My externship site review

The place where I did my externship will remain anonymous unless you are in the JJC Vet Tech program.

The good:
  * I got to see a lot.  This is a busy walk-in clinic that has a separate emergency clinic that operates in the same building overnight.  Advertising for the emergency clinic, I suspect, means that this clinic sees a lot of emergencies regardless of the time of day.
  * The Tech supervisor graduated from JJC so she knows what to expect out of JJC students and can relate on a personal level to the experience of being an extern.
  * The other Assistants/Techs are very nice and helpful.
  * They pay $100/week. 
  * Shifts are 6:30am to 1:30pm, so the possibility to work a second job or do things after your shift is there.  I chose to work the afternoon shift on Mondays and Tuesdays which I liked (1:30pm to 8:30pm) and putting in extra time in addition to your shift is no problem if you want to get your hours done more quickly.

The bad:
  * The doctors are always very busy juggling rooms and don't have a lot of time to answer questions.  Teaching time with doctors is very rare.
  * There are 10 or so doctors and sometimes a Veterinary intern on staff here.  It's hard to get to know them and to get them to remember that you are an extern looking to learn things so that if/when they do have time or something interesting they might let you know about it.
  * The Techs/Assistants, while helpful, will generally give newbies the easy jobs just to keep up with the pace, so if you want to try a catheter, jugular blood draw, etc you have to either wait till everyone else is busy and you are the only one available or speak up!
  * Techs/Assistants are not well utilized.  Doctors do most of their own blood draws, injections, radiographs, etc. so much of your time is spent restraining.  This leaves few opportunities to practice, so again you have to jump on opportunities when they arise.  (Techs/assistants are mainly responsible for surgery and hospitalized patients, though, so these are your best opportunities to get practice!)
  * I had to buy a uniform from them.  For 2 sets of scrubs it was about $100. 

The indifferent:
  * There is no structure at this clinic.  You aren't assigned to any job or vet, everyone just jumps in and does what needs to be done.  You go from prepping for surgery, to cutting nails, cleaning cages, drawing blood, mopping the floor, washing surgical instruments, shuttling animals around -whatever needs to be done at the moment.  There is little to no down time, but you aren't stuck with one task or one doctor all day either.

What I got to do:
Daily to several times a week:
  * restraining
  * cleaning cages, dishes, surgical instruments, the treatment area, etc
  * drawing up vaccines
  * TPR's for hospitalized cases
  * giving medication to boarding and hospitalized patients
  * prep animal for surgery (restrain for induction and intubation, then you shave, scrub the surgical site, and open the pack for the vet)
  * nail trims with or without dremel
  * cephalic blood draws on dogs
  * putting in IV catheters (almost always in dogs)
  * SQ injections
  * IV pump use

Weekly or so:
  * jugular blood draw(s)
  * putting drugs away (cabinets by type of drug, helped w/ re-learning drugs)
  * run in-house blood tests (PCV, Pre-surgical or Chems, rarely CBC's, or electrolytes)
  * nebulization(s)
  * giving subcutaneous fluids
  * monitor patients' anesthesia level

Rarely:
  * scrub in on a surgery (once, foreign body)
  * take x-rays yourself
  * dentals
  * calculate and/or give premed
  * induce anesthesia (once)
  * intubate (once)
  * anal glands, fecal collection
  * microscope work, mostly earmite checks (a couple aspiration biopsies and skin scraping results always because I asked to look at it)
  * run EKGs (done over the phone)
  * use esophageal stethoscope
  * set up suction and/or cautery for surgery
  * wing clipping
  * microchipping

Never:
  * fecals -always sent out
  * urinalysis -sent out
  * blood smears -sent out
  * physical exam -doctors do, although techs do TPR's on hospitalized cases
  * interact with customers by phone
  * needle aspiration biopsy -doctors do
  * skin scraping -doctors do
  * FDT/STT -doctors do
  * otoscope/ophthalmoscope use -doctors do
  * take histories-doctors do
  * bandaging -techs do, I just never did it
  * calculating fluid rates, estimating dehydration -doctors do
  * dental radiographs -not available except w/ regular x-ray machine
  * blood pressure, ETCO2 -BP available, ETCO2 not available

What I got to see:
  * oxytocin use, puppies being born (got to stimulate puppies to potty)
  * eclampsia
  * hit by cars
  * respiratory arrests and other emergencies
  * collapsed tracheas
  * toxin ingestions (Decon, Aleve, marijuana, transmission fluid, unknowns)
  * saddle thrombus
  * GDV
  * HGE
  * severe anemia
  * hepatic lipidosis in a cat
  * compound fracture in cat
  * lacerations, abcesses, necrotic wounds
  * an impalement
  * glucose curves
  * ACTH stim tests
  * acute and chronic renal disease
  * acute and chronic liver disease
  * acute and chronic heart disease
  * cardiac arrests
  * splenic, liver, skin, and other tumors
  * two eye removals  (dog and cat)
  * heat stroke (dogs and a chinchilla)
  * severe dry eye
Surgeries:
  * limb, tail, toe amputation
  * declaws
  * spays, neuters
  * foreign bodies/gastrotomies (rocks, blankets, rubber toys, etc)
  * cystotomies
  * blocked cat
  * CCL's
  * tight ropes
  * TPO's
  * patellar luxation correction
  * lumpectomies
  * aural hematomas
  * kidney removal (HBC)

Abbreviations in Veterinary Medicine

• AAFCO:  Association of American Feed Control Officials  -set standards for feed and it's labelling
• ACE:  angiotensin-converting enzyme
• ACT:  activated clotting time
• ACTH:  adrenocorticotropic hormone
• ADH:  antidiuretic hormone
• ADR:  Ain't Doin' Right 
• AD:  right ear
• AI:  artificial insemination
• ALARA:  as low as reasonably attainable  -what you want your x-ray exposure to be
• ALP:  alkaline phosphatases
• ALT:  alanine aminotransferase
• APPT:  activated partial thromboplastin time
• ARF:  acute renal failure  -sudden onset, kidneys appear swollen
• AS:  left ear
• AST:  Aspartate aminotransferase
• AU:  both ears
• AVMA:  American Veterinary Medical Association
• BID:  twice a day
• BM:  bowel movement, poop
• Bpm:  beats or breaths per minute (measure of heart or respiratory rate)
• C  calculus/tartar (on dental chart, graded C/H, C/M, C/S)
• C1, C2, etc:  cervical vertebrae -they are numbered with C1 being the closest to the skull
• cc:  cubic centimeters  -same as a mL
• CCD:  canine cognitive disorder  -doggie alzheimer's
• C/H:  calculus heavy (on dental chart)
• CHF:  congestive heart failure
• CL:  corpus luteum  -produces progesterone and maintains pregnancy
• C/M:  calculus moderate (on dental chart)
• cm:  centimeter  -metric system unit of measurement, 2.5 cm = 1 inch
• CNS:  central nervous system  -the brain and spinal cord
• CP:  corporal proprioception  -a test of the nervous system; one test is to pick up a dog's foot and put it down so the toes are under the foot, a normal response would be for the dog to immediately turn his foot back to a natural position
• CRF:  chronic renal failure  -slow onset, kidneys appear lumpy and shrunken
• CRI:  constant rate infusion  -administration of a drug in little bits over a long period of time, usually done via an IV drip
• CRT:  capillary refill time  -a test of perfusion where pressure is applied to an area like the gums and then released; the skin should blanch and then return to pink within 2 seconds
• C/S:  calculus slight (on dental chart)
• CVP:  central venous pressure  -measurement of blood pressure at a central vessel such as the vena cava, usually done through the jugular
• D:  diarrhea 
• DA2PP:  distemper, adenovirus (two types), parvovirus, and parainfluenza  -common multi-vaccination for dogs
• DER:  daily energy requirement  -much like BMR for humans, its the calories required to sustain life at rest, helps in determining amount of feed to give
• DMSO:  dimethyl sulfoxide  -a nonsteroidal anti-inflammatory drug (NSAID)
• DTM:  dermatophyte test media  -a culture test used to diagnose ringworm
• Dz:  disease
• EDTA:  ethylenediaminetetraacetic acid  -an anticoagulant added to some blood collection tubes, usually those with a puple top
• EEE:  Eastern Equine Encephelitis
• EH:  enamel hypoplasia/hypocalcification  -when the enamel doesn't form properly on the teeth such as in dogs exposed to high fever (esp. Distemper) as puppies when the enamel is forming
• ELISA:  enzyme-linked immunosorbent assay  -a type of rapid test that a vet can often do in the office and have the result in 10 to 15 minutes
• EOD:  every other day
• EPO:  erythropoetin  -a chemical released by the kidneys that spurs new red blood cell growth
• ETCO2:  end tidal carbon dioxide  -a measurement of the amount of carbon dioxide being breathed out by an animal, usually under anesthesia
• F:  female
• F1:  furcation detected (on dental chart)
• F2:  probe passes into furcation (on dental chart)
• F3:  probe passes through furcation (on dental chart)
• FAD:  flea allergy dermatitis or foreign animal disease  -allergic reaction to a flea bite, or an animal disease that is not usually encountered in the area where it was found, could be a vector for terrorism
• FDT:  fluoroscein dye test -used to find ulcers or wounds on the eye
• FE:  furcation exposure (on dental chart, graded F1, F2. F3) 
• FeLV:  feline leukemia virus vaccine
• FFD:  focal film distance  -the distance from the x-ray source to the film
• FIA:  feline infectious anemia 
• FIP:  feline infectious peritonitis  
• FIV:  feline immunodeficiency virus  -kitty AIDS
• FLUTD:  feline lower urinary tract disease  -conditions of the lower urinary tract in cats such as bladder infections, blocking, etc
• FORL:  feline odontoclastic resporptive lesion  -condition in cats where the tooth is absorbed by the body
• FRL:  feline resorptive lesion  -condition in cats where the tooth is absorbed by the body
• Fx:  fracture
• g:  gram  -unit of weight, roughly equal to that of a small paperclip
• GDV:  gastric dilatation and volvulus  -a life-threatening condition where a dog's stomach fills with gas and then twists around, cutting off circulation and causing tissue death
• GH:  gingival hyperplasia (on dental chart, graded H1, H2, etc)
• GI:  gastrointestinal  -the organs of digestion from the stomach to the anus
• GR:  gingival recession  (on dental chart)
• gr:  grain  -a unit of measuring weight, there are about 60mg in a grain
• H1:  gingival hyperplasia, 1mm
• H2:  gingival hyperplasia, 2mm, etc
• Hb:   hemoglobin  -the chemical in the blood that carries the oxygen
• HCT:  hematocrit -same as PCV. measures what percent of the blood is RBC's
• HR:  heart rate (number of beats per minute)
• Hx:  history
• IACUS:  Institutional Animal Care and Use Committee  -oversees animal welfare issues in research facilities
• ID:  intradermal  -(injections) made directly into the skin (as opposed to under it), usually for allergy testing or administration of a pain blocking agent
• IM:  intramuscular  -(injections) made into the muscle, usually the tricep (upper arm), quadricep or hamstring (upper leg), or epaxial (back)
• IMHA:  immune mediated hemolytic anemia  -an anemia caused by the body attacking it's own red blood cells (RBC's)
• IO:  intraosseus  -(injections) into bone such as the hip, femur (upper leg), or tibia (lower leg)
• IP:  intraperitoneal  -(injections) into the abdominal cavity
• Iso:  isoflurane  -a type of gas anesthetic
• IV:  intravenous  -in a vein or vessel
• kg:  kilogram  -a measure of weight, there are 2.2 pounds in 1 kilogram
• kVp:  kilovoltage peak  -a setting used for taking radiographs, effects the contrast in the resulting image
• L:  liter  -one-thousand mL, about the same as a quart 
• L1, L2, etc:  vertebrae of the lower back, numbered
• lb:  pound  -a measurement of weight, there are 2.2lbs in a kg
• LH:  luteinizing hormone -promotes ovulation and corpus luteum conversion in females and stimulates testosterone production in males
• LI:  large intestine
• LRS:  lactated ringers solution  -a type of fluid used both subcutaneous (under the skin) and IV
• M:  mobility (on dental chart, graded M1, M2, M3) 
• M:  male
• MAC:  minimum alveolar concentration  -a measure of the amount of an anesthetic gas that's required to render an animal unconscious
• MCHC:  mean corpuscular hemoglobin concentration  -the average amount of hemoglobin contained in the red blood cells, tells you if the RBC's arepale in color or not; light cells have less hemoglobin and are often indicative of young RBC's
• MCV:  mean corpuscular volume  -the average size of the red blood cells in a sample, large cells indicate more young RBC's
• mg:  milligram  -one one-thousandth of a gram (g) 
• MIC:  the lowest concentration of an antibiotic that is effective, usually in laboratory conditions, used to determine dosage requirements
• mL:  milliliter  -one one-thousandth of a liter (L), a milliliter of water weighs about a gram (g)
• mm:  millimeter -a tenth of a centimeter (cm)
• mm:  mucus membranes  -often the areas on animals where color can be observed or a CRT can be taken such as the gums, tongue, prepuce, conjunctiva, etc
• MPD:  maximum permissible dose  -max amount of radiation a person should be exposed to in a year, 5 REM for occupationally exposed persons, 0.5 REM for everyone else
• MREM:  millirem  -one one-thousandth of a REM
• MSDS:  Material Safety Data Sheet  -the safety information about chemicals used in a workplace that must legally be accessible to anyone who uses the chemical as part of their job
• NM:  neutered male
• NSAID:  non-steroidal anti-inflammatory drug  -like Tylenol or aspirin in human medicine
• O:  missing (on dental chart)
• o:  owner
• OCD:  osteochondritis dissecans  -a condition where a piece of cartilage in a joint (usually the knee) tears and floats around causing pain
• OD:  right eye
• OS:  left eye
• OSHA:  Occupational Safety and Health Act -a set of laws designed to provide a safe workplace for employees
• OTC:  over the counter  -a medication or other product that's available in stores without the need for a prescription
• OU:  both eyes
• oz:  ounce  -equal to 2 tablespoons or 30mL
• p:  patient 
• P1:  the most proximal phalanx (bone of the finger/toe/digit)
• P2:  the middle phalanx (bone of the finger/toe/digit)
• P3:  the most distal phalanx (bone of the finger/toe digit)
• PCV:  packed cell volume  -a test to find out what percentage of the blood is red blood cells, it can help diagnose anemia among other things
• PDA:  patent ductus arteriosis  -a condition where a hole in the heart that's normal in fetuses persists in an infant or adult; usually results in a "washing machine" type of heart murmur
• PLR:  pupillary light reflex  -a test of the nervous system; a light is shined in the eye and the pupil is observed for contraction
• PO:  per os  -by mouth 
• PNS:  peripheral nervous system  -nerves that come after the brain and spinal cord
• prn:  as needed
• PSS:  portosystemic shunt  -a condition where a blood vessel allows blood to detour around the liver so that it does not get filtered and toxins build up in the blood
• pu/pd:  increased urination, increased thirst 
• q4h:  every four hours
• q8h:  every eight hours
• QID:  four times a day 
• Qt:  quart  -a measure of volume that's about the same as a liter (L)
• RBC:  red blood cell  -carries oxygen to tissues and carbon dioxide away from them
• RE:  root exposure (on dental chart)
• REM:  Roentgen equivalent man  -used to express dosage of radiation exposure
• RER:  resting energy requirement  -similar to BMR for humans, it tells you the number of calories an animal would need to survive (not including any exercise); used to determine amount to feed
• RR:  respiratory rate (number of breaths in a minute)
• Rv:  rabies (virus)  -often refers to the vaccine
• SC:  subcutaneous  -(injection) under the skin
• SE:  side effects
• SF:  spayed female
• SG:  specific gravity  -a measurement of how diluted or concentrated a liquid is such as in urine or blood
• SI:  small intestine
• SID:  once a day
• SQ:  subcutaneous  -(injection) under the skin
• STT:  Schirmer Tear Test  -a test for dry eye
• Sx:  surgery
• T:  temperature
• T1, T2, etc:  thoracic vertebrae  -the vertebrae with ribs attached, numbered with the one closest to the neck being T1
• TBW:  total body water  -the total amount of water in the body
• TID:  three times a day
• TPN:  total parentral nutrition  -providing nutrients to hospitalized patients intravenously when they cannot take it in through the digestive tract
• TPR:  temperature, pulse, and respiration  -vital signs
• Tx:  treatment
• UA:  urinalysis  -a test to look for crystals, bacteria, and other indications of disease
• URI:  upper respiratory infection  -a cold
• UTI:  urinary tract infection
• V:  vomiting
• VC:  vena cava  -the largest vein in the body, it drains into the heart
• VEE:  Venezuelan equine encephalitis  -zoonotic
• VI:  volume infused  -amount of fluids administered by a fluid pump
• Vx:  vaccinate/vaccination/vaccine
• VTBI:  volume to be infused  -amount of fluid set on a pump to be administered to the patient
• W:  wear (on dental chart)
• WBC:  white blood cell(s)  -the cells involved in protecting the body from infection
• WEE:  Western  Equine Encephalitis
• WNL:  within normal limits
• X:  extraction (on dental chart)

This is a radiograph of a one and a half year old female terrier mix who ingested rat poison. It came in as a referral from another vet. The initial complaint from the owners was that the dog was having difficulty breathing. We did a blood test and found out that she was severely anemic and on physical examination we found a huge hematoma on her neck where the referring vet drew blood from her.

The owners had no money for a blood transfusion so we gave her vitamin K (to treat the rat poison toxicity) and balanced fluid therapy with diluting her blood to the point where her difficulty breathing grew even worse.

The radiograph shows that her entire left lung was filled with fluid. The fluid is probably blood because rat poison affects blood's ability to clot and dogs who ingest rat poison often bleed into their lungs. She's lucky only one lung was affected!

After a couple days of hospitalization she went from a dog who couldn't lay down due to her difficulty breathing and having severely pale mucous membranes and no appetite despite her hip bones showing to a dog who'd wag her tail as you approached her cage and had fairly pink mucous membranes (almost normal), and who'd devour any food put in front of her.

I did her TPR's while she was hospitalized with us and by listening to her lung sounds you could easily tell which side was affected -the left lung was silent while you could hear breathing on the right side. Just before she was released, I could start to hear a little bit of air flow on the left side which was a sign that the amount of fluid was starting to go down in that lung.

Many of the vets and techs thought she was a gonner when she came in and we learned that a blood transfusion wasn't an option for her, but we were all super happy she pulled through. She was such a cute and affectionate little dog! <3

Guess the diagnosis #2

2 year old Lhasa mix came in with the owner complaining of vomiting for the last 2 days, and the dog's now refusing to eat as well. Can you tell why from the radiograph above?

Highlight here for answer: Foreign body. See the chicken bone in the stomach?

Guess the diagnosis #1

A 6 year old Sheltie mix came in having difficulty breathing, especially after exercise. Can you tell why by the radiograph above?

Highlight here for the answer: Collapsed trachea -see the dark tube leading from the head and following the path of the spine? That's the trachea. See how narrow it gets near the area of the front legs? It should be about the same diameter all the way down!

Week 6 of externship

I've gradually been able to do more and more at my externship. I'm now routinely drawing blood, putting IV catheters in, helping prep for surgery, giving vaccines, doing TPR's, etc. I learned how to do EKG's over the phone today and a few weeks ago I actually got to scrub in on a surgery! I've been practicing reading radiographs and anticipate the tests the doctors will run after looking at the animal and/or their chart. I collected some extra urine the other day and looked at it under the microscope, then I compared what I saw to what Antec reported and I was able to explain the discrepancies. In short, I'm pretty happy with my progress!

Of course, there are some frustrations as well. Techs get treated like poop by some doctors while others are happy to teach you things or even quiz you about certain topics. And just like any job there are things you'd rather not do: cleaning cages, sweeping, mopping, etc. It hasn't been a perfect experience, but it has been interesting and I think that's pretty much what it's all about.

Pharmacology math examples

Here's a typical pharmacology math problem:

1. A 30 pound Cocker Spaniel comes into your clinic needing amoxicillin for an infection. Your vet asks you to dispense the Amoxicillin based on a dosage of 11mg per kg. How much amoxicillin should the dog receive per dose?

Before getting into the problem let's approach pharmacology math by thinking about it in terms we are more familiar with. How about we temporarily change the problem as follows:
You have 30 eggs that cost $11 per dozen how much are all the eggs worth?

First, we'd figure out how many dozen we have by converting eggs to dozens of eggs. This is done by dividing the number of eggs by 12 because there are 12 eggs in a dozen. So, 30/12=2.5doz.

Since we know they cost $11 per dozen and we know we have 2.5 dozen, we just multiply 2.5x11=$27.50 right? See, you know how to do this!

With that in mind let's now attach our actual problem:

1. A 30 pound Cocker Spaniel comes into your clinic needing amoxicillin for an infection. Your vet asks you to dispense the Amoxicillin based on a dosage of 11mg per kg. How much amoxicillin should the dog receive per dose?

First you need to convert pounds to kilograms. You need to memorize the fact that there are 2.2 pounds in a kilogram. It's something you'll use a lot. So, for 30lbs you need to divide 30 by 2.2 to get 13.64kg as your answer.

This part of the problem is just like the previous problem where there were 12 eggs in a dozen. 30 eggs divided by 12 eggs per dozen was 2.5 dozen eggs.

Second part: you have a dose of 11mg per kg. You have 13.64kgs. 11mg per kg means that for every kg you need 11mg. This should tell you that you need to multiply 13.64 by 11. 13.64x11=150.04mg per dose.

This works just like the eggs costing $11 per dozen. 3 dozen would cost $33 because $11 times 3 dozen = $33.

2. The next day the owner of this Cocker Spaniel comes back to the clinic saying they can't get the dog to swallow the pills. Your vet asks that you give them liquid amoxicillin instead. The liquid you have contains 62.5mg of amoxicillin per milliliter. How many milliliters should be given per dose?

Well, we figured out before that the dosage is 150.04mg. And we have a solution that contains 62.5mg per ml or for every milliliter there are 62.5mg. So, we need to know how many 62.5's are in 150.04. We do this by dividing 150.04mg by 62.5mg and we get 2.4ml.

If you have a hard time following that we can try once again to use something more familiar to understand how to work it out: Coffee has 100mg of caffeine per cup. You need at least 300mg to get through your next Keller test. How many cups of coffee do you need? 300mg (needed) divided by 100mg (per cup) = 3 cups.

Now try a few on your own before peeking at the answers:

3. A 10lb cat comes into your clinic with a cold. The vet asks you to prepare doxycycline using 5mg per kg as the dose. How much doxycycline should be given per dose?

Invisible answer: (highlight to see)
Pound to kilogram conversion: 10lbs/2.2kg per lb = 4.5kg
Dose: 5mg x 4.5kg =22.7mg

4. You have doxycycline available in liquid form that contains 10mg per ml. How much of this solution should be given per dose?

Dose: 22.7mg/10mg per ml = 2.27ml

5. A 5lb puppy comes into your clinic and is diagnosed with roundworms. The vet asks you to draw up a dose of Strongid to give to the puppy based on 8mg/kg. The Strongid you have is 50mg/ml. How much Strongid should you prepare?

Pound to kilogram conversion: 5/2.2=2.27kg
Number of mg: 8mgx2.27kg=18.16mg
Number of ml: 18.16mg/50mg per ml=0.36ml