Fireworks in the ER

Well I can safely say that I made it through my very first holiday weekend working in the emergency room, and I only considered pursuing an alternate career once . . . maybe twice. I spent most of Saturday trying my best to sleep, knowing that I would need it to make it through my first overnight shift (I have never been much of a night owl, and was actually voted "most likely to fall asleep before your grandmother" by my classmates in veterinary school). As it would be, Saturday was probably the most beautiful day of the year and I was having an internal battle ignoring the gorgeous weather (when you live in Michigan, summer days like that are SO VALUABLE) and shutting myself in a dark room. But three cat naps, a large Coke, and a bit of an adrenaline rush later and I was ready to go!

The good news is that I had absolutely no problem staying awake. The less-than-ideal news is that within an hour of me walking in the door I had five patients arrive and all of them were trying to die. Time to triage. I had a chocolate Labrador in EXTREME respiratory distress turning blue. A Chihuahua HBC (vet language for "Hit By Car") without a pulse. A white-as-a-ghost old yellow Labrador with a (likely) bleeding splenic mass. A young never-been-vaccinated Rottweiler with acute vomiting and diarrhea. And a terrified little Yorkie with a drain cover attached to his paw.

So the Rottweiler went into an isolated room to wait and not contaminate the hospital with possible canine parvovirus. And the poor terrified Yorkie was moved to the very back of the line, as unfortunately or fortunately (depending on how you look at it) she was the most stable. Meanwhile chest compressions and CPR had already been started on the Chihuahua. The blue Labrador was sedated and an oxygen mask was thrown over his face on top speed O2 delivery. His color was slowly fading from blue to a much more normal pink.

Thank the Lord I had another doctor (and one with a year of experience - priceless!) to help me. We made it through the night, one patient at a time. The poor Chihuahua did not make it despite our best efforts and the two old Labradors were euthanized - one in particular really wrenching at my heartstrings (though I do think it was the best decision for him). I used wire cutters that were at least four times the size of the tiny Yorkie to cut away that pesky drain cover. And that was a much needed very rewarding case. We performed a few diagnostics on the Rottweiler puppy, but he ended up going home on a bland diet and a promise to follow up at his regular veterinarian. And that was Saturday night to Sunday.

I think (hope) Sunday night was a much more typical overnight. I spent the greater part of it removing porcupine quills from the muzzle of a couple of Akitas. I'm pretty sure the porcupine won that fight. Some of the quills were actually quite satisfying to remove. Others were soft with saliva and quick to to break, frustratingly so. But it seemed like every time I was starting to get fed up with a soft and friable quill, the next one I pulled would be a great big one that came out very smoothly and gave me that rewarding feeling all over again. There really must have been a million of them though.

A possible foreign body ingestion, a coughing Labradoodle, a few puncture wounds, and a stunned wild barred owl later and the Fourth of July weekend was over. Go America. We may not have seen any real fireworks to celebrate our independence, but I think its safe to say we had our own little show in ER.

The Internship Begins!

Well I made it through day one! - although it was a close call during the two-hour safety video, and even closer when I accidently dropped the urine cup for my drug test into the deepest part of the toilet! I learned that we are not allowed to wear neon blue tennis shoes at MVS, but CAN have "Dr. Awesome" embroidered on our scrubs and lab coats.

Three Weeks to DVM

Well that was fast. To fast. Only a mere three weeks/one clinical rotation/twenty-one days stand between now and graduation. It feels like just yesterday that I found out I had even been accepted to begin veterinary school. I lived in a little apartment right next to a railroad, and a train was passing through when I opened the "Congratulations. You have been accepted." e-mail. I had my roommate read the e-mail out-loud to me. Just to make sure it was real. Of course I could not hear a word she was saying over the noise of the train. But the excitement on her face told me I was in. This was it.

And now here I am about to graduate. Kind of exciting. And just as it all began, I am heading out of East Lansing with a bang. My last three-weeks of formal veterinary training will be with the Emergency/Critical Care Medicine Service. This will be the last time I introduce myself with, "Hi I am Christina. I am a senior veterinary student working with Doctor whomever.". After May 6, it will sound something a bit more like, "Hi I am Dr. Cooper". Pretty cool.

Of course graduation is merely the first step of the uphill climb that is the first year of practice. So do not fret - I am aware that I am certainly not on Easy Street. But this first step is pretty much crucial, and making it is something to celebrate. So I am going to take these last three weeks and cherish them. Cherish my classmates, who have become some of my closest friends. Cherish the teachers and advisors that support me every day. Cherish the animals. Cherish the clients, in all their glory. Cherish the learning.

And celebrate. Congratulation to the Class of 2011!

I read an article today that touched on the religious illiteracy of the average American. I was inspired by the article and so decided to do a little religious exploration and appreciation. I found these quotes from religious works less familiar to myself, and thought they were pretty out-of-this-world.

Thousands of candles can be lit from a single candle, and the life the candle will not be shortened. Happiness never decreases by being shared. - Buddha

A good word is like a good tree whose root is firmly fixed and whose top is in the sky. - The Quran

From MU to MOO

Another rotation is done (Anesthesia, check), and another one is just starting up (Large Animal Medicine!). In between, Logan and I found some time to go for a stroll along the banks of the famous Red Cedar and enjoy the Memorial Day Weekend sunshine!

On Day 1 of Anesthesia, I could not name five opiates. Now I can name seven full agonists (hydromorphone, morphine, oxymorphone, fentanyl, tramadol, methadone, and meperidine), a partial agonist (buprenorphine), and an agonist/antagonist (butorphenol).

The full agonist opioids act on mu, kappa, and delta receptors. In small animals, the mu receptors provide the most analgesia whereas in large animals the kappa receptors provide the most analgesia. You have to keep in mind though, that the mu and delta receptors are most responsible for unwanted side effects as well. Full agonist opioids have a linear effect, so that the more of the drug you give, the more effect you will get.

Fentanyl patch absorption will increase with heat - an anesthesiologist actually overdosed and died while using Fentanyl, and when they found him he had Fentanyl patches shoved in every warm and cozy crevice of his body. He was actually using the properties of the drug to increase absorption! (Be careful with Fentanyl patches because people are CRAZY!)

I learned that Buprenorphine (the partial agonist) takes a super long time to start working. It takes almost thirty minutes to have an effect when its given IV. I had to make myself REMEMBER to give my patient a dose of Buprenorphine at least a half hour before extubation.

Butorphenol is a kappa agonist and a mu antagonist. Butorphenol doesn't provide the greatest analgesia, but it has a pretty nice sedative effects. The really cool thing about Butorphenol is that you can actually use it to reverse a full agonist opioid. For example - I made my patient a little to comfortable on Hydromorphone and she didn't want to wake up after anesthesia. Within about a minute of receiving Butrophenol IV, she was looking at me asking, "What just happened?". AND unlike reversing with Naloxone (which is super expensive anyway), you don't reverse all of the analgesia (pain control) when you give Butorphenol.

PS: When you do use Naloxone to reverse an opioid, make a 10% solution in saline and give about 1mL at a time to effect.

So what are the side effects of opioids? Respiratory depression, bradycardia, dysphoria, changes in GI motility, and vomiting! Yum!

I didn't just learn about the opioids. I learned about benzodiazepines, phenothiazines, alpha 2 agonists, dissociatives, anticholinergics, ETC (all in three weeks!). I am going to try to create a journal of what I learn from day to day - because there is A LOT of cool stuff. Starting tomorrow though, I'm off the the drugs and onto ruminant medicine!

I will leave you with some pretty sweet intubation INFO: Rabbits are intubated blind. Ferrets, calves, birds, sheep/goats/llamas, dogs, and cats are intubated via visualization. Foals/horses are also intubated blind (like the rabbits). In cows, you have to intubate blind with palpation. So if you ever find yourself stuck on Noah's Ark performing anesthesia: You'll be all set!!

Almost Summer

Just a reminder to everyone that baseball season is right around the corner. Spring training is underway, and the Tiger game will be televised on Saturday. Even without Curtis Granderson wearing the Old English D, I am stoked.

Until then - March madness! Go State!

The Truth About Meat-Eaters – A Guide for Vegetarians

(I wrote this in response to an incident in which a vegetarian I had never met before told me I was "not only an animal-hater, but environmentally apathetic" because I ordered chicken with my Pesto Cavatappi. I know a lot of AWESOME vegetarians, and this entry is not for you. This is for that anonymous woman at Noodles and Company, and any other vegetarians that feel the same way she does.)

Vegetarians are constantly trying to figure out if you are a vegetarian or not – just like Catholics are always trying to figure out if you are Catholic or not. The whole ordeal makes me feel very uncomfortable about my own eater-identify. I often wonder how critically I am judged by what I order at a restaraunt, or what I purchase at the grocery store. Do vegetarians really think less of me because I eat meat? To those that do (and I know that isn’t all of you) – I would like to take this opportunity to explain myself.

For starters, just because I order a chicken sandwich does not mean that I fight pitbulls in the evening (I must not care about animals if I eat them, right?) and take a fifty-minute shower in the morning (aren’t omnivores environmentally apathetic?). The sad thing is – I have found that this is exactly what SOME vegetarians assume about meat-eaters. When a lunch date is not swallowing a soy-based burger, each bite of beef washes away a little more of the vegetarian’s respect. This judgemental attitude particuarly irks me because I am a firm believer in animal welfare (not rights – but that is another debate) and in the sustainability of the environment. AND, I eat meat.

So why do I do it? Well I think the most honest answer, and the one that really outrages some vegetarians, is that it tastes great. It’s like asking why I drink soda. It is not healthy and thousands of acres of land are pillaged to grow the sugar in my soft drink, but I thoroughly enjoy a nice cold Coca-Cola on a hot afternoon (as do many do-gooders and vegetarians). And frankly, I think that is all the reason a meat-eater needs to provide for an interrogating vegetarian. In my experience, a lot of vegetarians will actually appreciate the refreshing honesty in the answer.

If I really want to shock a vegetarian that is scorning my meat-eating habits, I exclaim “I LOVE VEGETABLES” as I pile on the broccoli next to my roast beef. This is another vegetarian assumption that I would like to repudiate. Just because I eat meat, does not mean I do not eat vegetables. Bring on the carrots, peas, and asparagus – the more the merrier! The fact of the matter is, I was designed to eat vegetables AND meat. Just like a dog – I am an omnivore. The hunter-gatherer society left modern-day humans with the dental structure and digestive tract of a full-blown omnivore. So there, I blame my Neanderthal ancestors for surviving to pass on this meat-eating trait! What were they thinking?

Now I realize many vegetarians have heard this argument before, and are skeptical because our bodies were designed to do a lot of things that are morally frowned upon. For example, men were designed to have sex with as many women as possible, which typically is not culturally acceptable. Just because our bodies are designed to eat meat, does not mean we should eat meat. Okay, I get that. On the other hand, would you fill your car with just iso-octane when it is designed to run on gasoline (both petroleum and iso-octane)? Clearly, providing proper nutrition for your body is not comparable to polygamous activity.

Vegetarians argue that a meatless diet is actually healthier for the human body, and scientific studies have shown that American vegetarians are less likely to develop obesity, diabetes (direclty related to obesity), and some forms of cancer when compared to the general population. To this I say, of course! When was the last time you saw a vegetarian over-indulge? Now when was the last time you saw an American over-indulge? The real nutritional benefit is not in the elimination of animal protein, but in the concious attention to proper diet that mandatorily accompanies vegetarianism. We all know that America has a food problem, but preaching the benefits of vegetarinism is not going to solve it.

I agree with vegetarians when I say that we eat too much meat in America. It is certainly excessive to have three meat-containing meals per day, where meat is a luxury in most parts of the world. Where we differ, is in my realization that completely eliminating an animal-based protein source from the human diet is not a health-wise decision. Feeding a cat a vegetarian diet is considered animal cruelty. Pediatricians warn against the risks of raising a child as a vegetarian. Why then would I eliminate animal protien from my own diet?

Many omnivores turn into vegetarians after visiting a slaughterhouse or meat-processing center (or by viewing a documentary on such places). I will not argue that the process it takes to go from cow to hamburger isn’t a bit gory and unsettling to watch. However, the cow is not alive. The animal is humanely stunned and rendered unconcious before any of the real slaughtering activity takes place. To this I say, treat me nicely well I am alive, and you have my permission to eat my body when I die (or use my body for science/medicine). Do vegetarians view organ donation or post-mortem medical examination as cruetly to humans? Vegetarians cannot scorn and assume that meat-eaters believe in inhumane animal treatment. Farmers, like the rest of us, are driven by money and economics, and healthy well-cared-for animals will always render the greatest profits.

So what about the environment? I am always hearing about the vast amount of land and water that goes to domestic farm animals (particularly cows), when it could be used to grow vegetables that would feed a greater population. Now, I will be the first to admit that I do not know how true or untrue this idea is. If we could feed the world by getting rid of beef, then this argument may be the most valid of all the vegetarian arguments against meat-eaters. However, I believe that the real food problem we face is a problem of distribution and not of the ability to produce enough food. In fact, today more people in the world are obese than are starving. That tells me that we must have enough food, but are not distributing it properly.

Furthermore, vegans are the only people that can justifiably believe their diet supports global sustainability. Vegetarians that consume dairy cannot make this argument because dairy cows probably require the most resources of all (high concentrate feed and plentiful fresh water). Beef cows generally graze land that is not suitable for farming in the first place.

In summary, meat-eaters can still be good people that care about animal welfare, support the sustainability of the planet, enjoy vegetables, and maintain a healthy diet. Americans certainly overindulge in meat products, but eliminating meat entirely is not realisitic or valid. I congratulate the shear willpower of vegetarians. However, that is where the veneration ends. You are not a greater member of society because you manage to survive on vegetables alone. Nor are you any less of a person because you consume what you, as a human being, were designed to eat – meat, from an animal that was treated respectfully until it was humanely euthanized for slaughter. So to all the vegetarians that might read this entry – please do not scorn or frown upon the meat-eaters with whom you share a table. Enjoy your carrots, and please pass the steak.