of that area. Added to this, she also smelled appalling.
For her, we ran some electrocardiograms (ECG) to find out what was happening with her heart, which led to us finding out about the heart block, and treating it with Atropine. which showed us that she also had a fair number of secondary problems with her heart, as a lot of the beats were quite abnormal even after treatment. She also had some radiographs taken, dealt with by Radiology, on her hips and neck, and had had some done of her heart and chest a few days prior. For the incontinence and urine scald, we clipped all the fur around the lower belly and perianal region, and bathed the area with some mild shampoo - we did this twice during the day, once when she was recovering from the sedation used for her radiographs, which allowed us to shave and clean the area much more thoroughly than when she was awake. There wasn't much we could do about the pus nodules except clean their surface, though she did smell remarkably better after the second wash.
One of the procedures that I got to do today involved the Newfoundland as well. She needed a catheter placed so that there was I/V access while she was sedated, and that's one of the tasks that we need to complete during the year. My teammates had been able to run the ECG's on some of our patients, so I was chosen to try and place the catheter, which I managed reasonably well for a first attempt. Since Newfoundlands are such large dogs she had big veins, which makes finding them quite easy - although they can also be quite tough-skinned, and the veins themselves can slip away from the needle tip quite a lot sometimes. Her cephalic vein also branched into the accessory veins quite far up her leg, with a lump on or near the vein about an inch above the branch point, which somewhat limited my choice of spots to catheterize. It's necessary to start as low as possible on the vein, so that if the catheter is not successful, you can try higher up the limb next time. I did find it harder than I expected to pierce the skin, but managed to get the vein on very nearly my initial penetrative angle - I had to correct slightly to the right, but got the vein immediately once I had done that. She did bleed through the stylette a little while I was advancing the catheter into the vein (we use over the needle catheters mostly, which have a needle with a hollow plastic tube over it, the whole thing is inserted into the vein and then the needle is withdrawn, leaving the tube in place, the end is blocked with a cap, which is then replaced with an injection cap, which has a rubber seal on the end that you can inject through without hurting the animal, damaging the cap, etc) but not very much considering her size. I also had some minor trouble taping the catheter in place, as she had very puffy fur and was by that point determined to lie on her side instead of upright, which made things slightly more difficult. Nevertheless, I was pretty pleased with my attempt, and I'm looking forward to gaining more practice.
The most interesting things we did today were probably with the motor neuron schnauzer and the Newfoundland, as the others were mainly dealt with by the nurses, or by other departments. The schnauzer was looking much better than she had been yesterday, which had been an improvement on how she had been over the last half of last week - when we arrived this morning, she was in sternal recumbency (lying on her chest, fairly upright and centered) and was very bright and wagged her tail when she saw us. She also had a lot more energy, and seemed to be less withdrawn. She ate some food (shredded chicken and prescription dog food meatballs) and was able to urinate on her own, which was a big improvement from having to have her bladder expressed manually - it's not really pleasant for the animals, and dogs can get funny about urinating or defecating inside once they're toilet-trained. Since she was so much better, we started doing a bit of physiotherapy with her, so she doesn't lose too much muscle tone and to start getting her back on her feet, hopefully. (I'm not sure what was causing her problems, the last I heard of it was that it could have been a tumour, poisoning, or botulism, so it may or may not be something that can get better, per se)
Her therapy involved the use of a sling that fits into a rolling framework, with holes for all four legs. It can be set varying distances from the ground, but the sling supports most of the dog's weight while still allowing them to feel like they're walking by themselves. She seemed to really enjoy it, though she had a bit of trouble keeping her back legs under her and they kept slipping forwards in a sort of bunny-hop fashion. It was quite funny doing our circuit of the main area, since there were three students and two nurses all cheering and coaxing one staggery little dog around the corridor. She seemed to enjoy it though, likely because she'd been recumbent for nearly a week, and bed rest can't be all that interesting for a dog. We did another short journey with her in the afternoon, and found that if someone helped support the weight of her bum, she could use her back legs more easily. It's a pretty good step forward (so to speak) and she may be able to go home and be cared for in her home environment if it turns out that she can use a sling (around her lower belly, so that her owners can help support her weight) to get around.
Our other interesting client was the Newfoundland, though this was one of the...less appealing sides to nursing. She's 12, which is very old for a giant dog, and she has a variety of health problems, including very weak back legs, a heart block, spinal pain in the neck and hip regions, and more or less complete urinary incontinence. She can get up on her own, but has a sling that is generally used to help her up and down, so that she doesn't strain herself too much. The urinary incontinence was one of the worse problems when it comes to quality of life, since she basically just trickled urine about half the time. This meant that her bedding was damp all the time, the floors where she lay down would be wet when she got up even a few minutes later, and she was getting some very severe pus-filled nodules/skin tags/lumps around the urethral opening due to the urine scald - more or less nappy rash - caused by the incontinence and more or less constant dampness of that area. Added to this, she also smelled appalling.
For her, we ran some electrocardiograms (ECG) to find out what was happening with her heart, which led to us finding out about the heart block, and treating it with Atropine. which showed us that she also had a fair number of secondary problems with her heart, as a lot of the beats were quite abnormal even after treatment. She also had some radiographs taken, dealt with by Radiology, on her hips and neck, and had had some done of her heart and chest a few days prior. For the incontinence and urine scald, we clipped all the fur around the lower belly and perianal region, and bathed the area with some mild shampoo - we did this twice during the day, once when she was recovering from the sedation used for her radiographs, which allowed us to shave and clean the area much more thoroughly than when she was awake. There wasn't much we could do about the pus nodules except clean their surface, though she did smell remarkably better after the second wash.
One of the procedures that I got to do today involved the Newfoundland as well. She needed a catheter placed so that there was I/V access while she was sedated, and that's one of the tasks that we need to complete during the year. My teammates had been able to run the ECG's on some of our patients, so I was chosen to try and place the catheter, which I managed reasonably well for a first attempt. Since Newfoundlands are such large dogs she had big veins, which makes finding them quite easy - although they can also be quite tough-skinned, and the veins themselves can slip away from the needle tip quite a lot sometimes. Her cephalic vein also branched into the accessory veins quite far up her leg, with a lump on or near the vein about an inch above the branch point, which somewhat limited my choice of spots to catheterize. It's necessary to start as low as possible on the vein, so that if the catheter is not successful, you can try higher up the limb next time. I did find it harder than I expected to pierce the skin, but managed to get the vein on very nearly my initial penetrative angle - I had to correct slightly to the right, but got the vein immediately once I had done that. She did bleed through the stylette a little while I was advancing the catheter into the vein (we use over the needle catheters mostly, which have a needle with a hollow plastic tube over it, the whole thing is inserted into the vein and then the needle is withdrawn, leaving the tube in place, the end is blocked with a cap, which is then replaced with an injection cap, which has a rubber seal on the end that you can inject through without hurting the animal, damaging the cap, etc) but not very much considering her size. I also had some minor trouble taping the catheter in place, as she had very puffy fur and was by that point determined to lie on her side instead of upright, which made things slightly more difficult. Nevertheless, I was pretty pleased with my attempt, and I'm looking forward to gaining more practice.
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