So far so good.

I've seen all sorts of things since I updated last and it would be dead boring to run through a list of them all. Highlights have been an increase in the number of testicles I have lopped off, a dog with onychodystrophy, a labradoodle with epilepsy, some yummy chocolate brownies, an ex-lap to hunt for a cause of cholestasis, an entropion-fixing operation, interesting clients, a necrotic tail tip, removal of the anal glands, listening to gallop rhythm cats, blood glucose monitoring, tooth rasping, a difficult case of mud fever management, cracking lemon drizzle cake and a dog with a ventricular septal defect. I will also never cease to be amazed by the amount of animals which are riddled with fleas or ear mites. Grim!

I have spent an awful lot of time peering into the eyes and ears of all the anaesthetised patients to try and improve my experience of looking into these orifices! It's a lot easier when the patients are anaesthetised and makes me swifter when dealing with the live & kicking ones. Talking of anaesthesia I was 'in charge' of anaesthesia on Friday morning and everything went under and got back up as planned. Words can't do justice to the feeling of relief! I have also worked all week on improving my pussycat handling. Having never had pets as a child I never spent much time manhandling cats or kittens and I think they can sense my cack-handedness. Little triumphs this week include tabletting my first ever cat (something I had managed to avoid until now!), tabletting five more and improving intramuscular jab technique for triple anaesthetic.

Last week I was looking after the family dog whilst my parents were away. Whilst it was a delight to have him around for walks at lunchtime, it was fairly exhausting making sure he & I both got enough exercise. I was relieved when they came back at the weekend.

It has been a really long week, but I really enjoy the work. It's slightly depressing to work all the hours under the sun for no financial reward; I imagine the counter argument to that would involve the experience freely given. Considering we're not able to act without supervision and in some cases we require a lot of supervision, but in other cases I think the practices get very good value for money.

One more week of mixed practice and then we're off to Wales. Tally ho!

Testicles: 4 pairs and counting

I'll fill you in on what I've been up to tomorrow, I promise. This is what two of the cats looked like when they came around.

Full speed ahead...

Long old first day, but a brilliant one. Morning in surgery and afternoon in consults.

1. 2x castrates. One very small set and one average set whipped off (closed technique) and scrotum glued.
2. GA and xray on a terrier with a sore toe. Not broken, but some DJD in the interphalangeal joints.
3. Lipoma removal and spay op on an older dog. Uterus iffy and ovaries all polycystic so better out than in. Lipoma shelled out nicely. I had scrubbed in because we weren't sure what they spay would be like and got to practise my sewing. It was very neat and getting less cack-handed each attempt.
4. Cat spay for charity. Very quick and neat. Flank entry.
5. Ultrasound exam on canine abdomen looking at the liver. Enlarged.

-Brief interlude for clearing up, hoovering, mopping and lunch-

Consults included:

• Vaccinations
• Re-examination and vaccinations
• Rabbit exam and myxi vaccinations. Also toe clip. Good refresher of how to restrain, exam and vaccinate wabbits.
• Stitch removal for a castrate op.
• Bloods for a doggie with endocrine disease.
• Toe clip for an ancient doggie.

-Afternoon gap for 30minutes (brightened by the introduction of doughnuts)-

• Ear exam and cleaning for a boxer
• Re-exam for lameness
• Ophthalmic re-exam following ulcer therapy
• Unwell and lameness exam
• Stitch removal for lump excisions
• Anal furunculosis re-exam.
• Pregnancy ultrasound. No puppies :-(

I've probably forgotten some, but the small animal consults go so quick that a few slip out of my mind. It was a really good day for learning; the practice I go to are just fabulous at letting me get involved. Definitely a challenge getting my head into small-animal gear though!

Obsessed with this song...

Scanner time!

16.02.2012

Only saw one appointment today once I got back from the GP. Disappointing!

Big blue roan chunky boy with bilateral swelling behind the ears. Spongy and seems to communicate. Scanned with ultrasound and the texture looked spongy/soft tissue with no large pockets of fluid. This was the second scan, revisiting because they have flared up again and seem to cause ridden discomfort (head shaking/dropping). Going to go away and increase work to see what occurs and work from there. Diagnosis subnuchal synovial bursitis.

17.02.2012

1. Vaccinations for a grey event pony. Late for appointment due to ridiculous road closure and non-existent diversion. In, out, shake it all about.

2. Bandage change for a lovely bay mare with an injury to her left metatarsus. Wound looks good and has a lovely pink granulation bed. No sign of infection and the wound beginning to contract nicely. Re-bandaged under pressure with an Allevyn dressing and Intrasite gel. Re-bandage on Monday. Also dropped off some Regumate for extremely hormonal little companion pony. She was kyoot.

3. 'Swollen bottom' on an old grey show pony with a very lovely elderly owner. Wasn't sure what to expect from a presentation of 'swollen bottom'; it actually seemed to have oedema around the tail base and anus which was a little pink and warm. It didn't seem to be itchy and wasn't very sore. No obvious puncture wounds. Dispensed steroid cream and bute. Advise to keep a close eye on the old fella.

4. Xrays on a very, very sore 20y/o grey showjumping pony. Was sore in front and now sore all around; constantly shifting his weight. Took lateral xrays on all four feet, but no apparent signs of laminitis upon development. [Must remember to look up basic xray settings...58kV and ?mAs] Advised to soak all hay fed for at least 24hrs and minimise feed to just enough to disguise bute (BID).

5. Back in the clinic xray and scan on the back of a big dark bay welsh x tb following an acutely painful back and poor muscling of the longissimus dorsi muscles. Medicated the facet joints under ultrasound guidance with depomedrone and used needle therapy with saline. Sedated with dom & torb + a little ACP.

6. Last, but not least, an ultrasound scan the left metacarpophalangeal joint of an ex-showjumper which was swollen and painful. Sedated with dom & torb. At the level of the proximal sesamoids (landmark for annular ligament) the annular ligament was absent (possible previous surgery) and there were pockets of fluid and a mesotenon stalk-like attachment between the sheath and the tendon. There were also islands of calcification in the DDFT & SDFT which were showing up with comet trails on the scanner. These can be better visualised with an off incidence (slight tilt) to the scanner. The tendon goes from black to white on the screen and the little patches stand out more clearly - allows you to see more clearly where they are. Following a sterile scrub we drained the fluid and injected hyaluronic acid (anti-inflammatory properties) into the space. We wrapped all this up in a pressure bandage and advised box rest for at least a week to let him recover.

Cleaned up and headed home for the day. Back here in mid-May and I can't wait.

Small, but perfectly formed.

A couple of days of notes to catch up on...

14.02.12

1. Castrate on a 7m/o little bay Irish Draft fellow. Sedated with dom & torb and injected lignocaine locally around the goolies (testicle, neck, skin of the scrotum). Sterile scrub of the area. Clamped on emasculators for 4mins for blood vessels & another 4 minutes for testicles. Emasculators go on nuts to nuts for first clamp. No trouble, nice and quick. Small, but perfectly formed.

2. Scanned RF tendon on a 20y/o bay connemara. We were hoping for ALDDFT damage as it is simpler to repair, but actually saw a lot of damage to the SDFT. Poor boy was very sore and swollen. 6months of box rest & support bandages to look forward to. Re-scan in 1 month.

3. Gorgeous gorgeous gorgeous little Welsh Sec A driving pony. Lateral xrays on both forefeet (I did them!) History of laminitis; concussion from driving may have played a role as not actually that fat for a pony. In Imprint shoes and doing really well. Farrier wanted to see xrays to have an idea of how much he could take off the toe. Was first time I saw Imprints go on; really clever little shoes.

15.02.12

1. Vaccinated another 13hh bay driving pony. Checked heart. More regular than my heartbeat (see below!) Pinch skin of the neck and inject under the skin. Not Proteq as she'd had a bad reaction to that last time.

2. Re-application of Liverpool ointment to a small nodular sarcoid on the right forelimb of a lovely little coloured mare. Job jobbed.

Cut my afternoon short here because unfortunately the funny arrhythmia I'd been experiencing for the last few days got worse and I ended up spending 5 hours in casualty having tests. Yippee. Not dead yet though. Must try harder. I learned was that I am very fit and that I don't have a murmur, electrolyte disturbances or thyroid problems. Woohoo!

Many dark bay geldings

First case this morning was stitch removal on a 17hh dark bay handsome old boy. Stitches were snipped out from a wound on the medial tarsus which the patient had managed to align right over his vein and I am reliably informed 'pissed blood everywhere' when he came in. Vet kept head right up next to stifle when leaning over to do the stitches. Thought this was pretty sensible for general kick avoidance. Also vaccinated their little shettie field mate who had a simply adorable pink hearts fleece rug on and was quite a character.

Second in was a set of forelimb radiographs on another big 17hh bay gelding with a history of laminitis. Radiographs were to check for changes in the feet consistent with laminitis or founder. No changes were present, but some osteophytes possible on the proximal interphalangeal joint. Took obliques to check out the osteophytes. Nothing major.

Got stuck in loads of traffic after a horrible accident where a lorry and a car seemed to have tangoed up the central reservation. The car had come off worse and the central reservation was all over the wrong side of the road. Grim.

Eventually made the visit, albeit late, to another dark bay gelding, 25y/o, for a general once over. This consisted of a mini-vetting (vet had to borrow my pink stethoscope - he worked it!); eyes, skin, heart, lungs, palpation etc. Some swelling was present over right stifle and tendon sheath of the right hind. Watching the movement he seemed to be dropping his hip more on the right hand side and at trot was visibly lame. Lameness worse to flexion, seemed to isolate to the fetlock (flexion rarely exacerbates stifle lameness). Took blood. Further appointment made.

Last, but not least two dentals. One on a gorgeous gray mare. No sedation required although she did fidget a little.Used power tools. Very good; had a feel of before and after and the difference is remarkable. Did teeth on a huge coloured 6y/o showjumper next. Sedated with Domosedan to take the edge off (he tried to rear a few times) and then did teeth with power tools. Had a few ulcers from sharp points on his teeth. Re-do in 6months. Got to have another cheeky feel. Love being out. Learning things!

A good day.

Them's my reasons and I'm sticking to them.

Blissed out cat

Because I am a sensible growed-up type of person and I value my career prospects I decided to set off for my first rotations as sleep deprived and unprepared as possible (I woke up this morning after about 4 hours kip and too much dancing next to a totally blissed out cat). It seems to be important for a vet to be able to operate on very little sleep and I felt the need to develop this skill. Them's my reasons and I'm sticking to them. Tomorrow morning at 6am I will reflect upon the decisions I made this week and probably wonder if my reasoning was sound, but that's what hindsight is there for. Week 1 is equine so I figure so intensive anatomy swotting during the vet's morning meeting might be a good plan. Fingers, paws, hooves etc. crossed.

T-minus two days until they let me loose

Cripes, where have the weeks gone? It dawned on me, whilst packing my worldly possessions into my van, that from Monday onward I am a vet. Granted, I will be a vet-in-training, but still a real-life vet. I hope that the first few weeks are gentle and give me a little chance to find my feet again. It's more than a little daunting to be released into the veterinary profession after so many years of lecturing on campus and watching from the sidelines. As my lovely flatmates helped me carry my stuff downstairs after our enchilada feast I felt a little fearful. It will pass. My new life as a veterinary rotations student is about to begin and I need to give myself over to that for a while and concentrate.

On a slight tangent, it seems prudent to remind myself and anyone else who happens to read that Rule #1 of the Royal Veterinary College is don't date anyone at the College. I hate being right sometimes.

On a complete tangent, my Macmillan Cancer Support vest is here (at home) and I am quite excited about going out for a run in it tomorrow. Let's keep the fingers crossed for blue sky and sunshine. I'm running the London Triathlon for Macmillan Cancer Support this year and you can sponsor me (if you so wish) by visiting www.justgiving.com/Hannah-Louise-Jordan.

Student Union

At work again this week because I'm scheduled for introduction to equine rotations track next week. The feedback from the others seems fairly positive. I'm not complaining one little bit; interval training my way back into using my brain suits me just fine.

Last night we had the first Hawkshead SU council meeting. There are many things discussed at these meetings, some are trivial, some are fascinating, some are dull and some controversial. Funnily enough, the latter usually centers around money. The main thing I take away from these meetings (aside from a list of action points) is a real sense of community and a love for the RVC as an institution. I often hear muttered grumbles about the SU and the decisions they make on behalf of the student body; much like national political parties, I really feel you can't complain unless you are involved and giving feedback. We can only represent you if you tell us what you think, so please do tell us what you think!

Whirlwind tour of clinical presentations

The last two days have been pretty packed with lectures and case work. We have skipped through vomiting, diarrhoea, weight loss, epistaxis, pale mucous membranes, jaundice, haematuria, coughing and dyspnoea, weakness-syncope-seizures and last, but not least, PU/PD. This whirlwind tour has been designed to get us thinking again after the Christmas break and aims to get us to consider possible clinical presentations and how we can use the clues from a history, presentation and clinical exam to work logically through cases to achieve a diagnosis. The concept is simple and the feedback from clinicians teaching current final years is that these students are measurably better at clinical problem solving. There is only one problem: I am absolutely terrible at it! Incidentally, the logical approach to clinical problem solving also runs as a CPD course (http://cpd.rvc.ac.uk) and I would recommend it very highly.

Learning about Endnote

I am sat in a computer aided learning (CAL) session which is designed to teach RVC 4th year students how to use Endnote software. The session so far has been informative and a good refresher on just how fabulous Endnote is when you are writing academic reports or essays. However, the delivery was a little muddled and on more than one occasion I found my mind wandering to other things. To be perfectly honest, I think this is more of a failing on my part than it is on part of the instructor who has tried very hard to get the key points across.

Lots of the yeargroup haven't bothered to come to any of these self-help research sessions. When they reach their research rotations block there will be much wailing, moaning and ganshing of teeth about how little help has been provided to them with their project. Once again this will be a case of the help being there and the students failing to take advantage of it, but perhaps that is just the view of a jaded graduate student who doesn't turn down free help with anything anymore. That was a valuable lesson learned on the last degree.

Whether the failing is on the part of the student for not attending, or on the part of the college for not pitching these sessions quite right (too slow and boring or too quick and impossible to follow... it needs to be just right like baby bear's porridge) there is a tangible improvement from the first sessions of these sort I attended. Improvement is not to be sniffed at and I hope that the RVC continues to listen to student feedback and make more positive changes. I feel like this is leading me onto a fairly serious rant about increasing student numbers, class sizes and the detrimental effects this has on small group learning, but I will save that for another time.

The great Moodle migration.

The college is making the move from the Blackboard learning environment to Moodle this year. The whole process is pretty arduous because resistance to change is always rife amongst the staff and students; it is easier for most people to follow the path of least resistance and a migration to Moodle doesn't fall under that category. 

The RVC is right at the forefront when it comes to developing online learning materials. Most of our lectures are recorded with Echo 360 software which allows students to review both the accompanying power point and audio lecture at home. In addition to this there are online multiple choice questions to test yourself and numerous computer aided learning (CAL) programs to accompany specific material. These are designed to encourage students to go hunting around a subject and increase their breadth of knowledge. These have evolved over my six years at the RVC and get better and better as more students feed back to the staff; the CAL materials aren't universally loved though and many students would prefer all the material to be lectured in a more spoon-fed format. Whatever course you are interested in, I can't emphasise enough the importance of considering the programme structure and methods of teaching when you are choosing your university. If the teaching methods don't suit your individual needs you're fighting an uphill battle from the start.

Anyhow, I digress. The task of migrating the material has already begun and I am joining the effort. I need to start wrangling with Respondus to get the job done; I'd rather wrangle with Dreamweaver any day and that's really saying something. 

This just about sums today up.

Say hello!

I haven't really been able to get myself into any rotations notes yet because we are still not started back. I'm trying to distract myself with work in the meantime before any hint of boredom sets in. If you happen to drop by the blog please introduce yourself and say hello; I don't bite, honest!

I currently have a student from France staying with me and she is taking a rotation in the Queen Mother Hospital for Animals over the Christmas holidays with the oncology unit. Today she had a few consults with a lymphoma patient and she has seen several dogs receiving chemotherapy for mast cell tumours. She really enjoys the research side of veterinary work and is considering pursuing a masters in her last year of the course. I think that's really nifty. In England there isn't much love amongst the students for those choosing to pursue a career in research; it seems to me that this is largely due to the fierce competition for places and that research is seen as 'taking a place from someone who really wanted to be a vet'. It's sad, but true, that most of the people who make this argument are only doing so to convince themselves that they still really want to be a vet. A large proportion of my colleagues definitely did not arrive here to be a vet; it is more that this is where they ended up and now they have to make the best of a bad situation.

I would very much like to work for some time in France and having Emilie with me has meant my out of practice French took a bit of a bashing last night. However, it is only by practice you can improve so once more into the breach I stroll... 

Does anyone ever look forward to stats?

Christmas day stroll along the front with my family.

Happy New year! I am sorry that I left things hanging a little two weeks ago. Now I have returned from deepest, darkest France and bonny Hastings I can happily report that I am not dead, I did pass and for the time being a state of normality has resumed. It has been a lovely two weeks without the constant pressure of having to revise, but it did take a few days for my brain to catch on and relax. I'm back on campus now doing some work before term starts again next week. Despite my best efforts I have spent more money than I should have and I need to try and undo the damage!

We start rotations proper on the 13th of February, but we have a few weeks of clinical problem solving and some lectures on how to go about our research projects with something resembling professionalism. I think it may be a little dull, but at least it's a nice gentle introduction. I am not looking forwards to stats. Does anyone ever look forward to stats?

Until next time.

"Accountability is something that is left when responsibility has been subtracted."

For starters, Finland has no standardized tests. The only exception is what's called the National Matriculation Exam, which everyone takes at the end of a voluntary upper-secondary school, roughly the equivalent of American high school. 

Instead, the public school system's teachers are trained to assess children in classrooms using independent tests they create themselves. All children receive a report card at the end of each semester, but these reports are based on individualized grading by each teacher. Periodically, the Ministry of Education tracks national progress by testing a few sample groups across a range of different schools. 

As for accountability of teachers and administrators, Sahlberg shrugs. "There's no word for accountability in Finnish," he later told an audience at the Teachers College of Columbia University. "Accountability is something that is left when responsibility has been subtracted." 

For Sahlberg what matters is that in Finland all teachers and administrators are given prestige, decent pay, and a lot of responsibility. A master's degree is required to enter the profession, and teacher training programs are among the most selective professional schools in the country. If a teacher is bad, it is the principal's responsibility to notice and deal with it.

(http://www.theatlantic.com/national/archive/2011/12/what-americans-keep-ignoring-about-finlands-school-success/250564/#.Tv4NA-e7HkY.mailto)

This is what I want for education in this country. The rest of the article talks about state and private schools and the author believes that this is the root of the problem. I believe that the root of the problem is the way we are taught and examined; if state schools raised their game then private schools wouldn't have a USP unless they specialised in one particular area. There are five things I would love to see changed about the way children are taught in the UK:

1. Teaching should be well paid, sought-after job with rigorous standards. 
2. No illiterate 'well-I-didn't-know-what-else-to-dos' should be in the crucial role of a teacher. Teachers should be an inspiration.
3. Constant examination stress should be removed.
4. Teaching and assessment should be individualised.
5. Not all students should be encouraged to go to university. Students should be encouraged to do what they want to do or what they are good at. University does not have to come into the equation.