Fluids and IV Lines

I hit the sack yesterday around 4 pm. No, I wasn't ill -- at least not in body. I was preparing for a cessation of sleep at 11 pm.

I arose around the appropriate time and played some lively music on my way to the large animal teaching hospital. Strange to be arising when I normally go to bed...

I began my shift at midnight and continued until 8 am. It was my first time working in the hospital, so I was glad to have a technician on with me the first four hours. She taught me the ropes of fluid changing and administering K-penicillin IV.
There were a couple horse cases, a couple alpaca/cria pairs.
The most intensive case was a neurological horse with pneumonia -- it ground its teeth, stood base-wide, knocked its water bucket around in a most vexatious manner, and pushed food around its feed dish non-stop. Perhaps it was frustrated because it couldn't open its mouth significantly. We had fluids running full-bore through two catheters into the horse -- even though we hung six 5-liter bags we had to add extra fluids every hour or two. Craziness.

Differentials for the case? Tetanus, RABIES, etc. Were hoping against the latter -- though I'm vaccinated for the disease I'd still have to get a series of shots if the horse was diagnosed with rabies. I'm hoping some of the neuro signs were due to a hypocalcemia that they started treating this morning -- hoping.....

After the tech left, things were good... and then at 6 am I discovered a massively kinked IV line that had occured some time within the past ~ one hour. The kink was incorrigible and not licked until the line was replaced. We had to turn off the lidocaine drip and wait for the clinical fellow to arrive.

And meanwhile the fluids on the neuro horse were trucking along, almost running dry from one bag (not a big deal, we just had to hang more). And the other horse's fluids were in a questionable state...

But we didn't kill anything, and it was really pretty low stress and I had a good time.

***
Tomorrow I'm ushering at the vet school graduation.

Cardio Fun

Today I was on cardiology and helped with three cases.
One was a re-check congestive heart failure case, another was a puppy with aortic stenosis, the third was a puppy with ventricular tachycardia.

We did an electrocardiogram (ECG) on the heart failure case -- it seemed to be doing well, all things considered.

Dr. Sisson did an echocardiogram with color-flow doppler on the aortic stenosis puppy as it made unreal, cat/squarking noises. The puppy had narrowed nostrils and probably a hypoplastic trachea -- hence the un-dog-like noises which elicited the labels of "exorcist dog" and "gremlin" from persons present.

We did an ECG on the V-tach puppy. The referring vet was right on the money with his diagnosis -- a few ventricular premature contractions for every normal beat.

Excitement

In June I get to do one, maybe two weeks of a preceptorship at Dr. Joe Snyder's clinic in Myrtle Point. I can hardly wait! His practice is James Herriotesque and what's more, he is of the Friends denomination and has Mennonite connections to boot. And he and his wife will put me up during my stay. Three more weeks to go...

Tonight I plan to attend another Socratic Club debate -- this one about Intelligent Design/Evolution. I really might post about the topic at some point.

Walking in the Country

Friend CS and I went walking in the country last evening. The sunset, the silhouetted mountains and trees, the breeze -- it was delightful.

Large animal palpation is one of those things you can't learn in a day -- at least not for most students. It takes practice, practice, practice. It made me stop to wonder if I'd be competent to practice in 12 months. But then, my degree of confidence with horse palpation has increased dramatically in the last two days. Perhaps there is hope -- others have done it, I guess I can too...

HOT

It is hot enough and muggy enough to be July.
91 degrees Fahrenheit in the middle of May.
Corvallis broke its previous high temp record (88 degrees F) from 1958.

Deception

I got to thinking about this topic because of the book "The Scarlet Pimpernel." You'll see why in a bit.

Lying... words spoken with the intent to deceive. And not words only, but any part of our existence created with the intent to deceive. Based on that, purposeful deception and lying are one and the same.

However, it seems to me that you could purposefully say/do things that would result in a person being deceived, without exactly lying to them. For instance, you would withhold information, make a statement, dress a certain way that would help them think something was the case that was not. It wouldn't be your fault, entirely, because it would be up to them whether they wanted to make a certain assumption about you. The intelligent skeptic could believe every definitive statement you said and yet refuse to make assumptions that would be the final deceiving portion of the situation.

Confused? Let me explain with a scenario or two from "The Scarlet Pimpernel."

As he strove to save nobility from Madamoiselle La Guillotine, the Scarlet Pimpernel engaged in both blatant deception and the sort of deception that requires a non-critical thinker on the opposite side. In one scenario he dressed up as an old hag and drove a cart (containing persons of nobility hidden among vegetables) up to the gates of Paris. He shouted pro-Republic phrases and told the guard he might not be able to return to the city the next day because his son might have the plague or small pox. The ruse resulted in the guard jumping back and not perusing the cart further.

Blatant deception in the scenario:
Telling the guard that his son might have plague/small pox. He had no son and the son of course did not have plague. The guard would have had to believe the man was a liar to not believe that statement.

Deception due to receiver's lack of critical thinking:
The guard assumed the man really was an old hag.
The guard assumed (possibly) the "hag" was pro-republic -- the "hag" never said he was, he just acted in a way that could lead people to believe that.
The guard assumed the cart was for the purpose of carrying vegetables and that nobility were not on board.

So what do you think? I believe that blatant deception is wrong. Though deception is used in the Old Testament (e.g. Rahab), it is not God's perfect way. Jesus said to let your yes be yes and your no, no. In other words, Christians have no cause for swearing to a statement -- their plain words should be trustworthy. But what about indirect deception? God loves truth... so wouldn't he want us to be open about our actions? To not even desire that a person remain in the dark, "deceived," about some activity of ours?

I would almost answer yes, and maybe I should, but first let's see where that would leave us.

Smuggling Bibles... deception? I think so. You are trying to keep the officials unaware of your actions. You proceed with the intent of keeping them in the dark. Maybe insert false bottoms in suitcases, hide Bibles among clothing. Is it wrong? Probably not, unless you state that there are no Bibles with you, or that you possess no contraband materials.

The Underground Railroad... deception? Sure. Disguising slaves in clothes, hiding them in wagons. "Underground railroad" itself is a misleading term. Smuggling slaves may have been wrong for other reasons (Paul instructed slaves to obey their masters), but the smuggling aspect... could have been done in a righteous way, I think.

Hiding Jews during the Holocaust... deception? Yep. Those of you who have read "The Hiding Place" may remember Corrie's married sister. She refused to lie, but still indirectly deceived the searchers by hiding Jews in her house. She told the searchers the Jews were under the table -- which was absolutely true, because the cellar was there. I think she was justified.

I think it's okay for Christians to keep information secret -- to love truth does not mean every detail must be open to every man. No problem with surprise birthday parties. But is it justified to dress up as something you are not in order to avoid the "radar"? Hard to say. What do you think?

***
Some random thoughts on lying...
Is it right under certain circumstances, wrong under others? Ethics are not situational -- they may often be broad enough to have different applications in different situations, but that does not mean that they are not valid for any given situation. Hence, lying is not made righteous if used to smuggle Bibles so that people can hear the Word of God. That's a hard statement to make, but I believe God is honored best when his Truth is upheld by our actions. Actually, if you believe you must lie to smuggle Bibles... perhaps you need more faith in God's power.

Is acting, lying? I do not think so, because the average observer knows that you are acting. However, acting may be problematic for the Christian as it habitualizes him to being fake. That is not a very good thing, and could promote deception in other areas of life.

Teeth and Tea

A small animal medicine test, bovine palpation lab (e.g. preg checking), mid-week meeting with Riverside Christian Fellowship, a tooth extraction lecture/lab -- and thus I have been brought to the end of the "work-week". But not really, because tomorrow we are doing a dental prophylaxis lab and then I work in the library. It has been a good week.

Hm, some more details.
Bovine palpation lab... it's fun to feel the babies floating around in the uteri -- everyone should have the chance sometime in their life. It's fun to search for ovaries and try to feel for CL's and follicles. The eyewear-style ultrasound machine is very neat. Perhaps one would say it looks futuristic -- goggles and all. A bit more height could be beneficial when it comes to palpating Holsteins -- but I really don't want to be any taller than I am. Today we didn't get to palpate -- the guy at the dairy was unavailable or something. Sad...

The mid-week meeting with Riverside Christian Fellowship... I arrived late (sort of because I was trying to get there after a friend) at Loren and Tina's (this month's hosts). After the meeting, I was shaking hands with Tina, cup of ice tea in the opposite hand. The action set up waves in my cup. The tea sloshed onto my dress, Carrie's dress, and the vinyl/leather couch. Imperfect action #2 for the night.
And then I was talking to Carrie, expressing my thoughts regarding something not strictly personal but not exactly whole-audience material, and here I was being too loud and the whole room (albeit small) of people could have heard me if they'd been paying attention. Hmph. But somehow, I have done enough potentially embarrassing things that they don't bother me like they used to. That state of emotions has its pluses and minuses.

I extracted a canine tooth from a dead cat -- yippee, the root didn't break off!

Shooting Darts

Today Dr. Jack Mortenson* and another man ran a dart gun in the indoor football practice field. They set up two target practice areas at right angles to each other -- one area for air pistols, the other for powder rifles. We cycled through the stations, and had a grand time shooting at the targets. Whoopee! I don't think I had ever shot a gun before -- but it seems to fit well with my competitive side. ;)
Now I need to go study renal medicine.

Quote of the day: "Can we workout over there?" -- asked by a couple football dudes of one of my classmates as we shot targets. They were referring to the corner of the field at a diagonal to the rifle shooting range. Um, that wouldn't have been the greatest idea.

* Wildlife vet for the Dept of Fish and Wildlife

Pet Day 2006

Today was Pet Day here at the OSU College of Veterinary Medicine. It's the big PR event of the year, and can be a lot of fun.
The last two years I was "stuck" in the food booth part of the day.
Not so this year -- being a junior meant that I could do nothing for Pet Day, I could wash dogs, I could do surgery on teddy bears, et cetera.
I began my day driving Andy to wear off some of his energy/maybe bad manners. Liz and I brushed him out and I braided ribbons into his tail.
I became somewhat soaked washing dogs for an hour and a half.
I worked in the libary for a while.
I did a harnessing and driving demonstration with Andy, and then Carol, Kristin and I took him out around west Corvallis. He did amazingly well in spite of a car alarm and barking dogs. It was nice to have Carol along -- she's a more seasoned Draft Horse Club member than I am, which takes some of the responsibility off me.

A Terrible Situation

Yesterday was a crazy day.
Arose earlier than normal, went through my neurology notes a bit more in preparation for the big test.
Anesthesia rotation from 8:30 to 11:45 -- basically uneventful as Jake and I monitored a case.
I left the rotation a bit early and, still arrayed in my scrub skirt and top, headed to the library with my colorfully tabed notes, neuro book, and notebook.
I began my three hour, open book neuro test shortly before 12 and made my way through the 14 cases. I was a bit spent by the time I finished, and headed for one of my classes.
What was supposed to be the first half of the classtime ended in an emotionally charged situation that was unlike anything I have ever seen or hope to see again. I was sitting there hardly believing what was happening, partially anticipating that something really bad could take place but not believing it would really occur, and then it did. And that was the end of class for the day.
Now the future of our class is up in the air and we might not have an instructor.
It is strange how something that will change future events could be effected in such a short time -- and it wouldn't have taken much to keep it from happening.
Pray for the situation -- for the lady who was teaching us, our class, and that rumors wouldn't spread. (That means no rumors from you, either! :) )
(Maybe I shouldn't post this, but those of you who aren't at the school don't know who I'm talking about anyway.)

Beginning of Travels

Monday I began an anesthesia rotation. We were sitting there on the induction/surgery tables, listening to Dr. Riebold talk about their standard procedures, and I was swinging my legs, fidgeting. Jen thought it was "cute," like some school child that couldn't sit still -- and she was thoroughly justified by outward appearances. However, the truth of the matter is that I was fighting to stay awake. It was a painful situation -- along with needing to sneeze, trying to suppress the nose twitching, and not feeling free to leave necropsy rounds this morning.

Monday morning was the sequel to the weekend, the reaping from the sowing of a very good but likewise crazy weekend.

I left Smuckers' on Saturday morning, travelling to Sisters by my lonesome. My efforts to procure a travelling companion were fruitless, and I was left to the company of a children's radio program, God, and nature. It really wasn't a bad situation.

I was driving through a controlled burn area west of Sisters when I spotted a young deer by the side of the road. It was alive and sternal, but making no attempt to get away. A ranger and a passer-by were standing there looking at it as I drove past. I felt some level of responsibility, being a third year vet student, almost a senior, knowing basic stuff about hoofstock, vital signs, and setting catheters... So I drove on a ways, and then turned back. I pulled over and went to talk to the ranger, but as I approached her I saw that there wasn't much I could do for the deer -- it's left hind leg was broken about half way up, bone ends sticking out and all. It would have required some major rehab. The ranger was nice and said they were waiting for ODOT to come do the necessary final treatment.

Later I was meandering through Sisters, killing time before the wedding and buying a couple gifts. A lady popped out of a store and immediately began speaking to me. Normally such people turn out to be a little off their rocker, talking to a stranger out of the blue. "Wasn't it sad..." she said, and I thought she was going to talk about some random news piece, maybe even some personal information. But then it became apparent that she was talking about the deer. I guess she was the lady standing there with the ranger and I was the "senile" one, not having recognized her.
Story continued...

In the Dead of the Night

I arrived in Redmond with a few minutes to spare. The wedding was nicely unique -- the groom and groomsmen wore leafy-camouflage-fabric vests under their suits, there were antlers on the bridal table, and they served barbequed (?) salmon as part of the buffet. Both bride and groom are into hunting and fishing, so it was apropos.
I ran into a number of ex-vet students -- one from Alturas, another who will be a large animal medicine resident at OSU next year, another who is currently a small animal intern at OSU (and whom I followed around last week on my rotation). Dr. Blythe (my neurology professor from first year) and her friend Zelda were there, representing the college and scoping out the wedding for ideas. Dr. Blythe's daughter is getting married this summer.

I traversed the high desert lands on my way to John Day, enjoying the sunny weather and non-citified terrain. In theory I was on my way to join the Hopewell and John Day Mennonites for whatever activities they were engaged in... but my friend VB called as I travelled, and I mentioned my friend Kasey Nash, and got her phone number. I knew she lived west of John Day, and thought maybe, just maybe, it would work to visit her that evening.
So I called her up. Kasey is a 2004 graduate of the vet school -- she is the "new vet" referenced here -- and works at Gambler Veterinary in John Day. She was home for the evening, and invited me to stop by (yay, I didn't have to invite myself over) at her place west of Mt. Vernon.
We had a grand old time talking about her vet work, crazy clients, her 6 mo. son, et cetera. After a bit her husband came in from moving cattle on their many acres of rented land, and after a bit more we headed to John Day for supper (there I go again -- make that dinner if you want).
I spent the night with the Nashes. At ~1:30 am Kasey's pager went off and an hour later we sped down to the clinic to see a dog with a suspected gastric dilatation volvulus (GDV -- er, twisted stomach in common dialect). The people drove all the way from Burns -- hence the hour wait. The dog's mucous membranes (e.g. gums) were more white than pink, and he was reluctant to walk.
Kasey inserted a stomach tube to decompress the stomach, but there was little/no spontaneous decompression. We thought the dog felt better after we pressed on the stomach -- it was more willing to walk. However, if I had regarded the ventral abdominal distention with more brain power I might have determined its inconsistency with a diagnosis of GDV. Ventral distention should have suggested fluid to my foggy brain, but I didn't think of that 'til later.
Kasey did abdominal radiographs, and the diffuse fuzz suggested something other than a GDV -- something more like a hemangiosarcoma of the spleen (these tumors often bleed out).
We took the dog to surgery and Kasey did an exploratory ventral laparotomy. The first bad sign was the quantity of blood in the abdomen (ding, ding -- ventral abdominal distention!). Then she was feeling around and came upon an ~5 inch mass on the spleen (hemangiosarcoma, most likely). The mesentery was peppered with smaller masses, and there was even a metastasis to the liver. I wouldn't have given the dog more than 6 months to live -- likely more like 2 or 3 months -- and his quality of life would have been questionable. We ended up euthanizing him. That dog had an amazing degree of stamina -- to come walking into the clinic after bleeding out into your abdomen, to maintain good vital signs (except for a faint heart beat) throughout the surgery -- pretty amazing.

We returned to the Nashes where I got a couple winks of sleep before joining Kasey in the kitchen. I don't know how she manages on such minimal sleep, but she kept perking along.
I invited myself over to VB's for an hour+ before church. My youth group gave a singing program at the John Day Valley Mennonite Church. I was a bit faint at times, but managed to survive.
We gave a second program in Madras -- my voice was pretty spent by then -- and headed home to Hubbard.
What a weekend!