Tuesday, January 18, 2011

M.I.P. (vet school, dairy cows, & Justin Bieber- together at last)

Always be on the lookout for a wolf in cow’s clothing.  This is what they look like right before they attack. (photo courtesy of travelblog.org)
When I write these blogs, I often think back to vet school often because I really enjoyed my time there. The last two years of vet school are undoubtedly the best, mainly because of the variety of experiences you have. In those two years, vet students rotate through different clinics and specialties such as Surgery, Small Animal Medicine, Large Animal Ambulatory, and Equine Medicine & Surgery.  You’re doing practical work. You’re fixing things.  You’re solving puzzles. Instead of sitting in a classroom or behind a microscope, you’ve got your hands on animals. 
The “hands on animals” part is where the unpredictability lies, and nowhere is this more evident than in the Large Animal rotations.  During this time, you spend a significant part of your day working on horses, cattle, sheep, llamas, goats, or whatever else may come along. You’re outside in the barns listening to your instructors talk you through milking cows, suturing up horses with barbed wire cuts, telling you how to avoid having the llamas spit on you, etc. 
But above all, you’re listening to them tell you how not to get “Mocked”. 
A “Mocking” was the most dreaded thing that could happen to you on large animal rotations. It meant that you had been totally outsmarted by an animal and were being made to look like a fool. What made this even worse is that every clinician wore a radio, and whenever a student (or, for that matter, an entire group of students on a rotation) was getting Mocked, a radio call went out summoning all of the other students to the area where the drama was taking place. 
The radio code for this was “M.I.P.”- Mocking In Progress.  Being the object of an M.I.P. was undesirable, but being called to witness somebody else’s M.I.P. was the highlight of the week. 
One Fall afternoon, I was on equine rotation watching a subtly lame horse run to and fro between barns as I desperately tried to figure out where the problem was. There are a lot of reasons that I don’t work on horses. One of the biggest is that equine lameness has always baffled me. When a person who is good with horses tells me where the leg problem is, I figure that there are three possibilities:
 1) they’re really good,
 2) they could be making it up, or 
 3) they might have magical powers.
Just when I was about to have to swallow my pride and tell my rotation mates that I could only tell that the limp was in one of the front legs, I heard our professor’s radio come to life.
“M.I.P at the dairy barn! M.I.P. at the dairy barn!” 
I had been rescued.  All instruction, learning, and productive activity stopped immediately, and the whole group migrated over to the milking parlor to see what was up. 
A circle of people had already gathered to see the spectacle. In the middle of the circle was an angry Jersey cow that had doubled back on the students trying to herd her into the parlor to be milked. She was trying to make a break for it and get back into the open pasture when she was intercepted by two of the students assigned to dairy rotation. They were trying to turn her around and get her into the barn. She was having none of it. 
When a cornered cow is angry, several things usually happen. When we arrived, she was spinning around wildly in circles looking for a way to evade the students trying to interfere with her escape plan.  While spinning, she was bellowing a low, drawn-out, loud moo. She was slinging snot and spit and manure in wide arcs around her as she turned, like a lawn sprinkler filled with… well… the kind of things cows are typically filled with. The cascade was soaking bystanders and students who ventured too close to the whirling beast. 
Eventually, the two saturated and frustrated students literally pushed the cow in the direction they wanted her to go (as dairy cattle go, Jerseys are small). Half a minute later, she had her head in a feed bucket and was eating away as if nothing had ever happened. With the standoff over, the people and cow involved got a standing ovation from the assembled crowd, then it was back to business as usual. We went back over to the equine barns. There was a lame horse waiting for me there, and I hadn’t figured out the puzzle yet. 
That was about 12 years ago, but the memory of a Mocking stays with you. In practice here in Odenville, other kinds of Mockings happen occasionally. This one was pretty good, so I figured I’d take a picture and share it with all of you. I had been gone for a couple of days during the holidays and came back into town to find this: 
In my absence, one of the BAH crew had turned my office door into an homage to Justin Bieber. We’ve had a lot of fun with it. We still occasionally add new images to it, but like all good things, it must eventually come to an end. I figured that I’d share it before the magic is gone… 

Wednesday, January 12, 2011

Wide Open!

We are fortunate to have a guest blogger for this post, Dr. Wendy Fraser.  Dr. Fraser is currently out on maternity leave but left us this blog to enjoy in her absence.  Congrats again to Dr. Fraser and her family on their new baby girl!

I am a huge television fan.  It is truly one of my guilty pleasures.  After the kids are finally in bed I like to sit down, relax and let my mind focus on the intriguing plots of Mentalist, House, Criminal Minds and the like.  My selections are admittedly intellectual junk food.  Why do I like these shows so much?  I like them because in one short hour a mystery is solved.  There is always a rewarding answer at the end of an hour, everything is neatly wrapped up and everyone is satisfied.  That rarely seems to happen in real life, particularly in veterinary medicine.  I like the fantasy that everything has an answer and if that answer can be found in under an hour so much the better. 
Real life is much more frustrating.  For example, one Tuesday morning when working at another clinic in the Birmingham area, an owner called about a sick German Shepherd.  The owners were concerned because the dog would not come out of the dog house.  The receptionist recommended that the owners bring the dog in for an exam.  We went about the usual workday until late afternoon when the receptionist said, “I think that sick dog that wouldn’t get out of the dog house is here.”   There were no clients in the lobby so I was curious as to how she knew that that particular dog was here.  When I walked up to the front lobby and looked out the window I knew how she knew:  a truck had pulled into the parking lot and on the back of the truck was a HUGE doghouse.
The driver of the truck and his companion had begun to unload the dog house and carry it into the clinic.  The dog that wouldn’t get out of the doghouse was now in the lobby, doghouse and all.
I started to take a medical history from the owners.
How long had the dog been in the dog house?  Two days.
Has he eaten anything?  No. 
Does the dog ever run loose?  Sometimes. 
Inside the dog house was a 70lb, 3 year old German Shepherd lying on his side, his eyes were unfocused but he was breathing steadily.  To the side of the dog were some scrambled eggs and there were two pieces of toast on top of the dog.   I took the top off of the dog house, dusted off the eggs and toast and moved the dog to an exam table.   At first, the dog appeared to be in great health.  He was a healthy weight, had no skin lesions, was staring straight ahead and breathing deeply.   All the vital signs appeared normal.  What do I know about the dog at this point?  He was young, was healthy three days ago, doesn’t have an appetite for eggs and toast, and is in a coma.  That was all the information I could gather and when presented with a case such as this you have to consider all factors, even beyond what the owners tell you (for any other TV junkies out there, think… House.)  These owners would like to do whatever they can to help the dog.
At this point, my diagnosis of the dog is open, WIDE OPEN.  This means that I have no idea what is wrong with this dog!  Typically in a case like this Dr. Bean, Dr. Compton and I put our heads together and come up with what is called a differential list of possible causes and try to pick diagnostic tests that will help to rule in or out any of the illnesses on the differential list. That’s exactly what I started to do.  The most likely causes in this case were trauma or toxins because the dog wasn’t skinny or sickly looking, indicating that it had not been ill for long.  He looked great and was in fact a beautiful dog.   
It had been almost an hour since he arrived at the clinic and I was still not close to solving this one.  Unlike on those medical dramas on TV, dozens of assistants had not appeared to take samples and whisk my patient away for tests.   I drew blood samples to send to the lab and treat for dehydration, infection and inflammation.  My only options now were to wait until the next day for his blood work results and monitor him for responses to my treatments.
The blood work results from the next day were normal.  We tried every reasonable course of treatment but nothing that I did seems to change the dog’s condition.   After 3 days the owners elected to euthanize him.  Many, many hours were spent thinking about this dog and there was no satisfying answer at the end.  All that we have are unanswered questions, frustration and sadness.
So, how do I cope with cases like this?  I go home, put the kids to bed and watch an hour of junk!