RANT HERE thread

[cdo96]

I've actually known officers who would make people move if they did this. Roadside stops are already dangerous for police officers and that's without introducing the possibility of getting creamed by somebody going 75 because you wanted to pull over on the shoulder of the highway.

Oh I know. It's soooo bad. Last time I was pulled over, I turned hazards on a pulled further into a less crowded residential area. Officer was so thankful he gave me a warning instead!

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[twelvetigers]

Not arguing here, TX drivers are pretty bad. (That road rage though- being a good TX driver involves having a strong vocabulary of explicit words.)

But in my experience, Tulsa (OK) drivers are worse! I've driven in a lot of big cities both in the US and in a couple different countries, and Tulsa has the second worst drivers I've ever seen. (The first being Naples because they literally pull onto sidewalks and incoming traffic if the traffic is even slightly bad, and blatantly ignore stop lights. For obvious reasons I didn't drive here hahaha).

I don't think Tulsa is that bad. It has the same brand of a-holes as Dallas, but with a LOT less actual traffic.

My husband travels all over for work and has driven all sorts of rental cars in all sorts of cities. His most harrowing experiences so far have been in Massachusetts.

 

[cowgirla]

Not arguing here, TX drivers are pretty bad. (That road rage though- being a good TX driver involves having a strong vocabulary of explicit words.)

But in my experience, Tulsa (OK) drivers are worse! I've driven in a lot of big cities both in the US and in a couple different countries, and Tulsa has the second worst drivers I've ever seen. (The first being Naples because they literally pull onto sidewalks and incoming traffic if the traffic is even slightly bad, and blatantly ignore stop lights. For obvious reasons I didn't drive here hahaha).

Having also driven in a lot of big cities, I would agree on Tulsa drivers. I've seen some interesting driving manuevers by Tulsans. Most of which were probably illegal, all of them were just begging for Darwin to take over.

 

[twelvetigers]

Having also driven in a lot of big cities, I would agree on Tulsa drivers. I've seen some interesting driving manuevers by Tulsans. Most of which were probably illegal, all of them were just begging for Darwin to take over.

Maybe I disagree because I'm ONE OF THEM... zipping around in my bright orange Mustang, defying death whenever possible.

 

[Skimble]

In what world would it make sense to hide keys in the bushes outside?

In the world that you are too drunk to drive home and don't want to get a DUI and have no where to go. He was told the keys being in the car made it an automatic DUI.

 

[LyraGardenia]

I don't think Tulsa is that bad. It has the same brand of a-holes as Dallas, but with a LOT less actual traffic.

My husband travels all over for work and has driven all sorts of rental cars in all sorts of cities. His most harrowing experiences so far have been in Massachusetts.

I didn't think Tulsa drivers were that bad either, but it's been a long time since I've driven there regularly. And I was 17 when I did, so probably not the best judge. I've seen some scarily bad drivers in both Missouri and Kansas.

 

[vetmedhead]

I didn't think Tulsa drivers were that bad either, but it's been a long time since I've driven there regularly. And I was 17 when I did, so probably not the best judge. I've seen some scarily bad drivers in both Missouri and Kansas.

One of those scarily bad drivers was probably my dad

 

[deleted498041]

Incredible amounts of impostor syndrome here. Kinda meta, if I am aware that it is likely impostor syndrome but at the same time seriously concerned that I may be finally exposed as a doofus who coasts along by understanding just enough to look like I know what I''m doing is is impostor syndrome or am I actually stupid, 'cause I feel actually stupid.
Telemetry data is cool and probably useful but I need a masters in data analysis and several levels better understanding of Excel to be on a level with my telemetry guys. And they're like "you just do this and manipulate all of it at once and here's this formula and you can write one just like it, easy." I'm thinking I'll need a ton of hand holding and they all must think I'm a class-A idiot and if they don't already they will in the next week as I ask all these stupid questions.

Sigh, I just need to be like "Man up FTB! Pull on those big girl pants and do the thing!" There's a very real fear that I can't do the thing and will never be published or taken seriously.

Anyone worked with telemetry data or Excel that I can run a stupid question by to shore up my facade?

:X Now I'm having imposter syndrome. I've never worked telemetry data and I only have one rotation left. Should I have?

For real though, I have massive imposter syndrome that comes and goes, if that makes you feel better! I haven't seen a case of CHF from intake to diagnosis in vet school, I haven't seen a pyometra in school, I've only placed one drain, only unblocked one cat... All small, kind of random things, but I worry about seeing them for the first time post-graduation and maybe not recognizing what's going on, especially now that I matched to an internship with so much primary case responsibility on ER. A clinician pointed out what she said was pulmonary edema on a ferret rad a couple days ago and I just didn't see it at all.

 

[Bottle of Bear]

:X Now I'm having imposter syndrome. I've never worked telemetry data and I only have one rotation left. Should I have?

For real though, I have massive imposter syndrome that comes and goes, if that makes you feel better! I haven't seen a case of CHF from intake to diagnosis in vet school, I haven't seen a pyometra in school, I've only placed one drain, only unblocked one cat... All small, kind of random things, but I worry about seeing them for the first time post-graduation and maybe not recognizing what's going on, especially now that I matched to an internship with so much primary case responsibility on ER. A clinician pointed out what she said was pulmonary edema on a ferret rad a couple days ago and I just didn't see it at all.

You'll get the hang of it Robin Williams . After all that's what internships are for -- to practice your skills in exchange for being overworked and underpaid.

 

[mmmdreamerz]

In the world that you are too drunk to drive home and don't want to get a DUI and have no where to go. He was told the keys being in the car made it an automatic DUI.

I get that but seems weird that they would excpect him to know that...sounds like he was trying to be responsible by not driving...

 

[Skimble]

I get that but seems weird that they would excpect him to know that...sounds like he was trying to be responsible by not driving...

That's what he thought too! I mean he was in the bar parking lot, so it's not hard to figure out that he likely got drunk in the bar. I've heard of other similar situations in PA too.

 

[deleted498041]

You'll get the hang of it Robin Williams . After all that's what internships are for -- to practice your skills in exchange for being overworked and underpaid.

Robin Williams lol. I like that!

The overworked and underpaid thing is for sure! I drew up a mock budget today and with just living expenses calculated, I'll be spending all of my paycheck except for a whopping $40 a month, approximately...

 

[Trilt]

:X Now I'm having imposter syndrome. I've never worked telemetry data and I only have one rotation left. Should I have?

For real though, I have massive imposter syndrome that comes and goes, if that makes you feel better! I haven't seen a case of CHF from intake to diagnosis in vet school, I haven't seen a pyometra in school, I've only placed one drain, only unblocked one cat... All small, kind of random things, but I worry about seeing them for the first time post-graduation and maybe not recognizing what's going on, especially now that I matched to an internship with so much primary case responsibility on ER. A clinician pointed out what she said was pulmonary edema on a ferret rad a couple days ago and I just didn't see it at all.

Meh. You really, really quickly get used to doing things for the first time with a quick glance at a book or VIN or help of an experienced tech. I usually bumble my way through things, then actually have time to look up tips and tricks and videos afterwards so I'm much improved the next occurrence.

I know it doesn't make the imposter syndrome go away, but truly... you'll do fine. You made it through vet school. Lean on people you need to for your weaknesses, stay humble, keep learning. You'll be good.

 

[vetmedhead]

Robin Williams lol. I like that!

The overworked and underpaid thing is for sure! I drew up a mock budget today and with just living expenses calculated, I'll be spending all of my paycheck except for a whopping $40 a month, approximately...

 

[fromthebox]

:X Now I'm having imposter syndrome. I've never worked telemetry data and I only have one rotation left. Should I have?

For real though, I have massive imposter syndrome that comes and goes, if that makes you feel better! I haven't seen a case of CHF from intake to diagnosis in vet school, I haven't seen a pyometra in school, I've only placed one drain, only unblocked one cat... All small, kind of random things, but I worry about seeing them for the first time post-graduation and maybe not recognizing what's going on, especially now that I matched to an internship with so much primary case responsibility on ER. A clinician pointed out what she said was pulmonary edema on a ferret rad a couple days ago and I just didn't see it at all.

Telemetry: Only if you plan on doing monkey research. Due to B virus/ or challenge with EBOV/VEEV/other nasty things concerns we can't take TPRs on monkeys without sedation and that can really mess with your disease model or change your values/mask effect. Plus you can't sedate them too often as they have to be NPO'd and don't always eat well that day etc.

I've only unblocked one cat and seen it three times. I've had a pyo on surgery but not from presentation. I've placed a couple drains, but not a ton. You will see the common things commonly. With human docs, especially surgeons, they say that the volume you see in your first 5 years is what solidifies your ability. You may be shaky in those first months, but if it's a good intern program you won't be alone right away. Remember it's ok to leave the exam room and go look in a book if the patient is stable. Know what you know and don't know and be honest with yourself about it. You will be wrong sometimes but that's part of learning.

You got an internship! You are not an impostor. I don't doubt my vet skills any more, but my scientist skills are rusty and I'm nervous and PMSing. Bad combo.

 

[deleted498041]

Meh. You really, really quickly get used to doing things for the first time with a quick glance at a book or VIN or help of an experienced tech. I usually bumble my way through things, then actually have time to look up tips and tricks and videos afterwards so I'm much improved the next occurrence.

I know it doesn't make the imposter syndrome go away, but truly... you'll do fine. You made it through vet school. Lean on people you need to for your weaknesses, stay humble, keep learning. You'll be good.

For sure! This year has definitely made me feel more comfortable at finding the answers to questions efficiently. I saw my first anterior lens luxation last month that also presented with hypermature cataracts and anterior uveitis and was extremely proud of myself for not only having my gut instincts pay off when it came to a diagnosis but being able to find images that mirrored what I saw in my patient to confirm those gut feelings.

I'm fairly good at managing imposter syndrome 99% of the time, but there are some things that I'm just insecure about. I'll have a huge case load next year, so I'm sure that insecurity will be gone pretty quickly.

 

[Bottle of Bear]

Robin Williams lol. I like that!

The overworked and underpaid thing is for sure! I drew up a mock budget today and with just living expenses calculated, I'll be spending all of my paycheck except for a whopping $40 a month, approximately...

Government be all

 

[deleted498041]

Telemetry: Only if you plan on doing monkey research. Due to B virus/ or challenge with EBOV/VEEV/other nasty things concerns we can't take TPRs on monkeys without sedation and that can really mess with your disease model or change your values/mask effect. Plus you can't sedate them too often as they have to be NPO'd and don't always eat well that day etc.

I've only unblocked one cat and seen it three times. I've had a pyo on surgery but not from presentation. I've placed a couple drains, but not a ton. You will see the common things commonly. With human docs, especially surgeons, they say that the volume you see in your first 5 years is what solidifies your ability. You may be shaky in those first months, but if it's a good intern program you won't be alone right away. Remember it's ok to leave the exam room and go look in a book if the patient is stable. Know what you know and don't know and be honest with yourself about it. You will be wrong sometimes but that's part of learning.

You got an internship! You are not an impostor. I don't doubt my vet skills any more, but my scientist skills are rusty and I'm nervous and PMSing. Bad combo.

That makes me feel better Because of the nature of my school's program, I'm never sure if some of my deficiencies are standard for most fourth year vet students or if it's something I really need to get a handle on before graduating.

 

[JaynaAli]

My experience was that vet school laid the foundations well enough, even though I didn't see everything. Even when you don't know what is going on, vet school has likely prepared you to make a plan on how to act to figure it out. If a female dog comes in lethargic, has a fever, and was maybe vomiting what are you going to do? Even if it doesn't scream pyometra to you, you're probably going to recommend bloodwork, rads, fast scan, etc which will help you diagnose the patient. There are very few instances, even in emergency work, where you can't take 5 minutes to look something up or call a mentor if you really need to. The ER doctor I was on with first gave me a 'quick and dirty' rundown of the common emergencies she saw most often during the first week or so. I even pulled books out in front of owners when needed. Imposter syndrome will never go away, but you will be okay. Even if you make mistakes, you learn from them and move on.

One instance, I had a couple rush their dog straight to the back while it was seizing (first seizures of its life) at 4am. I thought, okay, seizures...big categories are neuro (which I won't be able to do much about except give diazepam right this minute) or hypoglycemia (and I need to get it some sugar). I had a tech check blood glucose and draw tubes for labs later...GLU too low to read. Okay great, not neuro. I run through differentials for hypoglycemia in an adult dog with the owner while I figure out how much dextrose to give/set up a CRI. So what next? I told them I was comfortable with where we were at that moment but wanted to make sure we were on the right track and I wasn't forgetting anything I could be doing for their pet at that moment until the internist came in at 7. After I checked the book I called a mentor...the owners were completely fine with that and even thanked me for making sure my plan was right. We never figured out why that dog was hypoglycemic despite imaging and four days in the hospital, but I was able to manage it until help arrived. I expect you will be able to do the same.

 

[orca2011]

:X Now I'm having imposter syndrome. I've never worked telemetry data and I only have one rotation left. Should I have?

For real though, I have massive imposter syndrome that comes and goes, if that makes you feel better! I haven't seen a case of CHF from intake to diagnosis in vet school, I haven't seen a pyometra in school, I've only placed one drain, only unblocked one cat... All small, kind of random things, but I worry about seeing them for the first time post-graduation and maybe not recognizing what's going on, especially now that I matched to an internship with so much primary case responsibility on ER. A clinician pointed out what she said was pulmonary edema on a ferret rad a couple days ago and I just didn't see it at all.

I swear I'm just winging things half the time and I only have what, roughly 5 months left of my internship? I somehow still haven't unblocked a ton of cats (just has been my luck on ER). You'll mess up from time to time, and while it sucks, it's part of the whole learning process. Just make sure you get the take away point from what you did wrong and learn from it.

Just remember that your goal of ER is to stabilize it. You don't need to find all the answers (although I swear sometimes we're expected to have though of everything and done like a full IM workup on an overnight...), IVC, BW, a/tFAST and fluids are likely going to be your mainstain dx/txs with the additional imaging and specific BW needed from time to time.

Oh and really good resource if people have read through it, is VIN's Getting Through the Night series. Goes through your most common emergencies, and dx/tx for them with drug doses.

My rant: Bought new face lotion...except I'm not entirely convinced it's face lotion. Normally, I like to get one that has SPF in it and this one supposedly does, but it smells more like straight up sunscreen than any other face lotion with SPF I've tried in the past and the labeling isn't quite clear now that I read it more closely.

 

[SkiOtter]

My rant: Bought new face lotion...except I'm not entirely convinced it's face lotion. Normally, I like to get one that has SPF in it and this one supposedly does, but it smells more like straight up sunscreen than any other face lotion with SPF I've tried in the past and the labeling isn't quite clear now that I read it more closely.

I definitely use a face lotion with SPF that smells like straight up sunscreen. Potentially yours is still a face lotion?

 

[orca2011]

I definitely use a face lotion with SPF that smells like straight up sunscreen. Potentially yours is still a face lotion?

Maybe...it just got me off guard. What's your brand? The one I tried is Simple. I normally go with the generic of Aveeno's, cause I'm poor, but the store didn't have any.

 

[Balesofhay]

Maybe...it just got me off guard. What's your brand? The one I tried is Simple. I normally go with the generic of Aveeno's, cause I'm poor, but the store didn't have any.

That's definelty lotion. I have sensitive skin so I've used it before and def smells like sunscreen so you're good.

 

[SkiOtter]

Maybe...it just got me off guard. What's your brand? The one I tried is Simple. I normally go with the generic of Aveeno's, cause I'm poor, but the store didn't have any.

I use CeraVe because my dermatologist recommended it to me. I have suuuper sensitive skin so I go with what the derm tells me haha
Mine's SPF 30 which is nice

 

[cdo96]

I don't think Tulsa is that bad. It has the same brand of a-holes as Dallas, but with a LOT less actual traffic.

My husband travels all over for work and has driven all sorts of rental cars in all sorts of cities. His most harrowing experiences so far have been in Massachusetts.

Maybe it's just the time I'm in Tulsa then. I rarely go to Tulsa except to go to the airport and then the occasional date. Somehow, even though it's essentially 1 road from Stilly to the Tulsa aiport, I get lost everytime. Last time I ended up in the heart of downtown on accident. It was weird.

Having also driven in a lot of big cities, I would agree on Tulsa drivers. I've seen some interesting driving manuevers by Tulsans. Most of which were probably illegal, all of them were just begging for Darwin to take over.

They're crazy! I can't deal with them hahaha.

Maybe I disagree because I'm ONE OF THEM... zipping around in my bright orange Mustang, defying death whenever possible.

crazy people. Maybe it's bad because I'm like "wait I'm lost, and the flow of traffic is 80 mph right now. I need to get over and that's not happening"

 

[lilylilac]

I use CeraVe because my dermatologist recommended it to me. I have suuuper sensitive skin so I go with what the derm tells me haha
Mine's SPF 30 which is nice

Hmmmm I'll have to look into this brand more. My skin is unbelievably sensitive too and I haven't really been able to find something I like yet.

 

[orca2011]

Hmmmm I'll have to look into this brand more. My skin is unbelievably sensitive too and I haven't really been able to find something I like yet.

I've used CeraVe in the past. I don't have particularly sensitive skin but I liked it. My sister's dermatologist recommended it for her as well as she apparently has super sensitive skin now.

 

[Balesofhay]

Hmmmm I'll have to look into this brand more. My skin is unbelievably sensitive too and I haven't really been able to find something I like yet.

I use the bert's bees sensitive lotion. It's the only lotion that doesn't make my face burn

 

[deleted498041]

My experience was that vet school laid the foundations well enough, even though I didn't see everything. Even when you don't know what is going on, vet school has likely prepared you to make a plan on how to act to figure it out. If a female dog comes in lethargic, has a fever, and was maybe vomiting what are you going to do? Even if it doesn't scream pyometra to you, you're probably going to recommend bloodwork, rads, fast scan, etc which will help you diagnose the patient. There are very few instances, even in emergency work, where you can't take 5 minutes to look something up or call a mentor if you really need to. The ER doctor I was on with first gave me a 'quick and dirty' rundown of the common emergencies she saw most often during the first week or so. I even pulled books out in front of owners when needed. Imposter syndrome will never go away, but you will be okay. Even if you make mistakes, you learn from them and move on.

I swear I'm just winging things half the time and I only have what, roughly 5 months left of my internship? I somehow still haven't unblocked a ton of cats (just has been my luck on ER). You'll mess up from time to time, and while it sucks, it's part of the whole learning process. Just make sure you get the take away point from what you did wrong and learn from it.

Just remember that your goal of ER is to stabilize it. You don't need to find all the answers (although I swear sometimes we're expected to have though of everything and done like a full IM workup on an overnight...), IVC, BW, a/tFAST and fluids are likely going to be your mainstain dx/txs with the additional imaging and specific BW needed from time to time.

Oh and really good resource if people have read through it, is VIN's Getting Through the Night series. Goes through your most common emergencies, and dx/tx for them with drug doses..

Thanks for the recommendation on that! So glad I get a VIN membership through my internship next year, as I'd completely forgotten to check out that series.

Question for both of you: I've never aFASTed/tFASTed anything in my life and I've probably done full abdominal ultrasounds three times so far? Do you have any recommendations for resources on knowing what you're seeing? I know you're looking for fluid lines, obviously, but I had a resident one time talk to me about comet tails and other things I've never heard of and don't remember now. Just worried I'll flash something and completely miss what's wrong. Is it bad that I haven't had that experience yet?

 

[lilylilac]

I use the bert's bees sensitive lotion. It's the only lotion that doesn't make my face burn

I'm highly allergic to most metals and lanolin, so I looked this up to check. Apparently there's an ingredient with aluminum in it. Oh well, I'm bound to find something soon!

 

[SkiOtter]

I use the bert's bees sensitive lotion. It's the only lotion that doesn't make my face burn

lol do some makeup removers make your face burn too?
(IM LOOKING AT YOU NEUTROGENA PINK GRAPEFRUIT WIPES, among others)

 

[Balesofhay]

lol do some makeup removers make your face burn too?
(IM LOOKING AT YOU NEUTROGENA PINK GRAPEFRUIT WIPES, among others)

All of the simple stuff except the lotion is fine. The berts bees face wipes burn like hell though. I tend to stick with simple's Micelle or their plain wipes and have for the longest time. Except for the one time try of berts bees

 

[orca2011]

Thanks for the recommendation on that! So glad I get a VIN membership through my internship next year, as I'd completely forgotten to check out that series.

Question for both of you: I've never aFASTed/tFASTed anything in my life and I've probably done full abdominal ultrasounds three times so far? Do you have any recommendations for resources on knowing what you're seeing? I know you're looking for fluid lines, obviously, but I had a resident one time talk to me about comet tails and other things I've never heard of and don't remember now. Just worried I'll flash something and completely miss what's wrong. Is it bad that I haven't had that experience yet?

I honestly still have a hard hard time with lung rockets and crap like that. Part of it I think is cause the ultrasound we have on ER causes a lot of artifact so most of the time I'm just kind of like "eh...is that really there?" and sometimes will try to confirm it on the nice ultrasound machine if it's free. Haven't bought this (http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118369599.html) book, although I plan on it and I'm sure it'd be helpful. We actually had a CE/wet lab on it and for some reason, us interns weren't allowed to go but everyone else could. It was actually kind of annoying.

aFast, I feel like I'm a little better at and that's mainly cause it's easier to identify things and we get to practice AUS on all animals when we rotate through electives (and I honestly try to do a mini exam if it's slow enough when I aFast things).

 

[Trilt]

I honestly still have a hard hard time with lung rockets and crap like that. Part of it I think is cause the ultrasound we have ER causes a lot of artifact so most of the time I'm just kind of like "eh...is that really there?" and sometimes will try to confirm it on the nice ultrasound machine if it's free. Haven't bought this (http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118369599.html) book, although I plan on it and I'm sure it'd be helpful. We actually had a CE/wet lab on it and for some reason, us interns weren't allowed to go but everyone else could. It was actually kind of annoying.

aFast, I feel like I'm a little better at and that's mainly cause it's easier to identify things and we get to practice AUS on all animals when we rotate through electives (and I honestly try to do a mini exam if it's slow enough when I aFast things).

literally just got that book from amazon... two days ago. don't remember whether I got the suggestion for it here or on VIN, but from my skimming looks really helpful. Been a bit too busy to mess around but I feel I sorely underutilize our ultrasound because nobody's particularly comfortable so hope it'll help.

 

[orca2011]

literally just got that book from amazon... two days ago. don't remember whether I got the suggestion for it here or on VIN, but from my skimming looks really helpful. Been a bit too busy to mess around but I feel I sorely underutilize our ultrasound because nobody's particularly comfortable so hope it'll help.

Our bosses gave us a giftcard to Amazon for the holidays and I plan on using it to buy that. Not sure why I haven't yet...Probably cause there is a copy floating around the hospital that I could find at any time or just ask someone to confirm at this point.

Wherever I end up next year will need to have one. I use it soo frequently now. Had a case relatively recently where a dog came in for lameness (i think)/decreased appetite. Was breathing kind of heavy so I did a tfast. Had pleural effusion. O was in such denial that the fluid was what wast causing the lethargy/decreased appetite. Tapped the dog and I'm pretty sure it was cancer related based on cytology and the fact that it was like a 12 yr Old English Sheepdog. Surprisingly not a hemoab. Totally that it was going to be that instead.

 

[JaynaAli]

Our ER-use ultrasound was a huge, crappy beast of a machine with a tiny screen and temperamental probe...it was named Bertha. About all she was good for was looking for free fluid and cystocentesis. I know how to do an aFAST and the four areas you concentrate on, but really my ER utility of ultrasound it to look for major pericardial effusion, abdominal effusion, and large splenic masses. The seasoned, rockstar ER vet was used to Bertha and could sometimes pick out mucoceles and more subtle changes, but my ER US skills are minimal. Because of that I really didn't charge for my brief ultrasound. I figured the machine had been paid off a decade or two ago so that was okay. Patients don't need a full diagnostic ultrasound at 2am.

I've also been told that the book Orca linked to was useful. A radiologist recommended it to us interns.

 

[WildZoo]

All of the simple stuff except the lotion is fine. The berts bees face wipes burn like hell though. I tend to stick with simple's Micelle or their plain wipes and have for the longest time. Except for the one time try of berts bees

The Micelle wipes are the best! Use those when I'm too lazy to use my actual micelle water.

 

[jmo1012]

Thank you all for your thoughts. My family is pretty close and we all get along well so this has been really hard. I just can't believe he's gone. It's really all quite shocking and devastating.

 

[Skimble]

I'm highly allergic to most metals and lanolin, so I looked this up to check. Apparently there's an ingredient with aluminum in it. Oh well, I'm bound to find something soon!

Most face lotions make my face burn too, and I have very dry skin. Right now I'm using alba botanica night cream, and I love it. I also wash my face with coconut oil when I'm in the shower, once or twice a week.

 

[dyachei]

Which frickin' roads do YOU drive on in MN? We drive 80mph in white-out snowstorms! And trucks still pass you.

Ok, granted, we're not like Florida drivers who seem to read '6' as '9' when it comes to speed limits, but I honestly can't say I've noticed too much *slow* driving up here.

Of course, when you're weaving in/out and passing people on the shoulder like I do you just sorta ignore slower drivers.

can confirm.

florida drivers are the absolute worst. And I've been in the car when LIS is driving

 

[LetItSnow]

:X Now I'm having imposter syndrome. I've never worked telemetry data and I only have one rotation left. Should I have?

For real though, I have massive imposter syndrome that comes and goes, if that makes you feel better! I haven't seen a case of CHF from intake to diagnosis in vet school, I haven't seen a pyometra in school, I've only placed one drain, only unblocked one cat... All small, kind of random things, but I worry about seeing them for the first time post-graduation and maybe not recognizing what's going on, especially now that I matched to an internship with so much primary case responsibility on ER. A clinician pointed out what she said was pulmonary edema on a ferret rad a couple days ago and I just didn't see it at all.

Dude(tte).

Vet school isn't about seeing everything from intake to diagnosis in vet school. It's about learning how to make medical decisions. Pure 'n simple. It isn't some kind of pictorial atlas of all medical conditions that you're supposed to pattern match on. Pattern matching is what experience is for, and you don't have that.

If you're going off to do an internship with ER-heavy responsibilities, it likely means you will be surrounded by techs who are experienced. Trust your techs. They know ****. If you ask right, they'll tell you the diagnosis before the animal arrives and they'll be right 90% of the time - you just have to suss out the other 10%.

And when in doubt, always always always remember your basic role on ER isn't to fix ****: it's to stabilize the patient and get them in the right hands. Keep them breathing, beating, and not bleeding, and you've basically done your job. Maybe you goofed up a little and forgot to save urine for IntMed to culture the next morning, or you gave an nsaid when you shouldn't, or ... you know, whatever. All the little crap. Who cares - that might be frustrating to the next doctor, but ultimately you didn't let the wheels come off the cart and that's all that matters. Stabilization is your job on ER. Fixing is not your primary responsibility (obvious exceptions being obvious, like suturing up some laceration repair).

But even then you're going to find yourself in ambiguous situations where the right step is unclear: do you vomit this dog or not? do you suture this back together or say "not a chance" and open-wound it? The answer is always: Tell the owner all the pros and cons, make sure THEY understand that there's uncertainty, and give them options. I have given the "vomit yes/no, scope yes/no, surgery yes/no" speech so many times in the last 2 years......

So you haven't seen a pyometra. Big deal. You know what it is. You know to consider it on any intact middle-aged female (esp with that classic history of ADR who was in heat a few months ago). And you know how to diagnose it (rads! ultrasound!). And you know how to fix it (stabilize and spay!). Right? Boom, done. Who cares that you haven't seen it. (As an aside, one of my first pyometras was a reportedly spayed female that I ultrasounded; I kept staring at the caudal abdomen saying "why is there a big bifurcating tube back there......"? Not as spayed as she was reported to be.)

Question for both of you: I've never aFASTed/tFASTed anything in my life and I've probably done full abdominal ultrasounds three times so far? Do you have any recommendations for resources on knowing what you're seeing? I know you're looking for fluid lines, obviously, but I had a resident one time talk to me about comet tails and other things I've never heard of and don't remember now. Just worried I'll flash something and completely miss what's wrong. Is it bad that I haven't had that experience yet?

If you've done full abdominal ultrasounds you can aFAST - it's just a four-quadrant search for fluid, right? A *true* FAST-scan can be done in 15 seconds. In reality, most of us do something between a FAST scan and a diagnostic ultrasound; especially the more comfortable with ultrasound you get. And if you're in a situation where a dyspneic patient is too unstable to radiograph and you don't yet have the chops to dx it with ultrasound but you suspect fluid or air because you put your stethoscope on them - ok, fine, that's life. Tap the chest. Never be afraid to stick a needle in a chest.

Comet tails are a resident showing off their ultrasound chops and trying to impress you. (It's an artifact, don't be impressed.) You don't need to know what comet tails are to do a FAST scan.

For someone just graduating I would focus on aFAST (know your four quadrants, know how to find fluid, be comfortable aspirating it). For the chest, I would focus on recognizing pericardial effusion. Those are the biggies. Pleural effusion and a pneumo are things you'll more easily pick up on radiographs until you're more comfortable with ultrasound.

I don't have a reference for you - maybe Orca's book is great, dunno. But I do know the ultimate reference is experience. When I went into ER practice, I FASTed like every other patient through the door if I had time (I only charged them when it was well and truly indicated.). I mean, it vomited once? Hey, let's FAST scan it as long as there aren't other patients waiting! My techs used to roll their eyes, but after a few weeks they got used to Dr. LIS just being weird and liking to scan everything. There just isn't any substitute for doing it over and over. Fast forward almost two years and I use it for diagnosing a much wider variety of things (it's a great tool for those "should I cut or should I not cut" suspected foreign body patients), and I'm debating doing some more advanced training and starting to offer diagnostic ultrasounds instead of 'just' FAST scans. But I started with just "Ummmm.... nope.... there's no fluid there."

Bottom line: Keep it simple, focus on stabilization when you're on ER, use the tool to the level you're competent and trust experience to grow the competency, and trust your techs as long as they are experienced old hands.

 

[Caia]

I don't have a reference for you - maybe Orca's book is great, dunno. But I do know the ultimate reference is experience. When I went into ER practice, I FASTed like every other patient through the door if I had time (I only charged them when it was well and truly indicated.). I mean, it vomited once? Hey, let's FAST scan it as long as there aren't other patients waiting! My techs used to roll their eyes, but after a few weeks they got used to Dr. LIS just being weird and liking to scan everything. There just isn't any substitute for doing it over and over. Fast forward almost two years and I use it for diagnosing a much wider variety of things (it's a great tool for those "should I cut or should I not cut" suspected foreign body patients), and I'm debating doing some more advanced training and starting to offer diagnostic ultrasounds instead of 'just' FAST scans. But I started with just "Ummmm.... nope.... there's no fluid there."

Bottom line: Keep it simple, focus on stabilization when you're on ER, use the tool to the level you're competent and trust experience to grow the competency, and trust your techs as long as they are experienced old hands.

Actually, this brings up a topic I've been looking to discuss.

I can see myself being the same way and wanting to FAST scan almost everything. I also see it in practice a lot where vets will just pop the probe on quickly or sometimes even snap an anonymous rad.

But what happens if you do find something? And that something requires intervention? How do you go back to the client having done something that they didn't give consent for?

 

[LetItSnow]

But what happens if you do find something? And that something requires intervention? How do you go back to the client having done something that they didn't give consent for?

I think you have to answer that yourself. As in, I don't think there is a right answer.

Since it's non-invasive (that's important to me) and more or less risk free (I mean, ok, they might roll off the table, but....), I don't worry about consent. I mean, I don't specifically get consent to do my PE, either. So if I found something, I'd just go back to the client and say "Hey, just to be extra cautious, I took a quick glance with the ultrasound, and I saw blah blah blah." I wasn't charging clients for the FAST unless it was a fully-indicated diagnostic in my first 4-5 months of practice since I was doing it as much for me as them and it wasn't strictly 'indicated'. I was charging for obviously-indicated patients (the 7-year-old lab with a fluid wave and white gums.....).

But if that makes you uncomfortable (the idea that you're scanning without consent) then you shouldn't do it. In that case, you would just tell the client "Hey, I'm trying to get some more experience with our ultrasound equipment - do you mind if I do a quick scan on Fluffy? I'm not going to charge you for it" or some variation of that that best works for you.

A good example would be a parvo patient we had that had been in hospital 48 hours by the time I picked it up. When I got it, the patient was on its second rebound (so, it had already had the first fake bounce, gone back downhill, and was now improving for reals) and doing great and I was discharging. It was a quiet morning, so when the techs got it out of isolation to send home, I just scanned it quick. Purely for experience.

Found a big (really impressively big) structure with an anechoic interior right over the cranial abdomen. It looked exactly like a pancreatic cyst, except those aren't documented well (or at all) in pediatric patients (at least, that I'm aware of). And I couldn't confidently associate it with the pancreas. Puppy is recovered, bouncing around, eating - clinically great.

So I just told the owners "Hey. I'm trying to get more comfortable with our ultrasound, so I was scanning your dog and I found this weird thing and I don't know what it is, etc. I know fluffy is doing great, but you may want to follow up with your doctor or a specialist." Super nice people - they rushed off to IntMed who ultrasounded and said "wow, that's weird". Talked about cytology, surgery, or just monitor. In the end they did nothing, rechecked in a month, and it was gone.

So that's how I handled an incidental finding that from MY perspective needed intervention (in the sense of "somebody smarter than me should check this out"), even though in reality it turned out not to need it. Downside: I cost the owners $500 in an ultrasound and recheck. So yes, there's a risk if you find something incidental that leads to an unnecessary work-up. Thing is, you never know how necessary it is until after-the-fact.

 

[Caia]

I think you have to answer that yourself. As in, I don't think there is a right answer.

Since it's non-invasive (that's important to me) and more or less risk free (I mean, ok, they might roll off the table, but....), I don't worry about consent. I mean, I don't specifically get consent to do my PE, either. So if I found something, I'd just go back to the client and say "Hey, just to be extra cautious, I took a quick glance with the ultrasound, and I saw blah blah blah." I wasn't charging clients for the FAST unless it was a fully-indicated diagnostic in my first 4-5 months of practice since I was doing it as much for me as them and it wasn't strictly 'indicated'. I was charging for obviously-indicated patients (the 7-year-old lab with a fluid wave and white gums.....).

But if that makes you uncomfortable (the idea that you're scanning without consent) then you shouldn't do it. In that case, you would just tell the client "Hey, I'm trying to get some more experience with our ultrasound equipment - do you mind if I do a quick scan on Fluffy? I'm not going to charge you for it" or some variation of that that best works for you.

A good example would be a parvo patient we had that had been in hospital 48 hours by the time I picked it up. When I got it, the patient was on its second rebound (so, it had already had the first fake bounce, gone back downhill, and was now improving for reals) and doing great and I was discharging. It was a quiet morning, so when the techs got it out of isolation to send home, I just scanned it quick. Purely for experience.

Found a big (really impressively big) structure with an anechoic interior right over the cranial abdomen. It looked exactly like a pancreatic cyst, except those aren't documented well (or at all) in pediatric patients (at least, that I'm aware of). And I couldn't confidently associate it with the pancreas. Puppy is recovered, bouncing around, eating - clinically great.

So I just told the owners "Hey. I'm trying to get more comfortable with our ultrasound, so I was scanning your dog and I found this weird thing and I don't know what it is, etc. I know fluffy is doing great, but you may want to follow up with your doctor or a specialist." Super nice people - they rushed off to IntMed who said "wow, that's weird". Talked about cytology, surgery, or just monitor. In the end they did nothing, rechecked in a month, and it was gone.

So that's how I handled an incidental finding that from MY perspective needed intervention (in the sense of "somebody smarter than me should check this out"), even though in reality it turned out not to need it. Downside: I cost the owners $500 in an ultrasound and recheck. So yes, there's a risk if you find something incidental that leads to an unnecessary work-up. Thing is, you never know how necessary it is until after-the-fact.

Thank you for your thoughts on this. I like your approach to it and I feel like that would be a reasonable way to get more comfortable with ultrasound without needing an indication each time (and an owner willing to pay for it).

Consent is something that is really hammered into us at my school so unfortunately it's kind of a non-starter to even bring this up.

 

[Balesofhay]

Waiting for that last LOR writer to respond to my email is driving me up a wall. The app is done except for that and I'm not so patient

 

[jmo1012]

Generally most experienced ER techs will be amazing and your saving grace...but don't fall into that trap until you know they are because the practice I did my internship had a large number of less experienced ER techs (the specialty techs knew everything and I do mean everything) and were no help in a bind. I just remember thinking oh gosh I don't know and you don't know?? I didn't expect this! I came from practices where the ER techs knew it all. I think my experience was the exception not the rule, but I worked for a huge practice with a huge internship so know that does exist! Also, be cognizant of who keeps an eye on charges when you are "practicing" because although not everyone will care of you are building your skill sets, some people and some practices will be strict (and then you just have to get good at under the radar haha).

 

[WildZoo]

As an aside, one of my first pyometras was a reportedly spayed female that I ultrasounded; I kept staring at the caudal abdomen saying "why is there a big bifurcating tube back there......"? Not as spayed as she was reported to be.

Same thing happened with the first pyometra I ever saw! Took the owners a while to agree to imaging, and for whatever reason the uterus wasn't visible on rads. Surprised the poor thing lived as long as she did before before they finally agreed to ultrasound and we ended up doing an emergency spay that day.

 

[fromthebox]

Also, be cognizant of who keeps an eye on charges when you are "practicing" because although not everyone will care of you are building your skill sets, some people and some practices will be strict (and then you just have to get good at under the radar haha).

I have been places where the U/S probe is in Cubex/Pyxis so that you HAVE to charge if you're using it. I have some feels about how useful that is to the learning interns/students etc. Most people I know are like "pop a probe on it." but sometimes...

 

[DVMDream]

I wish I had an ultrasound. But, I do not.

I did stab a needle into a chest yesterday.....removed lots of air.

 

[jmo1012]

@fromthebox there really are two sides to it - on one hand yes practicing to improve is great and a goal, but there is also the cost and maintenance of the machine, the responsibility carried by the doctor and clinic to provide medical services but also keep the clinic open. I had a couple of mentors who were very against doing anything without the clients permission because they had ended up in sticky situations by doing seemingly benign things like a fast scan. Meh. That's the difference between academia and private practice (although academia definitely audits those charges of they get any hint it was done!)