I did it! I am a vet!

The past week has been excruciating. I just finished all my exams and found out on Friday night that I passed everything. This is so unreal and I still feel like I am dreaming. I am a vet at las :)

Hmm,, now what?

Beyond tired

When is my holiday?

I have not forgotten nor abandoned the blog. But my life has been busy, and I have been sleep deprived way too much. I am behind for studies and assignments, and just basically manage to survive day by day at the moment. This year has been pushing my limit to the extent that I just had another burn out, which makes it four times this year. It is very exhausting, and I have never been able to rest and recharge properly. I'm looking forward to finishing my studies, and have a good decent holiday. And hopefully, I would be able to blog more during that time.

Externship, Relationship and Residency

I really enjoyed my externship at the University of Glasgow. The pathology department was quite chill out, and my supervisor was great. I had learnt heaps, and applied my knowledge into diagnostic aspect of veterinary medicine. I had read several histopathology slides, describing the tissue change and providing diagnosis. My supervisor was happy with my performance, and she believed that I am at the level of late first year resident - My head just blew up like a balloon that day, yays. Then I was given real cases that I needed to write a report back to clinicians. I was thrilled, and I got them right, yip yip!

I had discussed the residency program in veterinary anatomical pathology and training for the board certification with my superviser. We had a long talk, and I decided that it wouldn't hurt to apply for this year (If I get in, I would start as a resident next July). I had shortlisted the residency program according to their training quality and location. Well, I would be spending three years of my life (or six years if I'm doing a combined PhD-residency program) at one of these if I get in:

The Royal Veterinary College, London, UK
University of Guelph, Ontario, Canada
Cornell University, New York, USA
UCDavis, California, USA

This meant I would need to move to another country once I am accepted in. It is unfortunate that the training system in Australia has not been very well established. All of my lecturers and professors in pathology had recommended me to train in either USA or UK. Funnily enough, one of them said "Just do it while you are young and have no attachment. When you are single, there aren't many things to worry about". It seemed like that is not the case for me anymore.

A path to walk

This brought in another issue about moving, which I would need to properly discuss with Boyfriend D once I get back to Melbourne. I had sent a long email to Boyfriend D, explaining the whole situation. Early on in our relationship, I told him that after a few years of practising as a veterinarian, I would be moving to another country for a residency program. The plan had changed, and that might happen a lot earlier than we expected.

Boyfriend D felt unsure about everything. He seemed unease, but understood that it's my dream to become a veterinary pathologist. He said that he would be mad if I don't aim for the best, and pursue my dream.

Even though I might not get it, I had thought of several case scenarios. I had had a few long walk to think through and consider all the options. The issue was rather tricky, and I realised that this may soon become our first relationship crisis, if we don't think through and communicate properly.

I had been mentally exhausted, and felt a bit down recently. At times like this, I just wanted to hold Boyfriend D tight, and tell him how much I love him. Now I understand how agonising it is to decide between your career and family. This would be one of the crucial forked paths of my life.

Travelling time

Meeting the family sort of went well. I introduced Boyfriend D just as a good friend. My mum's cooking was nice and homey, but bit too hot for Boyfriend D, A, and including myself! It was a delicious agony as we coped with the spiciness. I think I must have lost the ability to eat spicy food. Then my mum was concerned that Boyfriend D did not eat very much. Hmmm, she was very observant. And before half way through the wine tasting, my mum and sister got bored so they left earlier, lol. I'm glad that Boyfriend D met my mum and sister even though they didn't talk much. This will be a reference when I came out to my family. I have just driven them to the airport and now I'm getting a bit homesick - I can't believe it.

As the topic suggests, it is really a travelling time. Boyfriend D has gone back to New Zealand for a week. He is not out yet, so our contact at the moment is kept minimal. We are just being super cautious, as he is staying with parents and doesn't want his family to get suspicious.

Glasgow summer is colder than Melbourne winter. How do these guys cope with the breeze?

Before Boyfriend D gets back to Melbourne, I'm leaving for an externship in veterinary anatomical pathology at the University of Glasgow, Scotland for a month. It will be my first time travelling to Europe. I'm feeling both excited and nervous, as I'm setting a step closer to my dream. Also I have a thing for guys wearing kilts, haha. It would be nice to try them on and immerse myself into the Scottish culture, and try everything. No offense to everyone, but I have been warned that they speak funny there. Hopefully, I will be able to make sense of the Scottish accent. Boyfriend D also has both Irish and Scottish family background, though he only speaks English with a Kiwi accent. I just know that different tartan patterns relate different clans or family groups, though tourists often just pick the pattern they like. I will need to find the pattern that relates to Boyfriend D's family then. Anyone have any suggestion of the things to do and must-do's in Scotland? So far I have got: eating Haggis, getting a photo of myself mooning in kilts, hiking, visiting Loch Lomond, Scottish folk dancing (one of the vets at uni told me),  and learning Scottish slangs.

Busy busy busy!

It has been more than a month since I made a post. My life as a final year vet student has been keeping me busy with rotations and assignments. So far, I have been in general practice, diagnostic imaging ie. radiology, ultrasonography (ultrasound), pathology, anaesthesiology, food production animal (cattle, alpacas and sheep medicine), small animal medicine, critical care and emergency, equine medicine...and the list goes on.

I have been surviving through on a weekly basis and feel slightly sleep-deprived. This year has been very intellectually challenging and the learning curve is steep. As of May, I only have around 7 months before I graduate. To be honest, I don't feel quite ready yet. Hopefully, I will gain more confidence and skills then become a lot more competent before December.

Apart from studying, I have been travelling from placement to placement. I have also managed to get an externship in veterinary pathology in Scotland. I have always been dreaming to travel to UK. This means I will have a month to enjoy the Scottish culture and try the local delicacy - kilt and haggis!

That is a pure Scottish Terrier there (or Irish, perhaps?)

Just a quick update on Boyfriend D. Everything has been going well. Now that I'm used to cuddle him in bed, it feels weird when I'm sleeping by myself. I should get a bolster when I'm going away, perhaps?

Life, study milestone and Turtle

It felt like only yesterday when I received an offer letter from the vet school. Oh, how much time has passed. Passing through the first year as a naive science student, then having a little family dramatic turmoil which was related to parental disapproval of studying to be a vet. It led to a gap year away from uni, and spending solid quality time at home with parents.

After all these years of studying abroad, and only getting to see them once or twice a year for a short period, my parents were like strangers to me. It took me by surprise when I actually realised this fact. Perhaps, the feeling is not dissimilar catching up with your lost long close friends. Something remain nostalgically the same, but some change with time. Now I'm getting really for some quality time at home with family, and maybe coming out to them is about due at the end of this year after graduation.

Finally, I have reached the promised year of lecture-free. Relaxing as it may sound, it has turned out to be rather mentally and physically draining in a different way compared to attending 8 lectures in a day. We have been rotating through different aspects of veterinary medicine each week - general practice, small animal medicine, anaesthesia, small animal, diagnostic imaging ie. radiology, pathology woot!, production animal ie. sheep, cows, alpacas, critical care and emergency medicine, and public health, etc. Also not to mentioned self-organised extramural placements in veterinary practices, and a 6500 words literature review to be submitted for journal publication. Sometimes, life can be uncertain, but I'm pretty sure that I will be having a holiday-free year, Gahhhh. Many of us have adopted to survive on a weekly basis due to information overload, the steep learning curve and sleep deprivation.

Clinical-wise, I have done bits of everything including castrations, spaying, and seen lots of blood and gore. That's alright til I went for dairy farm visits on a stormy Melbournian weather. We did pregnancy testing on 80 cows ie. shoving one whole arm up the cow's rectum. The weather was being unfriendly, and we were soaked as well as got pooed on our face, because some cows decided to shoot some organic projectile to us. Large animal vet - Nah, I'm sure it's not my thing.

Not the one I saw, but similar clinical presentation

My highlight as a veterinary pathologist wannabe was figuring how to humanely euthanise a run-over turtle. After consulting a book on exotic pet medicine and website (have a look for pictures and more detail if you're curious), I proceeded through the steps. It was rather brutal visually, but at least pain was minimal. Then I took every opportunity to learn from the dead, therefore a post-mortem examination was performed, and it was the right decision to euthanise the turtle since its pelvis was broken in pieces, in addition to cracks and fistulas (holes) in its carapace, which exposed the organs to the environment. It's similar to having holes in the tummy, and the intestines poke out to say a greeting. The turtle was beyond the stage that it could be saved.

Another way to swiftly kill an turtle is blunt trauma to the head, especially if it is found in the middle of no where and can't be transported to a vet - find a big boulder (bigger than the turtle's head obviously) and smash the head forcefully. This is even more barbaric to see, but it is more humane than leaving the turtle to dry off and die in heat. The method was recommended by a wildlife research fellow.

Anyway, it is quite scary that I am going to be a vet in roughly 8 months! Where has my time gone?

Green, the (2011) and Morals

Over the months, I have downloaded a fair amount of films, and I finally have time to watch them all. So the first to go on the hit list is Green, the (2011). Despite an average review, I really like it, since I can relate to some of the characters in the film. Apart from the obvious GLBT theme, there is a subtle moral massage that I picked up.


*Spoiler warning*

It's about litigation and motive behind it. Sometimes, I really think that it's pretty dogs eat dogs in the cruel world, sometimes not. A character in the film saw an opportunity to sue the protagonist despite the lack of evidence, due to the exploitable nature of the protagonist. In the end, I have to say the protagonist is too naive, and even dropped the legal counter-attack, despite his reputation being ruined. For me, it would be an eye for an eye (to be exact ten eyes back, haha). By the way, the protagonist's partner is hunky, and seems to be a cook. A hunky cook - what more can one ask?

I love it when men show intimacy

When I entered vet school, I first thought money is not an issue for me. Guess what, I have become more financial-oriented after all. Greed, one of the seven deadly sins, huh? I wouldn't be surprised if I end up in hell considering this sin alone, but I don't think I believe in heaven and hell, haha. Anyway, money often does the wonder in general, even for veterinary practices. I vaguely recollect a saying of "The rich does no wrong". In the service industry, you could say no money, no service, yah? Same is for vet med, and to be exact you could say no money, a jab of lethabarb then.

Imaging a poor old but really nice lady came in with a sick dog in need of a surgical emergency intervention, for an example, GDV ie. Gastric dilation volvulus (stomach enlargement and torsion). Without a prompt and appropriate intervention, it's gonna be one hell of agonising death. Veterinarians are obliged by our Oath and law to intervene animal suffering, but we also need gain our feet in the world of business. It's a bit like what my American mates told me how people are left to dead if they don't have health insurance or money to pay for treatment. Jobs in medical field are tricky, as we are speaking about life of our patient. 

I'm quite glad that I decided to study vet rather than med. My religious belief is indeed twisted, and I  have to admit that part of me is somewhat amoral, though I adhere strongly to professional ethics (I guess my religious belief and moral stance deserves a proper post sometime later). So sometimes, it's basically "No money? Ok, let's not the patient pointlessly suffer any further. It's lethabarb time!" in my head, despite my dispassionate temperament, I say that in a much more considerate and compassionate tone to clients. Well…vet consult is a service-based business, isn't it? People are paying for a good service, so my Dexter mask is well paid after all.

A considerable number of vets are anthropologist though, in comparison to our medico counterparts according to my med friends. There is a lot of shelter medicine veterinarians out there. They are really quite something, working with abandoned animals. It isn't much cashflow in field, and the pay is depressingly minimal. However, many shelter vets are fulfilled with their job, and happy with what they got. These guys are the saints and angels of our profession, indeed. I respect their skill of making the best out of limited resources, and utilise everything that they have. 

Back on the topic of litigation, there is a well-known Australian eye specialist, who actually taught us. A while ago, he warned his GP colleague not to perform a certain eye procedure. Despite the warning, the surgical procedure was performed, and inadvertently the optic nerve was damaged, then the patient came out of the surgery blind. The owner sued the vet, and also the specialist for lack thereof due diligence, because the owner believed that it's also the specialist's fault. What a pestering call! Guess what, specialists being specialists, they are generally on the more wealthy end of the profession (not to mention he owns a well established practice). In addition to that, he loves flying a plane, so his customised comprehensive insurance is quite something. I have to say he struck back pretty hard: hiring the best available barrister in the country was easy with the insurance money. Funningly enough, his barrister was on a totally different plane of level to that of the owner's, and the barrister managed to take over the negotiation and legal proceeding. The winner was clear, and the barrister managed to talk the other party into believing that the specialist was so angelically kind that they didn't take the matter further, and sue the owner back, lol. 

Morals learnt; dogs eat dogs, but beware of getting eaten back; know thy enemy before thou strike, know not, thy head shall be rolling; insurance may save my ass. After all, we don't live in an ideal world, and nothing is free. There is a lot of funny people out there that are monetarily motivated.

Cold hard truth

All I am thinking lately has been about exams, so I should not be bragging about it except the fact that I am half way there. E (my lab partner) and I decided to go out for some munchies, after having sat an exam. We trotted around the city of Melbourne indecisively, before leisurely settled down at Journal Canteen (one of the places I used to study for exams). Our topics of conservation again revolved around life and other deep-thought issues. At one point, we talked about the nature of the truth.

One of the pathologists (we both respect) apparently made her neighbour cry, after telling the truth about the fate of the little bird her neighbour brought in. As many of us have progressed through veterinary studies, we have touched on the topic of wildlife, and learnt that a small baby bird abandoned by its parents generally doesn't stand much chance in this cruel wild world. The poor subject often either starves to death once it is abandoned, or gets picked up by kind-hearted people, then gets dropped off at a vet clinic/animal shelter. 

Truth calling?

Well...what happens behind the clinic door/shelter is then unknownst to the general public. The bird is often given a highly-overdosed shot of sodium pentobarbital either by intravenous (into a vein) or intraperitoneal (into the abdomen), for the purpose of euthanasia on humane ground. For many in the veterinary profession, the action is adequately and reasonably justified, as the bird is very likely to die, unless it is close the fledgling stage, or able to fend for itself. This would prevent pointless suffering. Another aspect is that if the animal is non-native, which means it may post threats to the local species, it is by law that the animal must be destroyed.

So the poor neighbour was given the synopsis, and she did not take it well. It might have been courteous to withdraw the truth, and only provide part of it. But upon retrospection, I would certainly have trouble putting an acting mask on for the purpose of deception, so I could understand why the pathologist decided to do as such.

E and I agreed that that the truth should be provided if possible, and only if the recipient seems capable of taking it. However, this is because we have become dispassionate while dealing with issues like this. I have heard of parents telling their kid that the family dog is going to a farm, and will never come back. Then the kid goes heartbroken, and asks if the dog will miss him/her.

Certainly, there is a moral dilemma. Is it worth to tell the truth to people, even though it may hurt them even more?

My Christmas and New Year 2011

A tad of procrastination wouldn't hurt, since my brain is totally fried up, and needs some time to cool down. After having made a list of what to do in December, I realised that I would have a really busy month. At first, I thought I would have a quiet relaxed December for once, but this was proven wrong, as there are so many things lined up for me to do. These include a meeting with the Dean and teaching staff for academic issues (not mine, but the whole year level in general: I will need to prepare some docs, and deal with some politics - I had dealt a lot with, but not my cup of tea), getting a flight to Japan and meet my family there for a trip, moving house (to inner Melbourne suburb) , taking a temporary post as an assistant veterinary anatomical pathologist between Christmas and New Year (This seems extremely workaholic, but I don't see doing pathology stuff as work, because I enjoy it :D), organising a placement at DPI Attwood, staying outdoor and do some surfing for a week, getting some massage, having a quiet day to retrospect and reflect on oneself etc.

Obviously, I won't have much time to chill out, and this makes me realise that this year I have gradually shifted from my introvert Type B ego to Type A personality slightly. So I really need to learn to prioritise things properly: all vetties seem to have an imbalance study and social life. My personal life has been compromised, since entering the vet school, but I have been getting better than doing the balancing act.

OMG! Are they all for me?

Some of my Canuck mates are staying over the summer, since our uni will be starting on Monday 2nd January 2012. Lovely, isn't it? We have decided to patronise one of our favourite contemporary pub-restaurants, which is along Yarra River for the New Year Eve.  This will be a perfect cooling spot for the Australian summer, as we all will feel like constantly being in an medium-heat oven. There are bound to be lots of vetties pranks and inappropriate shenanigans, though I won't be overly drunk but will stay high throughout the night for sure.

Since I will be most likely be spending Christmas Day at uni, doing some yucky work and the faculty can get really quiet, I downloaded the new Michael Buble Christmas Album 2011. I will be singing his songs, while making a Christmas pudding for the first time, then singing and sharing the pudding with pathologists on duty, before heading to the PM room, butchering ex-animals to bits and pieces.

So what is your plan this December? And anyone have advice on balancing life?

Homosexual rams

Today is Melbourne Cup Day, and it is a public holiday for Melbournians to gamble - to be exact it was yesterday by the time I finish this post. Even though  I'm stuck in the vet library, I had a gambling draw with the vetties. My horse was Modun, and she/he seemed to do ok, since I got $5 from the draw somehow :)

With 6 exams lining up, for me to study (cram) through. Unfortunately, that won't leave much time for me to blog. I have decided to settle down in one of the private cubes in the vet libraly, as my second home for now until the end of this month. The cubes are very old, and look pretty much like a prison cell. What a perfect place to confine myself! Many of my mates now know that I have entered the alternative world, and won't be in contact for a while (also the phone reception in my cube is pretty poor).

Brucella ovis is trasmitted between rams by anal sex, lol

There are severeal subjects that I need to go through. One of them being Small ruminants, in which I have to study about reproductive diseases in rams. In one lecture, we were told how groups of rams have their boy parties in a paddock, and engage in homosexual behaviours. Who say gay is un-natural, huh? I vaguely recall someone saying "In order to reduce the degree of orgies in rams, they are separated into smaller group, usually 3 to 4 per group. Then we can just let them go wild within their group, without having to worry about the disease spreading everywhere".

So I will now disappear into another dimension for a little while. Until then, take care.

Added 02/11/11
I just found out today that Modun actually came last, so I got a price for being the slowest horse in the race, lol. Not sure if I can say it's lucky/unlucky.

Colleague and criticism

Over one lunchtime, me and two of my clinical lab groupmates, E and Z, had an interesting albeit short conservation about criticism. As we know that we all will be working together, and seeing each other almost 24/7 next year. We will really get to know each other through and through, and it will be similar to having intensive orgies relationships with an expiry date as of Dec 2012. There are bound to be some degree of interpersonal conflicts, if we don't communicate properly. Our group consisted of six people, equal number of guys and girls, but only one straight guy, lol. L is my lab partner, and we often have cafe hunts together. She is also my philosophy conversee. Z is the poor straight guy, who frequently answers a lot of my questions regarding treatment. Before I digress any further, how can we provide criticisms due to good intentions, without upsetting someone?

Halitosis (bad breath)

Me: Let's start with bad breath. If you start talking to someone and notice the smell, how would you deal with it?
E: Hmm.. that's hard. But if I know that person well enough, I would tell that person outright though not out loud. Otherwise, I will hand out some chewy or mints.
Z: What if you don't have any of those with you? What if that person is a lecturer/teaching clinician, whom we will be spending a lot of time with?
Me: I guess for that case the prognosis is hopeless. Well... better start training holding your breath then?
E: Oh.... for your information, please let me know if I have a bad breath. I don't wanna be talking to clients while they try not to breath. Hey... GVP, you're quite lucky then. Don't you get use to all the bad smell, since you spend so much time in the PM room?
Me: You're right. So far I can even put my face near rotten horse guts, and it seems that I have instinctively learnt to shut off my nose, but I can still smell farts and bad breaths somehow. Another thing, this year I have morped into a little grumpy beeping bomb. I know that I swear too much, but I can't help for now.
Z: That's alright. We are quite stressed right now, so everyone swears and used to it. Remember the surgery lectures, how many times did we hear vagina, penis, testes?
E: There were so many vaginas, penises and testes. That was more than enough.
Me: One thing that we won't have enough of next year rotations will be sleep. I will definitely get moody, and swear a tad more than usually. So tell me to f!@# off and get some coffee, if I'm acting like a dick.
Z: Only if you promise, you won't treat me as your PM customer after I tell you so.

In the end, we also talked about dandruff, dress code, low jeans exposing ass crack, etc.  We all agree that we prefer honesty, and don't mind being told off if there is something odd. Feeling upset is inevitable at first, but as long as there is a good motive behind, everything will be alright. One point that we took, before rushing to our prac class was that all of us are not perfect, but at the very least we strive to improve. Being optimistic as I am, I often think that if someone criticise me, it's only because they care about me. What is your approach to this?

Veterinary consult

As always life has been busy, but it got out of control recently in my case. The uni workload has increased as we approached to the end of the year. I seemed have hit my mental burnout, and felt quite depressed, but it appeared to be a common and "normal" thing among students in my year. After rejuvenating over one weekend with decent coffees and food, I felt much better once more. I really live on good food mentally and physiologically, ain't I? Hopefully, I will have more time for social life and this blog after my exams in late November.

Right, back to the topic. Veterinary consultation - hmm, I have little experiences with consults to be frank. The whole thing isn't very appealing for me personally, though some owners are quite sweet and lovely to chat to. Much like any other jobs dealing with people, servicepersons are bound have something to gossip about behind scene at the end of the day. In our case, it is behind the consult door and far away from the ears and eyes teaching staff/clinicians. Certainly, doing such deed is un-professional, and it is a breach of confidentiality, but we can't help being humans. Of course, no name or anything specific that may identify the clients is mentioned.

Anything in there?

How often you know that people aren't be honest outright. Well, that occurs frequently in veterinary consults. Owners sometimes tell us what they think we want to hear, but not the truth. Figuring out what is wrong with our little furry mates is much like doing jigsaw puzzles and detective work - integrating relevant information to make some sense or list differential diagnoses ie. likely causes/underlying pathology. When the truth is not given, our life is much harder and it's our friend who suffers consequently - well, our friend will then have an increaesd chance of becoming my customer on a PM table as a wrong diagnose can be proven fatal.

We were told of a case of a Labrador, responsible by the ER/critical care head vet. The dog was presented with pollakiuria (increased frequency of urination), hypersensitive sound (very hysterical even to being called its name) and hallucinated (it seemed to be chasing invisible flies in the consult). As usual, interesting and exciting things happen on Friday night. There was a little wine party at the owner's, and the dog became like so after the party.  She sedated the dog, did a thorough physical exmaination, checked the mouth and found bits of chocolate brownies. First thing cholcolate is toxic to animals, but they don't show neurological signs like these (chocolate toxicity will be posted at a later time).  Second thing is the brownies were no mere baked goods in this case. With her experience, common thing occurs commonly. She had seen way too many marijuana toxicities, and she believed that the dog munched on hash/weed brownies. She asked the owner explicitly to confirm if there is anything special in the brownies, and the owner did not say anything about the recreation drug. She then proceeded to explain the clinical picture and most appropriate treatments. The dog was induced to vomit, and she found some grass like materials with partially digested brownies. Thinking about probability the dog could have been poisoned from other source, but given the clincial signs and history of party, ingestion of brownies, it is most likely that special brownies were made for the gathering, and the dog (being a Labrador) managed to get some bites. I would say that vets with less experience and knowledge in critical care and toxicology, would not have figured that out right, and the patient's health could have been compromised as appropriate treatment was not provided promptly.

Like I said before, veterinarians are not in the consult to judge. We just want to do our jobs quickly and finish the session within the time limit (usually, 15 minutes). But, some owners just love talking on and on about their life, sometimes including private detail that we don't want to know. Consult charge is per 15 minutes, and some do not realise that they pay for us to listen to them talking. I guess it's better if they see a psychologist for this purpose.

An ideal consult would be a client come in with a calm and relaxed patient, facts provided, quick exmination, diagnostic process/work-up/tests, confirm the diagnosis, advise about the disease, management and treatment options. Fitting all of these in 15 minutes is challenging. Even though this is what majority of the profession are doing, sometimes it is not ideal since proper discussion of the disease and management are often left out. Many vets just reach for treatments eg. corticosteriods, antibiotics or NSAID, and tell owners to give the drug(s) to their pet without telling why. Consults are pretty much the balance between medicine and business. With the skills and experience I have right now, I would take ages to do a proper consult. Practice makes perfection, I guess.

Horse racing industry and horse vets

I have to admit I have never had a good impression of the Victoria racing horse industry. The industry is no doubt lucrative, and there is a lot of money talk involved as well as liability issues.

In the past weeks, a racehorse unexpectedly died on the racing track. There was a lot of public concern in term of animal welfare and jockey's safety. The field pre-emptive diagnosis for the cause of death was heart attack, which left me puzzled because I had never heard horse vets mentioning the condition before. So it left me to think that the racing industry must be trying to avoid negative public response, since there has been a fair number of accidents on race tracks. Animal welfare and right groups have been grilling and putting the racing industry on a hot seat.


Having confirmed the cause of death with the pathologist who performed the necropsy, the diagnosis was severe acute pulmonary (lung) haemorrhage, which was EIPH (exercise induced pulmonary haemorrhage). This condition is well known in racing horses doing strenous exercises though the severity of the condition is variable. The degree of bleeding the horse suffered was so severe that its chest was filled with blood. Oh poor horse! If this was to be known, there is no doubt the industry would suffer.


Anyway, there was case in pathology weekly round, which was likely to involve a lawsuit. We were looking down a histology slide of a horse's vein and told that the horse received IV (intravenous ie. into a vein) jugular (neck) injection of phenylbutazone, commonly used NSAID (non-steroidal anti-inflammatory drug eg. paracetamol) amoung horse vets. And apparently the horse got sick then progressively deteriorated over a period of 6 weeks before it died despite appropriate treatments. At the request of the owner, a necropsy was performed and samples of several tissues were collected for histology. Histopathology - evidence of endothelial (cell lining the vessel) damage, necrosis (cell death),  adhered thrombi (blood clots) and recanalisation of the vessel. There was septic thromboembolism (spreading of blood clots) due right vegetative (growing) endocarditis (inflammation of the heart valve) and embolic suppurative pneumonia (pus-sy inflammation of the lungs). In a nutshell, the injection led to sick neck vein, heart valve and lungs. It appeared that the vet mistakenly and injected the drug into the mural (wall) component of the vessel.

Why do we bother describe all those tissue changes (what I put up above is summarised version, by the way). During the round, there was an empathic row of laughters among us when the finanical value of the horse was known. The horse was worth AUD$3millions, for god's sake! And the legitation is now therefore worth the same amount, for the defendant's sake ie. veterinarian's! I do hope that the vet has some sort of work insurance otherwise he/she is screwed.

What a pity! They don't continue to make the calendar.

In general, horse vets are somewhat intimidating. They are quite uptight and strict but perhaps this is due to the nature of industry they work in. Of course, this is with a few exceptions. There is a male resident horse vet who was the topic of conservation among the girls (about of 80% the course are female, by the way) for a while when we first had a prac class with him - smiley, green eyes, hunk (albeit he is shorter than me) and sarcastic sense of humour.  In many movies, people working with horses and the work environment are depicted as macho and masculine. This often leaves a train of lecherous thought in one's mind; how much one fancy about doing XXX and enjoy having YYY in a horse barn!

Desensitised to the dead

A while back, I used to watch all those medical shows and wondered how doctors perform surgeries without feeling disgust. And now I understand since I has become desensitised, and I am able to perform necropsies while talking about lunch. It feeks like yesterday when a group of us vet students got excited for our first anatomy prac with dog bodies. But, we were warned that if we feel funny, just exit the prac room and get some fresh air. A fair amount of students, including me, felt light-headed and almost faint. It was the smell, sight and texture of cold muscles that almost made me puke. Well, I turned into a vegan and didn't touch any meat for a week. Then we had more anatomy classes, seeing images in lectures and touching the real stuff in pracs every fortnight. We gradually accustomised to the extent that we felt hungry during the prac, and talked about having steaks and beers after cutting a dog open. This is so wrong I know.

That only leaves one thing that a lof of people complain about while dealing with the deads - Smell! Well, some ex-patients are not so fresh and presented to us at a temperature lower than ideal ie. from a fridge. I think I'm somewhat more lucky than my peers that I have learnt to shut off my sense of smell while perfoming necropsies. One of the pathologists I know mentions about pathologists just get used to the smell, and our nose just doesn't smell anything malodouraous after a necropsy. Once she and her colleague had to do a necropsy of a baby hippo who disappeared for a few day during a period of warm Melbourne weather, and then appeared to float atop of the enclosure pond. The body was so emphysematous (bubbly like balloons) and the odour was ranked 10/10 in the degree of intolerability. After several hours their job was done, they returned back to the faculty, sitting in a staff tea room completely oblivious that they both had this obnoxious un-holy aura, which could be sensed several blocks away. The whole faculty became alert of the smell, and believed there was a gas leak hence commenced buidling evacuation unbeknownst to the offenders still in the tea room enjoying the sun and English afternoon tea.

Obviously, I have to be more careful from now, and take cautions about the scent. It would be horrid to others around me if I pop into a cafe for coffees after my heavy duties.

Human vs veterinary pathology

The topics of conversations, that my medico friend, P and I talk about, can be quite taboo in the ears of general public. The topic may involve saying vagina and penis out load, as we talk about reproductive medicine. Other includes how to open the skull, amputate a limb etc, and cases that we have. During one of our Sunday cuppa ritual, we ended up talking about two distraught cases she just had.


NOTE: This synopsis may be very distressing since it mentions an abused baby and body parts after an automobile accident.

GVP: Guess what, I got accepted as an extern in veterinary pathology to a few uni in US and UK !
P: Awesome, I know you love path, and for sure you're gonna enjoy it. The subject is quite interesting, but sometimes the pracs and work can be very depressing for us, as a lot of human pathology cases is related to forensic.
GVP: Hmm, like what?
P: Err, human pathologists deals with too many murders and accidents. I tell you about a case that we had the other day in our tute. There was a baby came through with oedema and congestion (basically, the head looks swollen and purple-red) from the neck upwards, and there were two faint lines around the neck. We were asked what is the cause of death, and no one got it right despite being told that it was very obvious. The tutor told us that the an electric cord fits rather too well with the lines on the neck, and make the exact impression if you try wrapping one around your neck, in which she/he demonstrated so. At this point, there was an ominious cloud floating in the room, and you could tell what everyone was like what the F!@#$~~~~~~!

P: Then, a  few people started hyperventilating (breathing fast) and you could tell people were having tears in their eyes, and my eyes were watery.

Then she told me about a gruesome case of a car accident. In essence, the body came in several pieces, and the forensic officers had difficulties collecting all the parts at the scene: brain materials, eyes, visceral organs here and there. I had an impression that the body trunk got crushed like a garlic in a press. The impact was so sever that the garlic was sent flying and splattered - also not to mention obvious mutilple opened bone fractures (fractures with bones poking out of the skin for us to see)
Lesson learnt, especially to male audiences out there: stick to the speed limit, drive slower won't kill yah!

At the end, we both usually thought that we're not desentisied about this sort of things in general, but that whole thing was just sickening. There is too many funny people on this world.

A necropsy and animal welfare breach

I poked into the pathology department at the other day, to see if there was anything interesting ex-animal coming in, so that I could excuse myself from studying and get some action. Fortunately for me, there was a 9 yo female dog with maxillary mass extending towards the level of the eye and ventral (towards the abdomen ie. lower) aspect of the maxilla, infiltrating the gum and extending caudally two third of the oral maxilla. The mass height was 10cm, so basically, the head just looked grossly abnormal that even kids can tell.

Let's see what is there.

History: the animal was seized by an animal welfare organisation, and was euthanised on humane ground. A full post-mortem/PM (after death) examination is requested.

Every now and then, there is a case related to animal cruelty comes through the department. A full necropsy (exmination of corpse, in particular non-human bodies: I tend to use PM and necropsy interchangeably, while refer an autopsy to human bodies) is required for the purpose of lawsuit against the suspected offender, therefore professional opinion and comments from a veterinary pathologist is sought in regard to the nature, manner of lesions (abnormal tissue, change of tissue) and/or death.

In general sense, a mass lesion could be anything ranging from a cyst, abscess, naevus to neoplasm (abonormal growth eg tumour). However, some sort of a tumour was very likely given the extension and distribution of the mass. Soft tissue sarcoma (cancer of connective tissue) came to my head as I palpated the structure, so the differentials goes a long way as there are several types, but I had fibrosarcoma (malignant tumour of collagen-producing cell) on the top of differentials.

We did a fine needle aspirate/FNA which is sticking a needle into the mass and retrieving a sample for microscopic examinations. When the sample staining was done a few hours later, I was quite content that I am right. The cells on the slide looked crazy, which is a typical appearance of neoplastic (abnormal and out of control) fibrocytes. It is now likely that the dog was neglected, and left to suffer from the tumour. A necropsy report is written to be provided to court as evidence and a source of expert opinion.

And I was left thinking: how and why on earth people can be be so retarded and ignorant, and leave animals to suffer? The cost of euthania is definitely not a valid excuse, since it will only cost like AUD$20 in animal welfare hospitals and some even put animals down without cost. Or even just surrender them to any animal shelter.

Let's have a look at some art

At the moment I'm digging through my overworked little laptop, searching for notes on tumours, for the purpose of exam preparation. These are interesting images from lecture materials that I come across. During high school, I did IB Fine Arts HL, and learnt to critic artworks. Guess what, that is what I like to do while looking down a microscope.

This is why we Ozzies carry sunscreens around - malignant melanoma (nasty melanin-pigment producing tumour).

 

Malignant osteoblastic osteosarcoma (nasty bone producing tumour of a bone cell lineage)

Plasma cell myeloma aka. Multiple myeloma (nasty antibody-producing white blood cell tumour)

Mast cell tumour (nasty tumour of white blood cells with histamine granules)

The purpose of microscopic examinations is to determine the type of tumour, which we are fighting against, and to grade whether the tumour so that we can decide what is the best treatment option. Some of you may have realised that I put nasty in all of the description. Yes, we usually say "O'oh" when we see this since they are likely to have seeded to several body system, hence the prognosis is usually poor.

Pathologists' dark sense of humour

A lot of my mates perceive veterinary pathologists as being laid back in general, which I think it's quite true after having spent some time with many. But, I have to add our humour is rather odd and morbid as well. It may be due having to deal with cardinal humours on a day basis, perhaps? There is a few examples (of many) that I have in my head:

You all must have heard people saying "Do as I said, not as I do", and many veterinary pathologists are like that (I'm included even though not a pathologist just yet). We preach veterinary students not to use food to describe lesions. But then, we describe a suppurative (pus-sy) lesion as cottage cheese or compare chylothorax (white fluid in the chest) to a thick milkshake. Worse than that, with a bit of blood contamination, the milkshake is said to have a strawberry flavour. Ewwwwww~

I was helping out a pathologist and a lab technician with a necropsy then we started chatting about cold Melbourne weather and somehow animal body cremation - turning 20kg mass into less than half a kg ash. The pathologist mentioned how her partner is having a holiday, and enjoying summer overseas while she is working and suffering this cold miserable weather. The technician asked if her partner was being naughty and she needs to use the cremation facility. She responded laughingly that she will let him know if her partner is planning to travel without her again. I can see a perfect crime there, nah?

Once we were looking at a tissue slide of a feline kidney during one of the weekly histopathology round. After looking down a microscope, I proceeded to ask about these big bubbles in the tissue, and I was told that they were fat. "Well, you are what you eat, isn't it?" quickly added someone in the room.

This last one really got me laughing; there was a dog skull transceted in halves. One of the senior pathologists looked the skull and said "Hmm, I'm amused that the cranial cavity (hole in the skull that the brain sits in) is tiny. Look at the dog, it's massive! The brain is also tiny. I really to see the owner of this dog". Comparing people and their pet for similarities is always a good fun, don't you think?

Laughter is always good, isn't it?

What is veterinary pathology and who are veterinary pathologists?

These two are the questions some of you might be wondering since I have yet to proper explain.

pathos = suffering
logos = study

In a nutshell, veterinary pathology is a branch of science dedicates to the study of animal diseases. It is one of the many core subjects, taught in veterinary medicine. We learn about pathogenesis of diseases (how and why a disease occurs, and what are the consequences eg. how does a tumour occur) and lesions (what happened to the body eg. inflammation).
 

To be a veterinary pathologist, one needs to have a Doctor of Veterinary Medicine degree or equivalent, spends at least three years in a post-grad training eg. residency, and then sits the American or European board exam becoming a diplomate of the college - total of 8 or 11 years in uni minimum. That sounds rather excruciating but I'm almost half way there, yeah! Furthermore, there are two branches in the field, namely clinical and and anatomical. Clinical pathologists basically read blood and biochemistry profiles, and deal with samples of live tissues while anatomical pathologists examine fixed tissued and perform necropsies. I have spent a quite considerable amount in both, but aim to speciliase and become the latter.

Now, what do veterinary pathologists do? They seek to gain understandings of pathogenesis and lesions. The roles of veterinary pathologists are thoroughly described in the following excerpt from American College of Veterinary Pathologists:


"....... Why Are Veterinary Pathologists Important?
Veterinary pathologists improve and protect human and animal health by:

• Diagnosing disease in companion and zoo animals, and wildlife. Veterinary pathologists examine animal tissue and body fluids to diagnose disease and predict outcomes.
• Diagnosing disease in food-producing animals. By determining causes of disease, veterinary pathologists help maintain herd health and establish if there is a risk to humans handling or consuming the meat or milk of food animals.
• Contributing to drug discovery and safety. Because of their broad-based biomedical training, veterinary pathologists serve as key members of pharmaceutical research and development teams.
• Conducting research. With experience in diseases of multiple species, veterinary pathologists are uniquely qualified to perform studies to advance our understanding of the cause and methods to prevent disease in animals and humans......."

Lastly, the reason for having an image of Contagion (2011) in the post. It has a lot to do with veterinary profession, and one of the Diplomates of ACVP was the scientific consultant during the production, here! I have got to see the film that some point :)

Roles and responsibilities of veterinarians

I'm sitting in my room, drinking a long macchiato, and wondering about what is beyond my to-come graduation and so on. But, there is usually one thing that I usually keep thinking when I have time for my mind drift philosophically: what are my roles and responsibilities as a veterinarian apart from the stuff that set up by the AVMA and AVA?

Hmmm... I can't hear my heart

The answer in response has always been changing through my yet-to-end veterinary training, and it will continue to be so. When I first entered the vet school, it was just simply treating the patients. Be it dogs, cats, horses, cattle, sheep, rats, mice snakes, spiders! etc. Over the years, I have added, tweaked and formulated a long response, which now becomes more like an equation and includes:

1. Consult with clients in regard to their concern with their pet, and provide up-to-date information so that a well informed decision can be made in the best interest of the patient.
2. Utilise the knowledge to approach the problem, on ethical and compassionate grounds.
3. Understand, value and endearvour to cherish the bond between human and animal.
4. Provide sound and well informed opinion to the general public in regard to issues related to the profession, in addition to educate pet owners.
5. Contribute, where possible, to the advancement of scientific knowledge and research, as well as the training of future veterinarians.
6. Participate in continued education and pursue one's interest in veterinary discipline and expertise.

With those said, I strongly view myself as a source of information for clients. However, clients facing with a dilemma frequently turns to veterinarians and ask this particular question that I'm really reluctant to answer in a consult, especially when dealing with a potential euthanasia: What would you do if he/she (the animal) is your pet?

"Damn, she/he is definitely not my pet. I'm not the one paying for the treatment bill. Can't you use your brain and make up your mind?" I say in my head before respond with a blurb I have for this situation in an auto-pilot mode.

"I'm afraid that it's not my responsibility to make a decision about Insert the animal's name. There is no right or wrong choice, so what you believe is the right decision is right, and I'm not here to judge." I say in a matter of fact tone but with sympathy, while looking at the client.

Nowsdays, pets are in general as part of the family in the western society. Many people consider their pet as their child. Therefore, I do not see myself morally and legally proper to be making such decision for someone else under the above circumstance.