Crossing Over - MN/WI CX video

I am way behind on my Cyclocross updates, and now the season is over! I will post about the Crossniacs Fall back that we hosted, the great St. Olaf race, and my intro into the 45min cat 3 race at the state championships later, but for now here is a fun video called, "Crossing Over: Why I Stopped trying to Explain Cyclocross To Family and Friends" about the racing in the region. Make sure to watch at 1:18 for our super local superstar on the seat post cam.

Rotation #13: Public Health

For vet students, Public Health is a bit of a catch-all subject that includes any situation in which humans and animals interact and may or may not spread diseases to each other. Our Public Health classes have taught us how to recognize lots of different zoonotic diseases (diseases spread from animals to humans) and how we can control the transmission of those diseases. We've also learned about food safety and production, human-wildlife interactions, and how the government prevents and monitors for diseases such as Foot and Mouth. The Public Health rotation was more about seeing these ideas in action through a series of field trips around the Twin Cities and beyond.

Our first visit was to the St. Paul Animal Control, who are responsible for protecting people from animals (as opposed to the Animal Humane Society, who protect animals from people). Animal Control are the people who come to check out dangerous dogs, deal with nuisance wildlife, pick up dogs and cats who are running loose (the traditional "dog catchers", a la Lady and the Tramp), and respond to complaints about people keep illegal pets (like tigers, bears, or in St. Paul, more than three chickens). Our trip to Animal Control was short, but we saw a number of dogs that were examples of the worst sorts of trauma humans can inflict on dogs. Terrified, leaping at their cages doors with barred teeth and fierce barks. No dogs should ever have to feel that scared when they see a human.

The next day was food safety day, with trips to two very different meat processing facilities. The first was to Lorentz Meats in Cannon Falls, MN, a small USDA-inspected slaughterhouse. This is the same slaughterhouse mentioned in Michael Pollan's "The Omnivore's Dilemma," in which the Lorentz family was commended for their commitment to local food and local farmers, as well as high standards for animal care and welfare. The Lorentz facility has a glass abattoir, meaning that anyone who wants to come see the process of slaughter from start to finish can. I was a little unsure of how I would react to seeing the animals killed, as the only animal deaths that I've seen have been through euthanasia- but after watching the process several times, I was surprised at how gentle and fast it all was. First the animal was standing there quietly, then the next second it was down. No screams, no thrashing, just poof, gone. The rest of the process wasn't much different than performing a necropsy, except that the workers were much much cleaner than we were and much more efficient.

We followed that trip with a visit to a live animal market in South St. Paul. While facilities that produce meat for sale to the public have to be USDA inspected, facilities that slaughter or process animals for one's personal consumption are considered exempt from inspection. The most common example of this would be the places that process deer from hunters. In South St. Paul, you can walk into Long Cheng Livestock Market, pick out a live chicken (or pig, goat, sheep, or cow), hand it to a worker who will slaughter it for you, and get it back to finish the rest of the process yourself. The market serves primarily immigrants who are unused to buying meat already processed or who want their animals handled or slaughtered in a specific way. At first the whole place is a little shocking, but I have to admit, I admire anyone who has such an intimate connection with the food they eat. We're often so distanced from where our food comes from that it was quite a change of pace to see people- even whole families with kids- come and take such an active role in their food. From a public health standpoint, while the facilities aren't as pristine as Lorentz Meats, the meat also is much less likely to stay in refrigeration for extended periods of time, reducing the risk of bacterial growth. People who are involved in the processing of their own meat are also more likely to have been exposed to pathogens in small amounts, likely building up some immunity to organisms that might otherwise make people very sick.

Bet you didn't know you could shop for a live chicken in St. Paul, huh?

After our day of meat processing, we checked out some of the interactive animal exhibits at the Minnesota Zoo. The Family Farm exhibit offers several areas where kids and parents can pet animals like goats, sheep, and chickens. We talked about what diseases each species can spread to humans and looked at how the zoo designed each animal enclosure to keep both animals and people safe. Then we went to visit the dolphins because.. well, dolphins are adorable. ;)

We spent one morning at Urban Academy in downtown St. Paul working with third and fourth graders. Each group of three vet students was assigned to a topic like "What Vets Do" or "Food Safety". I ended up with "Hand Washing," which was really more of an exercise in wrangling 15 fourth grade girls into one bathroom than an educational experience. At least they all ended up with clean hands!

We visited the Animal Humane Society in Coon Rapids to talk about how shelters manage their unique population of cats, dogs, and pocket pets, and how they work to prevent disease transmission. As always, it was a bummer to see so many homeless cats and kittens (and everything else too, but there seemed to be cats pouring out of every corner). They said during busy months, they take in 2,000 cats a month... ouch. Diseases that are normally simple, like upper respiratory infections, can become life threatening in a situation where you have that many stressed out cats in one place. I resisted the temptation to bring a kitty home, but if you're thinking of adding a cat to your family, please adopt!

Finally, we visited the Dellwood long-term senior care facility in St. Paul. This nursing home follows the Eden Philosophy, which believes that people are meant to be surrounded by living things. Centers that follow the Eden Philosophy try to incorporate animals, plants, and children into the daily life of their residents. At Dellwood, there were 10 cats, 2 dogs, and numerous birds and fish that lived at the center. The cats and dogs are free to roam throughout the building, although each one seemed to have particular people that they liked to stay with or visit on a rotating schedule. The cats were especially mobile, including one who traveled by elevator (he would enter the elevator with someone, peek his head out when it stopped, and if it wasn't the floor he wanted, continue to wait patiently in the elevator until it moved again). The animals helped transform the place from a sterile, hospital-like environment to a much homier living space. The animals helped everyone connect and provided an instant opening for a conversation ("Have you seen Maggie today?" "No, but go check Charlie's closet in room 203, she's usually asleep in his laundry til about 11!"). The animals present a few challenges as far as patient safety, but in the 6 years that the program has been in place, they'd never had a bad patient-animal encounter. I sure hope that I get to be surrounded by critters when I'm 90...

Although the rotation didn't have much to do with caring for patients in the small animal hospital, it was a good way to round out my experiences with food animal medicine. It was also a great refresher for the major zoonotic diseases (rabies!!), and a reminder of how many different roles animals play in our communities.

This rotation marked the midpoint of fourth year. I am 13 rotations and six months away from graduation. I have one month and two days until I take my National Boards, and just under a month until I have to submit my application for an internship. This next month will be a busy one!

Rotation #12: Oncology

I was fairly certain that Oncology was going to be The Saddest Rotation Ever. Dogs and cats with cancer? All day, every day? Occasionally there are days on Internal Medicine where it seems like all our patients, whether they present for vomiting or difficulty breathing or limping, end up with a diagnosis of cancer. You can tell at the end of the day who had a "cancer day"- they're usually in the Internal Medicine conference room late, typing long discharge instructions and having long sad conversations with pet owners about prognoses and statistics and mean survival times. So, you can see why spending two whole weeks of "cancer days" made me nervous.

But then, I walked into the Oncology Service on day one and was greeted by a small herd of dogs galloping in from the chemotherapy room. During my orientation, a scruffy wirehaired terrier mix kept wedging his head between my knees asking for petting, and a lanky 3-legged lab kept trying to steal peoples' lunches from off the countertops. Oncology felt more like doggy daycare than like a hospital, except that dogs would have to stop their socializing for a few minutes to have a physical exam and blood draw in the morning, then be taken to the chemo room individually in the afternoon for the 20 or 30 minutes that it took to receive their chemotherapy. Go-home time was chaotic, with each dog knowing which leash and collar was his own and going into a wiggle-butt happy dance when they knew it was their turn.

Don't get me wrong, Oncology was not all fun and games. In animals, the goal of chemotherapy (or radiation therapy) is usually not to cure cancer, but to provide palliative care. Often, that means animals go through a course of chemo to get them from a mean survival time of, say, six months to a mean survival time of 12 months. Cancers are very rarely cured, but because we use chemo at much lower doses that in human medicine, animals usually still have a great quality of life throughout their therapy and remission time. Chemo can buy pets another Christmas, another hunting season, or one last trip up to the cabin. But even if the dogs in the chemo room are feeling well and acting like themselves, the inevitable eventually comes. We had four euthanasias during my two week rotation, and they were all more emotional than usual since owners often develop a close bond to the Oncology staff throughout the course of therapy (or even just through the diagnosis of cancer, regardless of whether they chose to pursue therapy).

Cancer makes people feel hopeless and scared, especially if they've had to deal with cancer themselves or with a human family member. Having to deal with the human psychological component of oncology requires a lot of help from Jeannine Moga, the hospital's social worker. She has rounds each week with the oncology department to talk through difficult cases, bad outcomes, or really emotional owners. She also helps out on the hardest cases, like if parents are trying to tell a young child what's happening to the family dog, or if a senior owner's pet has just been diagnosed with cancer and they want to pursue treatment even though they don't have the financial means to do so. Jeannine is a wonderful resource and makes difficult things like the diagnosis of cancer a little bit easier to handle.

So, after two full weeks of cancer days, I have to say that Oncology is not The Saddest Rotation Ever. Somehow, through terrible things like cancer, little rays of hope shine through and pet owners really treasure having that one last Christmas or one last good pain-free week with their friend.

Indianapolis, IN

Megan is packed and ready to go for her two week rotation in Indianapolis, Indiana. This will be the exotics internship, so hopefully lots of bunnies, birds, and reptiles. And who knows what else! She will return on November 14th.

"Devoured"

Megan and I saw the Bare Bones Production company put on a spectacular outdoor show tonight, called "Devoured," for Halloween. There is one more showing tomorrow to make up a rained out show, so there is still time to see it. No tickets, just a donation is requested. Here is their webpage.

Here are some photos, and a video. Massive puppets, fire, live music, what else could you want?

Happy Halloween!

Big Ring Flyers/Green Acres

Two more races done, and only three more to go this season. Next up is the Crossniac's race which I am involved in hosting, then St. Olaf, then the state championship.

Two weeks ago was the Big Ring Flyers race in Hudson that was well, pleasant. This was my worst race last year, so I wasn't too stoked about it this year. It was the exact same twisty course too, and all on grass, so it was more of a cornering technical exercise than anything else. But, I was doing OK and having a fun battle with a quick little jr rider who I had 15 seconds on, when on the last half of the last lap my chain fell off and I was left in the dust as 5-6 places wizzed by. Oh well, I still finished stronger than last year!

Then this weekend was the awesome Green Acres race, that was a blast of a time. You can see from the slide show below, it started off fogy and a damp 46˚ but dried out a bit as the race went on. Not enough to dry out the mud though! A great asset for me was the large hill that started the race, which I was able to power up and blow past everyone around me. I do like those hills. They could catch up to me on my weak points later on in the lap, but I knew I could hold their wheel and pass them on the hill. The big hill lead to downhill slalom on a tubing hill (fast and fun!), then some wide spaced triple barriers, then off into the wilderness for some mud, grass, single track, more barriers, and high entry-speed sand traps that could take you down if you were not careful. I lost my back wheel on the rocky single track and bit my pedal into the hill and went down on the last lap, which lost me a spot. But I was still happy with my finish, which was in the 53 percentile, and a new record for me. My season goal of sub 50% seems to be getting closer...

Here is a slide show, with the first half taken by Megan and then some shots of fellow Crossniacs doing there thing, taken by me. Taken with our new Canon D7 camera, but that is another blog post..

Rotations #8, #9, #10, and #11

My, how time flies when you're getting married! I've fallen far behind in my rotation recaps. Hopefully this post will make up for it....

Rotation #8: SAM-B

Students on the small animal track take four rotations in Small Animal Medicine (SAM). The first SAM (SAM-A) is a chance for us to get oriented and learn the basics of how to approach a medicine case. Clinicians will usually ask us what we think the animal's problem is and how we would proceed with diagnostics and treatment, but they generally lead us along through our first cases. The next three SAMs (SAM-B's) are progressively more hands-off by our clinicians. We're expected to make more decisions about which diagnostic tests to run, which specific drugs and doses to use, and how to manage hospitalized patients. Obviously they'd never let us decide to run a test that would be a waste of money, or use a drug that isn't indicated, but the goal is to make us feel more like the primary doctor on the case rather than just an assistant. We're also expected to know more about pathophysiology (the reasons why a disease affects the body the way it does) and spend more time looking into current literature about diseases and treatments.

Thankfully, even though there are higher expectations, my first SAM-B felt easier than SAM-A. I think it was mainly because I didn't need to spend as much time figuring out logistics (like how to submit a blood sample), so I had more time to research each case. I also got more efficient at taking a history and doing a physical exam, which also helped to streamline things. My cases were in general less intensive than the patients I saw on SAM-A- I saw a lot more patients who were being managed for long-term diseases, like diabetes and hyperthyroidism, and fewer infectious diseases like blastomycosis or leptospirosis. It was a good rotation for working on my basic clinical skills and building a little confidence.

Rotation #9: Vacation!

My 9th rotation block was my second of two vacation blocks. We got married (yay!) and relaxed up in the Boundary Waters. My last break will be in late October, when I get a week off (since our Public Health rotation is only one week long)... then it'll be straight through until graduation. Yikes!

Rotation #10: Anesthesia

I've gotten a nice gradual introduction to anesthesia, starting with being the anesthetist for one dog in sophomore surgery lab, then for six dogs and cats in ESAS. The difference between those experiences and the anesthesia rotation is that my previous patients have all been relatively young and healthy. Under the supervision of our anesthesiologists, our rotation was all about getting comfortable with anesthesia of less-than-healthy animals- for me, it included a geriatric cat in renal failure and a ruptured eye, a dog with a large bleeding tumor on his tongue, and a cat with a heart murmur and several fractured teeth. For the first time, I had to handle situations like low blood pressure, slow heart rate, fast heart rate, waking up on the table (not during surgery, thank goodness!!), and monitoring a patient who's inside a CT machine (where you have to be across the room instead of right next to them).

Also, unlike our other anesthesia experiences, we got access to all sorts of fancy equipment- things like mechanical ventilators, end-tidal CO2 monitors, EKGs, and blood pressure monitors. We were also encouraged to try out anesthestic drugs and protocols that we'd never had experience with, so that we could get comfortable with how each drug and combination affects a patient. Our anesthesiologist is famous for letting us experiment, even if we choose drugs or doses that she knows won't be particularly effective (never putting the patient at risk of course- just leaving them awake enough to lead to phrases like "And then I removed the cat from her face.")... since we learn more from our mistakes than from being corrected. She'd never let us flounder, but she didn't mind watching us sweat a little while we tried to troubleshoot monitors, drugs, or catheters. Anesthesia was easily one of the most valuable rotations I've had yet!

Rotation #11: Ophthalmology

Eyeballs. Aside from derm, I can't think of any specialty that makes people go "Ewwww" more often. It's understandable, considering ophthalmologists have to deal with things like melting corneal ulcers or proptosed eyeballs (warning: links for the non-squeemish only!). But, it's hard to ignore the draw of a specialty that gets to bring eyesight back to animals blinded by cataracts. Most of what we did as students on the ophtho rotation were routine eye diagnostic tests, like measuring tear production or testing the pressure within the eye. We also learned how to do a proper fundic exam, which is an important skill for any general practitioner.

The best days, though, were the surgery days. We got to see our ophthalmologists perform goniovalve implants, which is one of the same procedures done to treat glaucoma in humans. Glaucoma occurs when the fluid produced inside the eye isn't able to drain out normally. The pressure in the eye increases, eventually causing pain and making the eye to go blind (remember Kirby Puckett?). A goniovalve is an implant that looks a little like a computer mouse. The "tail" is a tube that goes into the front chamber of the eye, and the "mouse" is a hole-filled plate that attaches outside the eyeball and allows the fluid from the front part of the eye to drain. It's not a permanent fix, since eventually it gets plugged with cells and protein, but it can buy months of pain relief and sight for an animal with glaucoma.

We also got to see a lip-to-lid resection, a form of plastic surgery for a dog with a tumor on one of his upper eyelids. The lid was removed and replaced with tissue from his upper lip (hence the name lip-to-lid). The lip tissue wasn't able to be attached to the muscles that normally make the eyelid blink, so the dog ended up with a bit of a droopy lid- but the alternative was removing the tumor, eyelid, and eye, so a droopy lid is a small price to pay.

Ophtho was a little light in the hands-on sort of learning, but a fun rotation to see what's possible for animals with eye disease. I still think eyeballs are kind of gross, though... ;)


Tomorrow is my last day of Oncology... hopefully I'll stay caught up on my rotation reviews!