W3: Anaesthesia rotation

Me monitoring a patient situated in the MRI chamber behind me. I am listening for heart rate via an esophageal stethoscope, while keeping an eye on the monitors for SPO2, EtCO2, BP etc

Most people have told me that anaesthesia was a relatively chilled week, but somehow I felt like it was pretty exhausting, maybe it was because I was churning out some content for the Cambridge Vet School’s Instagram page everyday for a week as well (@camvetschool by the way, if you wanted to check it out!) So I am quite relieved that I don’t have to do it anymore! Although I did enjoy seeing the audience engagement increased each time I posted something. Anywho on more pressing matters, here is a review of the anaesthesia rotation :)!

Overall thoughts and reflections

The first day was pretty chaotic (as with most first days) as we were still figuring out the routine of things. The thing with anaesthesia is that you arrive at Small Animal Theatre with your theatre scrubs and scrub shoes and then change into them with your name tag and put your scrub hat on to meet with the anaesthesia team for your induction/ briefing. (Oh, remember to bring water and snacks into the changing room too #essentials) There is a board with all the cases of the day with timings and people in charge of them and you sign up to a case each. When your case has been admitted, you change out of blue scrubs into your grey scrub top and normal clothes to go to wards/ reception etc to do a pre-assessment of your patient. You get really good at changing in and out of clothes real quick by the end of the week (I wore stretchy but formal-looking leggings to give myself some comfort, lol!) After you assess your patient, you come up with an anaesthetic plan with risk factors, considerations and your choice of sedatives, analgesic, anaesthetic agents etc. Then you discuss with the anaesthetist in charge about your plan, put in an IV catheter if needed, induce, intubate and start monitoring your patient’s vital parameters as required (useful to bring a fob watch and stethoscope with you!) Throughout the procedure you are monitoring your patient, with attention to their SPO2 , EtCO2 levels, blood pressure, heart and respiratory rate, temperature and to make adjustments to the anaesthetic agent or analgesia if needed.

What I found most stressful was during the critical moments of inducing your patient, as you need to ensure that they are at an adequate plane of anaesthesia to intubate ASAP in order to get oxygen (and/or medical air) into your patient. While monitoring your patient, you may get quizzed (which is also super awful but necessary evil- especially when you know you literally read it the night before, but I swear the stress just makes your brain go mush and delays your ability to recall facts..) so you are basically trying to do multiple things at once and I was pretty overwhelmed the first few times round (probably still am tbh).

What to revise to make the best out of your rotation

  • principles of anaesthesia – multimodal analgesia, the concept of targeting different levels of nociceptive pathways for analgesia, considerations for an obese patient, young patient etc
  • clinical exam for pre-anaesthetic assessment
  • anaesthetic machine check list
  • mechanism of action and common functions, effect duration of common sedatives, anaesthetic agents, analgesic drugs, for example:
    • alpha-2 agonists causes vasoconstriction -> leads to hypertension -> causing a compensatory bradycardia in patient (so you would expect to see some bradycardia in patient)
      • are sedatives but also have analgesic effects, can be antagonised by atipamezole (which works quite quickly in an animal, within ~5 minutes! I was v surprised)
      • takes about 10 minutes if given via IM in the animal to take effect,
      • duration: dose dependent -> NOAH resource
    • acepromazine ACP has loads of effects and mechanism of action
      • phenothiazine- main action central dopamine antagonist
      • a1- antagonism
      • anxiolytic
      • antiarrhythmic
      • antihistamine
      • duration: 6-8 hours
    • everything in the little clinical anaesthesia booklet
  • Minimum alveolar concentration MAC – the concentration of vapour in the alveoli of lungs that is needed to prevent movement (motor response) in 50% of subjects in response to surgical (pain) stimulus
    • MAC is used to compare strengths/ potency of anaesthetic vapours
    • Isoflurane – 1.3% in dog, and 1.6% in cat
      • Since it takes 1.3% of isoflurane to anaesthetise 50% of subjects, using it at 2-2.6% would theoretically anaesthetise 100% of subjects (and 2% is what I have commonly observed in past procedures done)
    • Sevoflurane – 2.4% in both species

Some things I learnt on rotation

  • anaesthesia considerations for obese pets
    • respiratory considerations- as increased intrathoracic fat (and intraabdominal fat) causes animal to be more prone to diaphragmatic splinting, respiratory depression
    • vet times article for more info
  • anaesthesia considerations for brachycephalic obstructive airway syndrome (BOAS) dogs
    • short nose breed dogs have a shortened skull and excess soft tissue relative to skull, resulting in compression of the nasal passage and excess pharyngeal tissue -> increased airway resistance, a.k.a. they cannot breath properly so a lot of care must be taken into account when placing them under general anaesthesia
    • potential risks in a BOAS dog
      • They are prone to airway obstruction during the perianaesthetic period hence need extensive monitoring and should not be left alone – in an acute emergency case of obstruction, first thing to do is to pull their tongue forwards to raise the larynx, which buys you some time to think about what to do next, and in severe cases you may need to re-intubate the dog
      • Regurgitation risk – 40-60% of BOAS dogs, can be caused by oesophageal diverticula, hiatal hernia.  A chronic increase in thoracic airway pressure also draws the stomach into  the chest, causing gastroesophageal reflux.
        • How to combat this – Fast BOAS dogs 3-6 hours prior to surgery
        • Prophylactic omeprazole, metoclopramide as regurgitation and cause gastric reflux of stomach acids that can harm the oesophageal lining
        • Keep HEAD RAISED, especially during induction
        • Intubate ASAP once pre-med and induced, inflate cuff ASAP to prevent possible regurgitation that can lead to aspiration pneumonia
        • If regurgitation has occured -> suction to remove the contents, or use a swab to remove as much as possible, you can even use a urinary catheter attached to a syringe to ‘suction’ it out
      • VIN article for more info
  • dental block seminar – purpose is to reduce systemic analgesia needed and provide a stable anaesthetic for patient during dental extraction procedures
    • types of dental nerve blocks
      • 1. mandibular – desensitizes the lower jaw including canine teeth, done extraoral (insert needle where the dip/notch lies on ventral ramus) or intraorally. When we did this, we put the needle in the appropriate area first before attaching the syringe containing lidocaine.
        • concerns: if done bilaterally, animal may lose awareness of jaw position and may clamp jaw down and traumatise tongue in the process, so better to do unilateral block or provide extra monitoring if unable to do unilateral.
      • 2. mental – desensitizes rostral mandible, incisor tooth
        • insert needle/ thread catheter through to the mental foramen
      • 3. infraorbital – desensitizes incisors, canine and first 3 molars (but depending on the dog’s facial conformation, may not provide sufficient coverage for the canine tooth root)
        • insert needle into infraorbital canal via infraorbital foramen
      • 4. maxillary – desensitizes branches of the maxillary nerve, upper rows of teeth and hard palate
        • 2 methods
          • a) thread a green catheter via infraorbital foramen to reach the nerve bundles located caudally
          • b) using lateral canthus of eye as a guide, follow to narrowest part of zygomatic arch and feed needle on the ventral aspect of the zygomatic arch to the nerve bundle area
      • 5. palatine – rarely done in small animal surgeries, more in equine
    • local anaesthetic agents – Na channel blockers
      • lidocaine
        • 5 minute onset time, duration of action: 1-2 hours
        • antiarrhythmic- effective for ventricular tachycardia tx but can be pro-arrhythmic in other heart conditions besides VT
      • bupivacaine
        • 20 minute onset time, duration of action: 6-8 hours
        • do not use IV! can cause myocardial toxicity, can cause arrhythmias
    • nb: if there is an area of infection like pus due to a tooth root abscess etc, the local anaesthetic (LA) would be less effective as infection increases acidity of the region. LA efficacy depends on the pH and pKa of the region.
  • non-rebreathing and rebreathing system review
    • vin article
    • useful to draw the breathing circuit out to help understand how it works
  • Westie WHWT breeds are prone to pulmonary fibrosis a.k.a. Westie lung, so although may not be picked up during lung auscultation exam, may see an abnormally high end tidal CO2 because of subclinical pulmonary fibrosis.

That is all from me for now! Stay tune for (hopefully) some vlogs coming up on the youtube channel 🙂 Oh! And I recently got a KO-FI link, so if you find the content on this blog useful, and would like to support to buy me a cup of coffee (no pressure!) You can do so here:

Buy Me a Coffee at ko-fi.com

W2: Neurology rotation

My beautiful rotation group – and now we are finally complete!

Yikes! Another week has gone by and we have completed our Neurology rotation… (no more neurology until we face our final year exams – not sure how I feel about that) This week felt slightly more manageable than Medicine week, maybe it is because we have familiarized ourselves with the routine of reading up history -> consults -> clinical/neuro exam -> discuss with clinician -> write notes/letters. It was pretty busy nevertheless, with our days starting at 8am and ending between 5-7pm depending on our cases. Sometimes you get emergency cases and that can be quite unpredictable as well! In addition, we also worked an evening shift each (at least 1) during the week which lasted until 9pm. So here is the rough structure of my blog post:

  1. Overall feelings and thoughts
  2. Useful things I have learnt/ picked up during the week
  3. A basic neurology consult & exam (notes for reference)

1. Overall feelings and thoughts – Before this rotation, I was worried because neurology seemed like a scary and unknown subject to me, having seen only 1 or 2 neuro cases in my past EMS placements. But actually, it wasn’t that bad. By the end of the week, I guess I was convinced by the clinicians that it is not as complicated as one might think! I came to enjoy neuro because of how systematic it was, where you go through the 6 components of a neurology exam (explained later in this post) and assess for any deficits and abnormalities to get to your neurological localisation. Once you have your localisation, you combine your clinical findings and signalment and can usually narrow it down to a handful of differentials (using VITAMIN D). In that sense, it feels more simple than Medicine where it could be any of the organ systems involved if you’re given vague signs like lethargy and inappetence. However, I did find that with Neurology it can be a lot harder if you have a case presenting with mild non-specific deficits. It involves a lot more case discussion and is not as clear cut as Medicine when it comes to the diagnosis (well, before conducting the advance imaging, MRI tests etc). For example, if you have a Medicine case with increased liver parameters in the blood work up, there is most likely a liver pathology involved. But if you have an animal presenting with spinal pain and increased inflammatory markers in the blood work up, it could be degenerative disc disease, infectious, inflammation or even a foreign body.. so you would have to do imaging and further tests to help your diagnosis.

One of the things I didn’t enjoy about neuro week was the number of breed-related cases you tended to see. It is unfortunate, but French bulldogs and Dachshunds tend to have a high risk of breed-related spinal diseases. It is not only unfair for the animal, but also a cause of emotional and financial distress for the owner. While waiting for better breeding laws to catch up in the UK, we can only hope that prospective pet owners think responsibly and read up on the genetic welfare problems of pets before choosing a specific breed.

At least I finished my last day of the week while it was still light!

2. Useful notes (compiled throughout the week)

  • Differentiating central vs peripheral vestibular lesions
    • proprioceptive deficits – seen in central vestibular lesion
    • mentation deficits – central (however, difficult to assess, as peripheral vestibular can cause animal to be nauseous and present ‘depressed’ without actual mentation deficits)
    • cranial nerve involvement other than CN 7, 8, sympathetic trunk – central
    • vertical nystagmus – more likely central
    • direction of nystagmus changes when direction of head position changes – central
  • When presenting on rounds or carrying out a neuro exam, it is useful to drill yourself to get used to this format:
    • mentation + behaviour – adequate?
    • gait (ataxic/ paraparetic and ambulatory/non-ambulatory *important*) + posture (head tilt etc)
    • proprioception/ postural reaction – deficits?
    • spinal reflexes – deficits?
    • cranial nerves
    • pain
  • Differentiating central and peripheral blindness
    • lack of PLR response -> peripheral blindness
      • as PLR pathway is subcortical and does NOT involve forebrain
    • lack of menace response -> central blindness
      • involves forebrain as it is a conscious response, so lack of it indicates a forebrain lesion as you lack the perception of a menace event!
      • more info 
      • nb: menace response usually develops in animal 3 month old and above in dogs (or 5-6 weeks depending on breed and species)
  • Acute phase proteins APP: albumin is a -ve APP while CRP is a +ve APP
    • so low albumin (alb) indicate inflammation, high CRP indicate inflammation; hence can be useful to assess if both correlate when looking at biochemistry test and suspicious of an inflammatory process going on)
    • low alb in inflammation occurs as increase leaky endothelial cells causes alb to leak into extravascular space, increased degradation, cytokine act on hepatocytes to downregulate ALB production and upreg SAA production, more info
  • Treatment for degenerative disc disease is SUPPORTIVE, pain relief and CAGE REST – possibly NSAIDs or steroids to reduce inflammation around disc and TIME for the annulus fibrosis or nucleus pulposus to heal
  • When getting a thorough history from client
    • Get comfortable asking owner weird questions – does dog eat horse poo (as could indicate ivermectin toxicity, toxoplasma or neospora infection through poo consumption)
    • Clarify the time of onset of the neuro abnormality (seizure, off its back legs etc) AND TIME of progression, when exactly did it get worse?
    • For spinal pain patients, ask: are they still climbing up and down stairs; showing any urinary/ faecal incontinence 
  • Nb: a normal gait in client’s perspective is not necessarily normal, so it is important to gauge (according to the owner’s perspective) if it has changed or not (to ensure you are detecting the actual abnormality and not the inherent breed related problem)

3. A Basic Neurology consult and exam

Key questions for a neurology consult

  1. Onset – peracute/ acute/ chronic (peracute: hours to a day (eg. dog was fine in the morning, when you popped to the shops and got back, found dog has hind limb paralysis), acute: roughly 1-3 days, chronic: roughly weeks to months)
  2. Progression – did it get worse or did it improve?
  3. Pain
  4. Symmetry – owner notice any symmetry in signs, ie. is one side worse than the other
  5. (Signalment- breed may not necessarily be important but parameters like age are more important, eg. SRMA usually in dog < 3 years old so if you have a 6yo dog with neck pain it is less likely to be SRMA)

Neurology exam is a systematic exam, with 6 main components

  1. Mentation and behaviour – observe patient when client bring it in, while chatting to the owners you can observe a lot from patient (depressed, BAR..)
  2. Gait analysis (3 different types of ataxia- vestibular, cerebellar, proprioceptive ataxia) & posture (head tilt, kyphosis, more info in this VIN article
  3. Cranial nerves – you can observe quite a lot even before touching the animal
    • CN II – vision (owner report if animal is stumbling into objects, see if animal can follow object movement when walking into consult room)
    • CN III – pupil size (constricted if normal, dilated if have lesion. Parasympathetic NS involved in constricting pupils, sympathetic NS involved in dilating pupils)
    • CN III, IV, VI – eye movement (so if animal able to move eyes around)
    • CN V – chewing and face sensation (notice any temporal m. atrophy)
    • CN VII – facial expression (notice any droopy eyelid, lips)
    • CN VIII – vestibular (head tilt, pathological nystagmus – flicking of eyes L to R or vice versa when head is stationary, a vet once told me an easy way to remember the lesion site is to see where the eye is running AWAY from (like running away from something bad), so if eye position moves L to R, it is running away from the L, therefore lesion site is on the L side)
    • then you carry out the cranial n. exam checking for all the cranial n. (using your forceps for facial sensation, corneal reflex.. etc)
    • side note: 2 CN tests that also check for forebrain/ conscious response are the menace response and the nasal sensation response (place forceps into nasal planum and trigger response)
    • tip on doing menace response: to ensure you get the attention of your dog, could do palpebral test first, then as you have their focus you carry out the menace response!
  4. Proprioception/ postural reactions (knuckling, placing test..etc)
    • with the knuckling test, it is not a weight bearing test so ensure you support the weight of animal when carrying out this test
  5. Spinal reflex
    • Besides the muscle stretch reflexes (extensor carpi radialis, patellar reflex..), perineal reflex and cutaneous trunci reflex (start CAUDALLY and move cranially), the main one to consider is the pedal withdrawal reflex!
    • The pedal withdrawal reflex involves pinching the webbing between digits to elicit a withdrawal response. Observe the strength and completeness of the response and not the speed. Ideally you want all 3 joints to flex completely and to look for subtle differences between thoracic & pelvic limbs or R and L limbs. Ideally do it while animal is in lateral recumbency but if animal is too stress you could do it while animal is standing. (but bear in mind there is the added difficulty of working against gravity to flex those joints.)
  6. Palpate pain

Doodles:

Menace response pathway: Lesion in optic n. and cerebellum causes ipsilateral signs; lesion in forebrain causes contralateral signs (Image cred: Jen)

Differentials – use VITAMIN D! nb: below is not a complete list but just the main ones we discussed in the morning introduction session*

  • V: vascular, for example FCE is peracute onset and improves quickly without pain usually (or pain subsides in 24 hours)
  • I: inflammation or infectious, common ones being MUO, toxoplasma, neospora
  • T: trauma
  • A: anomaly, structural abnormalities like chiari malformation
  • M: metabolic would see more symmetrical and generalised signs
  • I: idiopathic, usually epilepsy
  • N: neoplasia
  • D: degenerative, commonly disc diseases

Thank you for making it all the way to the end of this post, hope you are all safe and well, take care and see you in 2 weeks! In the meantime, I am attempting to finish a few vet school videos for the Youtube world. 😊

W1: Small Animal Medicine rotation

Thought I’d do a quick summary review of my first ever rotation week! To serve as an educational/ sentimental purpose for the future when I look back and see how far we’ve come.

I cannot believe it is the end of the week already! (well, not quite, as I still have to go in tomorrow eve for a hospital treatments shift heh) This week was pretty intense but super fun yet rewarding!

The dream team!! (Sorry Alex I promise we will take more photos next week)

Day 1 consisted of our introduction, it felt a little bit chaotic at first because we weren’t familiar with using the system to look up hospital records, (thank you kind intern J for helping us out!) who to refer to for things etc.. I also felt a little bit bad for asking lots of questions to the clinicians/ interns (thanks for your patience! heh) because I was double-triple checking myself to make sure I did the right thing (from asking history, where to bring patient, which sheet to fill in…)

Notes from day 1:

  1. When taking history, quantify the degree of inappetence, dehydration or lethargy using scales or percentages. (eg % of weight loss *measured in records* over a specific period of time or ask ”on a scale of 1-10 how would you rate Poppy’s change in appetite in [insert window of time’]”) This is important to quantify so it’s not entirely subjective!
  2. Always ask if their pet has travelled abroad!!
  3. Presenting on rounds: Summarise your case with succinct points (significant findings instead of every single test you did), have a list of differentials ready and be prepared to answer the questions ‘what is your plan/ what is the next step’ ! (talking with all eyes on you can be daunting, but with practice it can only get better!!! back yourself!!

Day 2 was a little bit busy for me because I was juggling 3 cases at one point and had a quick lunch – the combination of stress and eating quickly didn’t go well with my stomach, ended up with cramps throughout the day haha! But I got to practice taking bloods and putting in IV catheters so that was good, note to self to learn how to be more confident/ back myself when doing things under time pressure next time.

Notes for day 2

  1. Use the correct sheets to SOAP your patients! (Orange for first admit, blue for the next day sheet) Remember to double check the assessment and plan with your clinician, as it can get a bit busy at times!
  2. Need to work on taking succinct history notes while balancing a conversation with the owner, any tips of advice would be welcomed please!
  3. Learn to ask more detailed questions to differentiate between the conditions and terms, eg. if pet is having a urinary issue, ask questions to dfx dysuria, stranguria, incontinence, pollakiuria etc (same for vomit/regurg/coughing)
  4. extra note: could quickly look up differentials for potential conditions of your patient to impress clinician 😉

Day 3 and 4 somehow blurred into one but overall I think our group got into the swing of things and (somewhat) knew what we were doing. I found that making phone calls to owners was quite daunting, but hey like everything it takes practice! We also had differential rounds in the morning where the clinician comes and goes through the differentials of a condition which was pretty useful.

Struggled with IV catheter placement and got some pretty neat tips from the intern 🙂 !

  1. Loosen everything when you open your packet- give the hub and stylet a wiggle, give the bung a wiggle, so that when you’re in the vein you don’t struggle to remove those components 
  2. Steady the vein with your non-dominant hand (dominant hand is holding the catheter) by getting a firm grip and using thumb to ‘steady’ the vein parallel-y *veins can be very mobile* 
  3. Using your thumb and forefinger to pinch the wing holder- so u can use the other hand holding the stylet piece to flick off the hub – ADVANCE THE HUB AND NOT pull out the stylet – I never use to understand it when they tell me this but I think I understand now- the reason is simple, because if u remove the stylet before advancing the catheter it will kink 😅

Notes overall

  1. It is ok to make a mistake when presenting on rounds (like mixing up the gender heh) the team is really supportive and it makes for a good laugh sometimes.
  2. Still learning how to balance the importance of taking a TPR and trying not to stress your patient out. Sometimes when you have a non compliant patient, you have to persevere (ask for help as well!) and take a temperature for example if you are worried about pyrexia for the patient.

Day 5 started out with some seminars by the clinicians, followed by a clinical pathology case discussion where we were given practice cases (blood results, short hx) to work on. I found the clin path seminar super useful because amongst other things I finally understood the mysterious anion gap (that no one really talks about x)!)

In a nut shell, your blood contains a balance of positive and negative ions, with your main positive ions (Na+, K+) commonly measured on biochem test and your negative ions (Cl-, HCO3-) less commonly measured. The anion gap consists of the unmeasured ions, to simplify, anion gap = (Na+ + K+) – (Cl- + HCO3-) Examples of unmeasured ions are urea, lactate, phosphate, ethylene glycol, albumin.. etc. Low anion gap can occur if you have more negative ions, conversely high anion gap if you have more positive ions. The key takeaways in terms of interpreting your blood sample is:

  1. Low anion gap can be caused by low albumin levels
  2. High anion gap can be caused by increase in lactate (if bacteria producing them/septic), ketone bodies (if diabetic for eg), ethylene glycol (if toxicity), phosphate, urea

This is how I understood it anyway, please correct me if not! x

❤️Grateful for an amazing medicine team who were so kind + patient to guide us this past week !

Vet student chats: Hsiao Qien, 3rd year at Glasgow Vet Uni

Hi all, today’s post is a short and sweet interview with a veterinary student at University of Glasgow. I hope this can provide some useful insights to future applicants!

Scenic view of the University of Glasgow buildings with the landmark Gothic Bell tower dominating the skyline (image source: image: http://www.photoeverywhere.co.uk)

Q: Hi there, thank you for agreeing to be interviewed, could you please introduce yourself? 😊

A: Hey, my name is Hsiao Qien, but everyone calls me HQ. I come from the foodie paradise that is Malaysia!

Q: What year are you in and which other universities did you apply to?

A: I am going into my third year as a student at the University of Glasgow. I applied for several other universities, including RVC, Edinburgh and Liverpool, though I never received an offer from Liverpool.

Q: What is the best thing about being at Glasgow Vet School?

A: Unlike most other universities, students of Glasgow university are exposed to important vet skills, such as suturing and animal handling, right from the get-go. This allows us to have the competitive edge over students from other universities when it comes to clinical skills. The curriculum is also well thought out, in that the modules are taught in tandem of each other, instead of the usual segregation of topics. As such, we have a better understanding of how the various body systems interact with each other. This trains us to be able to think like vets, instead of students, and be more prepared for when we eventually graduate.

Q: How is extra-mural studies (EMS) organised at your university?

A: Pretty much the same throughout UK universities, we have an online database that provides us with loads of available placements. The filter button allows us to select placements based on our set preferences, such as location of the placement, type of placement, etc. 

Q: What is it like living in Glasgow?

A: The reason I chose to enter Glasgow was in no small part due to the legendary Glaswegian hospitality. People here are generally quite friendly, and it’s quite difficult to pass someone on the streets without smiling/ throwing a quick “hiya” their way. Living expenses here are also much cheaper compared to England. Finally, the relatively large enclave of Singaporean/ Malaysian students persuaded me to choose Glasgow. Having them around just reminds me of home, and it makes the long winter nights slightly more bearable.

Q: Any tips or advice for future applicants thinking of applying to Glasgow vet school?

A: Gain as much experience as you can before applying. That’s really the only thing that will help you stand out from the rest, because chances are that everyone applying to enter vet school will be just as academically qualified as you. Also, you should do your research on the vet school of your choice if you want to impress them. Most of them have a mission statement of sorts which you can align yourself to during interviews or when writing up your applications.

For more information on studying at Glasgow university:

Is studying veterinary medicine right for me?

A common question I get asked by people that I meet for the first time, when they know I am a vet student, other than ‘are you vegan?‘ is “awww, that is so cute, have you always wanted to be a vet? You know, I wanted to be a vet when I was little too….”

Obviously everybody’s story is different. In this post, I will first explain my story and if you are not interested (I don’t blame you, time is a precious commodity!), you can scroll along until the advice section where I list some tips to help you decide if studying veterinary medicine is for you!

So, how did I know that I wanted to be a vet/ go to vet school?

When I was in my last year of high school (17), I remember my Mandarin teacher talking about careers that can make a meaningful impact on the world, and that got me thinking, how do I want to spend the rest of my life? What kind of working environment do I envision for myself? I knew I didn’t want to work at an office desk my whole life and wanted to incorporate an outdoorsy component to my daily life. And then I realised that I wanted to work in an environment with animals, so I decided to see if maybe, being a veterinarian is what I really want to be.

My second choice of profession was to be a paediatrician. (3rd choice was to be a florist! If anyone was interested) I guess I had a passion to help beings that do not have a voice, fight for their rights and take care of them. I remember googling ‘should I be a paediatrician or a vet‘ in the past and came across an article written by Lee Wei Ling, the daughter of the late Lee Kuan Yew. At first, she was also deciding between being a vet and paediatrician, but decided to become a paediatrician anyway (after her father’s advice). This is quite common in Asian cultures (at least in Malaysia), where most people think that being a human doctor is infinitely more prestigious/ rewarding in terms of monetary gain/ respectable than being a doktor haiwan (translation: animal doctor in Malay, but it is inked with some connotations to being seen as ‘just a livestock vet’ mostly in Malaysia, in my opinion at least). I had to disappoint some relatives who preferred it if I took the human medicine career route, but 17 year old me had this opinion that there were many doctors and just not enough vets at present. I reckoned if most people became doctors, who will step up to save the animals? Not many people have close relationships or know much about what goes on in a vet’s life. This often leads to certain consequences. This TEDx talk by Dr. Melanie Bowden explains some challenges that vets have to go through daily that most clients are unaware of.

So, after having this realisation that I wanted to study veterinary medicine, I decided to do some work experience to prepare for university applications, to make sure that the job environment and lifestyle were suitable for me.

I did a couple of weeks shadowing a (very old fashioned yet kind) vet at a local small animal practice, who allowed me to observe his day to day proceedings. It was only then that I faced my preconceived ‘fears’ of blood and gore by observing a spay operation. If I passed out, that’s it, I thought to myself, I can’t be a vet. Trust me, I was very scared at first, held my breath as the vet made his first incision.. Then, I took a breath. Yay, I didn’t pass out. Jokes aside, it really wasn’t that bad. I was quite glad I did that so when it came to dissections at the vet school I was not fazed too much.

I also spent 40 hours volunteering at the national zoo. The national zoo was situated quite far away from home and I did not want to burden my parents to take me there every day for a week (~1 hour depending on traffic conditions, public transport took 2 hours, these services did not start early enough for me to be at the zoo at 7am). So how did I overcome this? I annoyed my friends and asked them if they wanted to go volunteering at the zoo with me (friends with cars, conveniently). Each day I went with a different friend to volunteer at the zoo and we would rake dried leaves, pick up droppings of weird and wonderful animals together (We even sawed a bunch of logs to build a fence post for the goats😂). We made many fond memories that I have kept in the form of old school Instagram posts. Thank you to my dear seven friends, who made it possible for me to achieve those work experience hours and helped me to be where I am today.

I also did some animal-related charity work to ‘boost’ my CV and clock in more hours of work experience. Volunteering at the local animal shelter PAWS, raising funds for PAWS through the Interact Club at school *link to the 2011 short news article * were one of the things I did back in the day. I realised that I do love working with animals, even if its sweeping animal faecal matter, sweating in the heat, the ‘unbearable’ animal smells- trust me, it really ain’t that bad!! I would always finish work feeling fulfilled. That was how I decided that, yeah, you know what, I think I can/ want to do this.

Wanting to work with animals is great, but oftentimes these jobs do not pay well. Hence I thought that by combining my nerdy side I could become a vet and (hopefully) be paid slightly better. That is pretty much my story on how I decided to study veterinary medicine!

Some tips and advice to help you decide if studying Vet Med is for you!

  1. Volunteer, volunteer, volunteer! Spend some time at your local animal shelter, local vet practice or local zoo. Email/ ring them/ turn up at their establishment and offer some help. If you can, shadow a vet to see what a day in their lives look like. They may get you to do a lot of cleaning in return, but bear in mind cleaning after your patients is also part of your job in looking after them!
  2. Do some online research! With the internet you can search up pretty much anything these days. I would recommend watching Melanie Bowden’s TEDx talk explaining what being a veterinarian really takes *link*, follow some vets on social media who post about their life (of course exercise caution, not everything you see on social media is real!), or sub to my youtube channel *shameless promo* *link* – where I will be talking about my final year vet school experience when it starts in September.
  3. Read! I read James Herriot’s books and found them really inspiring, I have also listed some links to other blogs and other useful resources here
  4. If you are in the UK, some universities conduct Open days where they take potential applicants on a tour in the vet school and around Cambridge just to see what it is like. Due to the current pandemic they are hosting virtual open days instead *cambridge link* *RVC link*, so you can even view them from the comfort of your own home!
  5. On the academic side of things, I would consider looking at what subjects are you most interested in to help you guide your decision. The subjects you love most tend to be the ones you are better at as well, seeing that you are more likely to spend time revising them! For the vet course, most universities prefer science A level subjects (Chem, Bio, Maths) but I have compiled a table listing them here
  6. Evaluate your strengths and weaknesses to see if you would enjoy being a vet. I feel like vet work not only involves scientific and critical thinking when working up cases but it also requires patience, empathy and communication skills when dealing with pet owners. Being on work placements made me realise that managing your client’s (pet owners) expectations is a pretty key part to the job. I used to be one of the people who would jokingly sayoh I dislike dealing with humans, that is why I want to save animals instead. However avoiding owners is not really an option (although it may be different in COVID times) and people skills is something that I am constantly trying to work on! However, it is worth bearing in mind that being a general practice vet is not the only career pathway you can take post-graduation as there are many other alternative career pathways from doing a vet degree!

Finally, I sincerely hope this post has given you some form of direction on deciding whether you want to pursue vet studies. Deciding to commit to 5 or 6 years of veterinary studies at such an early age is daunting and a pretty big deal!! (Looking back, I probably should have given it a little more thought, but I am still enjoying the course thus far so *fingers crossed* no regrets!) This is probably why most universities prefer you to apply with some form of work experience so that you can be sure  (or somewhat sure) that you know what you’re getting yourself into. 

Wishing you guys all the best! If you enjoyed this post or not, or have any questions, don’t hesitate to use the contact form to contact me 😊

5 things I wish I knew before going to vet school

1. Costs – tuition fees + placement expenses + cost of living in the UK

Vet school can be quite costly. Besides tuition fees, you also have to pay for your expenses while on EMS placements and also feed yourself during term time. Multiply that by 6 (or 5, if you are on a 5 year course) and it amounts to quite a sum (compared to being on a 3-year degree). Multiply it again with the currency exchange rate of your country…. then cry.

2. Average salary of a vet in the UK

piggy

Yes I am one of those people who didn’t conduct thorough research to find out how much a vet earns because surprise surprise, not all vets are in it for the money!! The starting pay of a new grad vet can vary, but average between £28-30k/ year (sources: my new grad friends, so probably not the most accurate). This of course depends on what type of practice you go into and the location of your practice. (Eg., London jobs have slightly higher wages due to the higher cost of living) A quick google search shows that the vet degree is on the higher end of the fresh grad salary spectrum, comparable to foundation year human medics, and sits at the 5th position of the International Pay League table when comparing vet salaries across 11 European countries, plus the USA and Australia. In short, the pay is actually not that bad, in fact it is actually pretty good. However, the pay increment doesn’t look very appealing when compared to other professions like business, economics, law and computer science. A survey done has shown that UK vet salaries are stagnating or in decline. To quote my housemate,  

you can probably get a better paid (corporate) job with a less demanding degree 

While that is a very bold sweeping statement, it is me assuming that a degree to obtain a corporate job involves fewer years of studying, fewer exams and manual labour (think mucking out at the stable or farm). I feel like most people go into vet because they want to help and save animals, so the money factor is probably not the main attraction when applying.

3. Your non-vet peers will graduate way before you do, and it will feel weird.

society

When I applied, naive Mayy was like ‘meh, 6 years is not that long, it’ll be fine‘. Little did I know that the FOMO (fear of missing out) would kick in when I would see my peers graduating and moving onto adult life, having the earning power and being independent, getting engaged, buying a house, having babies etc.. Or the awkward conversations at family or friend reunions when people ask you ‘wow, you’re still at university? I thought it was your final year last year! Aren’t you ashamed to be the only one your age as a fresh grad?‘ – I kid you not, the number of times I have to put up with these conversations I just…. I have no advice. Except that prepare to learn and be comfortable with seeing your peers advance in life while you are still at Uni, remember that life is not a race no matter what society tells you,

Comparison is the thief of joy” – Theodore Roosevelt

everyone is living life at their own pace, societal pressures may be there, but why should you care?  You will be carrying out meaningful work providing a service to the animals and the job satisfaction will be worth it! (I hope, well, stay tuned for my future post when I realise that job satisfaction may not be what it seems). 

4. You learn anatomy by doing dissections on an animal carcass.miller

In the first 2 years of vet school, we learnt anatomy through doing dissections on euthanased dogs. These early morning dissection sessions involve being in a lab filled with the stench of formalin, cutting through a cold corpse that bled loads (depends on your dog tbh) to learn about the origin and insertions of muscles, nerve location etc… Lets just say you do not want to be present with a hangover after a hard night out! Fast forward to clinical years, we still conduct post mortems (PMs) occasionally, bearing in mind that conducting PMs can be a common job for a farm vet to identify the pathology which led to the death of a farm’s livestock so it is pretty relevant task to do.

Why do I wish I knew this? So that I could have mentally prepared myself before rocking up to the lab to be greeted by a couple of animal carcasses and the stench of formalin, stinging my every orifice. Thankfully, I got used to it pretty quickly.

5. The academic workload can be quite intense (especially at Cambridge), but necessary

revision

In pre-clinical years (the first 2-3 years of uni) we learnt about animal anatomy, physiology, pharmacology, principles of pathology, principles of neurology, reproductive biology + animal husbandry…etc At first it felt like I was studying a pure science degree (which wasn’t what I had in mind when I signed up!), and at times I would feel frustrated and stressed learning endless lists of drugs, their mechanism of action to minute detail or the optimum pH of silage (which by the way, is 4.2, it has been ingrained in my head now), repeatedly questioning myself if this knowledge is even relevant or useful for veterinary work.

Now, being in clinical year, as much as I hate to admit it, the ground work covered in the first 3 years was actually useful/ necessary to understand the process of a disease and the best management strategies to treat or control it. Also, it gets better in clinical years. I find the content that I am learning now is more interesting and applicable to vet work, so I definitely feel a lot happier in being in clinical year. To those reading this article in pre-clinical years, hang in there friends, for the best is yet to come! 😊

ps: I didn’t realise this until like 5th year, but finding out what study method works best for you early on can help you be an efficient student, making the workload much more manageable. I would write more about this but I think it should be a post on its own!

There are probably a lot of other things I wish I knew before going to vet school, but these 5 things came to mind. What did you wish you knew before going to vet school? Leave them in the comments below! 🙂

 

EMS as an international student – woes and how to get around it

EMS = placements at vet practices/ animal-establishments for 2 weeks to learn/practice skills animal handling and seeing clinical work.

Before vet school, I had no idea that EMS placements would take up a lot of time and money. Don’t get me wrong, I absolutely love being on placements, it is one of the only times where I feel like I get to do some clinical work (under vet’s supervision), interact with the clients, puppers and actually feel like I’m closer to being a ‘proper’ vet!

In this post, I will talk about my struggles, how I overcame them and how despite the little challenges, I am grateful and privilege to learn and grow through many placements. Before I begin, just putting a disclaimer out there saying that everyone’s experience is different and that this is what has worked for me (so far!)

My struggles

1. No car 

Not having a car can be a bit of a hassle depending on where your uni is located and what type of placements you have to carry out. In my case, I found finding farm placements the trickiest because A: there are very few farm places around Cambridge (East Anglia), B: they are usually located in secluded areas only or most easily accessible by car (in comparison to small animal practices, stables located near areas with good public transport access) And if they are easily accessible, you’d have to find accommodation nearby (either walking distance or have access to public transport, more on that in point 2) and hope that they are willing to take you. 

Hence, I’d feel envious knowing my friends have the freedom of choice to drive wherever they want to and stick all of their stuff in the car boot and not worry about lugging all their equipment across many train platforms and buses to get to the placement. Oh and at Cambridge you can claim money for mileage expenses too.

“so why don’t you just get a car then?” well that costs money. Not only would I need to pay for the actual car (buy or rent one £300), I would have to pay for driving lessons and take a test to get a provisional drivers license which costs a lot of money (£150-250) (Singaporeans get a free pass at this since their existing driver’s license is recognised in the UK) ☹️ Since I didn’t fancy putting in effort/ money to get a car, what did I do instead?

IMG_5422

public transport – very obvious answer, i know! Tips include: get a 16-25 railcard, it saves you so much money (1/3 off your ticket price), link your railcard to your oyster card too. When finding placements, I always email/ check where the nearest train station is and work from there if its feasible (walking distance, etc). I also email the placement provider to tell them I am an international student without a car to check if its feasible to do the placement. This is more for farm/equine vet practices, as may limit what ambulatory cases you can see (eg., some vets prefer you to drive and tag along behind them to see cases, whereas some have space in their car to take you while they are out on calls). Get a pair of comfy shoes, pack light and your enthusiasm to brave the journey.

carpool with friends – I was immensely lucky to have support from my friends. They were really kind to let me carpool with them to certain placements (it was on their way, or we would be going to the same placement we had organised together), and in return I would either compensate in terms of costs, cooking/ baking for them or be the road trip DJ etc. This is harder to emulate, since everyone’s situation may be different, all I can say is if you can organise to do a placement with a friend, do it, its a lot of fun, but if you cannot, don’t worry, public transport is always an option.

Other tips: when emailing for placements, mention to them that you don’t have access to a car- they might be able to pick you up from the train station (but don’t take it for granted- remember that the practices do not owe you anything so don’t be an entitled brat)

2. Lack of accommodation

On the topic of organising farm placements (again, I know), since they are the trickiest to arrange in my opinion, whenever someone said “oh I have grandparents up in the Lakes” or “oh yea I will be staying with relatives in Yorkshire”, a pang of jealousy would hit me and I would think ‘oh, how nice for some‘. It doesn’t make sense to me to complain that it is unfair or anything, since I made the decision to come to the UK to study and really love it, so I don’t really have the right to moan. (well, let me just be salty for a little, haha) Without making a big deal out of this issue any further, here are some options that I have taken in the past that has helped me get around this situation. (Oh and this is after I have exhausted the vet school’s database for placements that provide accommodation)

  • when applying, I ask the placement if they provide/ have staff that are able to offer a room to rent (I have paid about £10-20/ night for these rooms in the past)
  • hostels – some places are located near hostels which are about £15-20/night 
  • airBnB – the price range for this varies tremendously since it depends on the location (if it is a touristy area expect higher prices, if it is a working area they may offer discounts for long-term stays of 14 days) 
  • friend’s house – free! + sell your soul (I kid, but you can try to ask friends if they are willing to rent a room to you, or do a placement with you, or offer to house-sit/ cat-sit/ dog-sit/ baby-sit in exchange) I have been so lucky in the past (thank u friends and my Da Yee (aunty)) for being so generous to host me/ feed me during placements!!!!map

So far in pre-clinical years I managed to stay with friends for 4 placements, my aunt’s for 1 placement, at the farm for lambing (usually they offer you accom) for 1 placement. In clinical years I have done 4 placements at home in Cambridge and MY (ideal situation), stayed with practice staff for 2, stayed at an airBnB for 1, and was set to stay in a hostel in Orkney for 1 but got cancelled due to COVID-19 (yes, I was willing to travel far and wide just so I can go to a farm placement that had accom nearby!)

3. Finances 

Using simple maths, (simple because maths is not my strong suit, only got A instead of an A* in A levels sadly) a typical placement costed me £260.

expenses example

Things that I could have done to reduce the cost: book train tickets earlier, or look for bus options, reduce the cost of my groceries by cooking cheap and easy meals (which I might write about in the future).

The RCVS requires us to carry out 12 weeks of pre-clinical EMS and 26 weeks of clinical EMS (pre-COVID days), so I would have to repeat this whole process of finding placement + accommodation + transport + money 19 times (assuming each placement duration is 2 weeks). 

Although it can sound a little overwhelming, and at times I was pretty stressed out when I kept getting rejections/ places getting booked up/ not meeting my species minima requirements… in the end it was still doable for me because..

  • It was a total of 38 weeks of placements spread over 6 years (12 weeks in 1st to 3rd year, 26 weeks in 4th to 6th year), so there is enough time for you to do your planning 
  • I got support from the vet school (you get £10/day allowance for placements in clinical years which helps)
  • I worked part time at my college library, cat-sitted to cover some costs 
  • College has an academic fund to which you can claim your EMS expenses (only started this year but better late than never!!)

If you have read until the end of this post, I hope you found this info useful and relevant! I feel like the ‘struggles’ of a vet student’s life is rarely spoken outside of vet circles, and prospective students should go into this knowing what lies ahead. I hope this doesn’t intimidate you about the admin work involved in organising EMS (in other uni’s it can be a different process, some organise them for you, some don’t. Personally I like the freedom of deciding which placements to go to and love being at Cambridge so yeah), instead I hope this post reassures you that regardless of how overwhelming it may seem at first, it can be done with support and determination. 😊

Final few tips

  • get looking early! ask seniors in advance, book places early and send out loads of emails because if you need a place that provides accommodation and is close to the train station, you have fewer options compared to others who don’t have any conditions
  • try not to feel demoralised with your situation and think of it as a way to be inventive and able to save money at the same time!
  • ask for help if you need. Seek help from your vet school to work things out. Besides that, I am more than happy to share with you which placements I have been to, just message me!

Mind set(s) to have on the first day of EMS

  • It is okay to feel nervous, you are entering a new environment and meeting new people. I always found it awkward as you are not sure where to place yourself. But a wise friend once told me ‘it is only awkward if you think it is‘. Sometimes we have to tell that inner voice that everything is fine and that everything will be fine.
  • Familiarise yourself with your surroundings and equipment – this will come in handy when it gets busy and the vet says ‘could you grab the otoscope/slide/ xxx from the other room’ and you can be helpful and resourceful/ impress the vet (and yourself) with how quickly you are able to adapt to a new place. 😎
  • SMILE ! Be kind to vet nurses and other staff. Remember, the vet student is at the very bottom of the food chain. 😂
  • Be curious and don’t be afraid to ask questions- BUT make sure you ask them at the right time (ie. not during a busy consult, in front of pet owner (discuss with vet beforehand if it is ok for you to do so)
  • be PROACTIVE- most vets love it when students want to learn, ask questions and engage with them! Don’t just sit and scroll on your phone/ quietly when in the car with the vets out on a call.
  • Be genuinely interested to help the staff, they would really appreciate it, and are more likely to let you know when interesting cases/ procedures are booked in for the week!
  • BACK YOURSELF – when you are asked to do a task you are not confident in doing (ie. putting an IV catheter for the 2nd time in your life), you can tell the vet what you’ve done in the past in vet school, and would like some guidance/ appreciate if they talk you through this. Remember the only way to get better at something is to actively do it!
  • Don’t be taken aback or go into defensive mode if/when they ask you to help do clean up work.
    • Context: You have done 5 years of vet school, only to be asked to clean up after a dog that peed all over the consult room/ clean the litter box of the practice resident cat. It takes a hit to your ego and you don’t want to do it in the slightest. (trust me we have all been there) Take a breath and remember that helping the vet/ vet nurse/ staff will help them help you in the future. After all, you want to get the most out of your time while at placement, so don’t sulk about it and lend a helping hand.
    • Obviously if they keep asking you to clean stuff and you miss out on the consults etc try and have a chat with them and politely ask if you could help them clean after you’ve observed in a procedure/ consult. Or if the vet/ vet nurse has time, try and ask them to go over bandaging or suturing patterns with you (if you find yourself hanging around with nothing much to do on a quiet day)
    • I personally would try and stick it out until the end as leaving the placement halfway would mean rescheduling and going through the hassle of booking more EMS. But if its reaaallly bad then you know..
  • You may meet some ‘mean’ vets – the ones who avoid the EMS student at all costs, do not acknowledge your existence etc.. Try not to resent them, I feel like everyone has their own reasons (busy day/ point in their lives) and we should respect their choices if they want to interact with us or not.
  • Similarly, you may meet some really great vets! In that case, thank them and show appreciation and gratitude for their teachings. ❤️