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NAVLE Season: How to Study for the Biggest Exam of your Life

NAVLE Season: How to Study for the Biggest Exam of your Life

The North American Veterinary Licensing Examination is required to practice veterinary medicine in Canada and the U.S.A. Normally the NAVLE season is in November/December for final year students. If you are in the usual school year start of Aug/Sept, then you get a chance to write in the Fall, and if you happen to fail the exam, you get a second chance to write in the spring (April), prior to your graduation in May/June. Those that are writing in the Fall would have registered for the NAVLE in August. I don't mean to brag but... in my graduating class all of the students that wrote in Fall passed the NAVLE - yup, a 100% pass rate. ;) Now, not everyone in my class wrote in the Fall. I know of one that had to cancel due to illness. I'm not writing this to say that the NAVLE was a walk in the park. As this post says "it’s arguably the most important exam of your life up until this point." I have a colleague who failed twice, and now needs to re-write the exam, but with COVID-19 restrictions, she is having a tough time staying motivated to study. This is one of the reasons why I thought it would be nice to give some of these veterinary students a place to focus on because it's four years of curriculum jammed into one exam that changes the course of your life. The questions on the NAVLE get rotated, and no one is to speak of the questions from the NAVLE - not that you'll remember any from that grueling 6 hours you sat answering multiple guess questions. But the basic concepts are the same. Preparation for Licensing in Canada For those who are preparing for licensure having graduated from a veterinary college that is outside of an AVMA accredited facility, there are more steps to obtaining your veterinary license than writing the NAVLE. 1) Everyone, including veterinary students at accredited facilities, needs to register with the NEB. Click here for more information. All of the links below will pertain to licensing in Canada, so if you're writing in a different country you'll have to check in with your licensing body. 2) If you graduated from a non-AVMA accredited veterinary school, you will need to complete the BCSE, PSA, CPE and the NAVLE (not necessarily in that order). The Basic and Clinical Sciences Examinations (BCSE) The North American Veterinary Licensing Examination (NAVLE) The Preliminary Surgical Assessment for the CPE (PSA) The Clinical Proficiency Examination (CPE). I recently created a post for those preparing for the PSA, which you can read here. If you graduated from an AVMA accredited veterinary school, then your Objective Structured Clinical Examinations (OSCEs) are used in place of the BCSE/PSA/CPE, therefore, for licensure these students will need the NAVLE and the provincial examination. Studying for the NAVLE When you are studying for the NAVLE, I recommend that you spend the majority of your time on the Big Four species: Dogs, Cats, Horses, Cattle. Roughly 77% of the questions that you will get are about those species groups. So if the passing grade is 70%, and you study these four species groups really well, plus the really important select few diseases of the other species, then you will be just fine! Don't over think it! For more information on the break down of the NAVLE, you can find a nice chart here. Tips on Studying for the other species/topics For the other species groups (swine/porcine, small ruminants, exotic/pocket pets, poultry, pet birds like parrots, camelids, cervids, public health, other), you should probably know a few things about the Notifiable (Reportable) diseases in your country (or your neighbour's - for us it's the U.S.A.). In general, anything that can be transmitted to humans will fall under your responsibility to educate the general public, so regardless of whether you want to learn about chickens, communicable diseases and public health are part of your job. As an example, if poultry encompasses 2% of the NAVLE, that's roughly 7 questions. But you can expect that of those questions, those really important diseases are likely to come up, so focus there. Here's a quick list of Reportable diseases for Canada, and below will be some links mostly from the Merck Veterinary Manual for those diseases to help you study. The diseases are either highly infectious which could wipe out a population of that species, which would drastically affect the global food supply, or they are contagious with a high mortality rate for humans if they contract the disease. You may wish to note how the disease is transmitted, how would you make the diagnosis, and something about how you would treat it or control it. Diseases affecting Multiple Species: Anthrax (Bacillus anthracis) Bluetongue (virus spread by midges Culicoides that affects ruminants) Brucellosis (Brucella abortus, Brucella suis, Brucella melitensis) Cysticercosis (Taenia saginata, Taenia solium - tapeworms of cattle and swine) Foot-and-mouth (Aphthovirus, a member of the family Picornaviridae) Rabies Rift Valley Fever (mosquito borne virus affecting mostly ruminant species and humans) Rinderpest (declared eradicated by the OIE) Trichinellosis (zoonotic roundworm transmitted by raw or under-cooked meat, historically from consumption of pork, but also found in carnivores like bears) Vesicular Stomatitis (basically, any vesicular disease of ruminants and horses should be biopsied) Equine (Horse/Donkey/Zebra): African Horse Sickness (viral disease transmitted by midges Culicoides) Contagious Equine Metritis (venereal bacteria Taylorella equigenitalis) Equine Infectious Anemia (virus passed through blood feeding insects) Equine Piroplasmosis (tick-borne protozoal disease) Venezuelan Equine Encephalomyelitis Bovine (Cattle): Bovine Spongiform Encephalopathy (BSE, mad cow disease, a prion infectious disease) Bovine Tuberculosis (Mycobacterium bovis) Contagious Bovine Pleuropneumonia (a highly contagious Mycoplasma) Lumpy Skin Disease (pox virus) Of the other species, pigs (swine) encompass the next most abundant exam questions (approximately 6%, or 22 questions). Swine/Porcine: African Swine Fever Classical Swine Fever (Hog Cholera - enveloped RNA virus in the genus Pestivirus of the family Flaviviridae) Pseudorabies (Aujezky's Disease) Swine Vesicular Disease Small Ruminants (Sheep/Goats): Peste des petits ruminants (viral disease similar to Rinderpest) Scrapie (similar to BSE and CWD a prion infectious disease) Sheep and Goat Pox Poultry (Chickens/Turkeys): Avian Influenza Fowl Typhoid (Salmonella gallinarum) Newcastle's Disease (Avian Paramyxovirus) Pullorum (Salmonella pullorum) Cervids (Deer/Elk/Moose): Chronic Wasting Disease (prion disease like BSE) Other thoughts while I was writing this: Don't spend all your time learning about Sensitivity and Specificity. Sure, you'll get one or two questions on epidemiology and R0, but focus your time on the species that will count. On top of the above reportable diseases, think about creating a list of Top 5 or 10 diseases for the other species groups (similar to the VIN prep course). How do you identify or diagnose the disease? How do you treat or control that disease? If a disease or condition affects multiple species, it's probably something to study. Think about Vitamin deficiencies or toxicoses that can occur. To practice a NAVLE for timing of the exam, to ensure you can get through it all within the time allotted, you can head to the NBVME website to take a practice test or purchase a sample test. I did the VetPrep program for studying for the NAVLE and I took part in VIN's NAVLE prep course. VIN NAVLE prep course For the newest course catalog for VIN, head here. It essentially goes through the Top 20 diseases that you should know for each of the species groups. The next course offering will be for Spring 2022. If you are writing in the Fall and missed the registration for the current course, you can also go to the course archives and find a course. Don't forget that the VIN membership is free for veterinary students. A few of my classmates preferred to use the ZukuReview (which will email you a prep question every day if you sign up for their email list). I really hope that you find this information useful and Good Luck!

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Ethical Dilemma: To Euth or Not to Euth

Ethical Dilemma: To Euth or Not to Euth

I have posted about Euthanasia in the past. It was the only part of becoming a veterinarian that made me not want to become a veterinarian. I was in grade 6 (so that age is what, 10 years old? I'm pretty sure), and a veterinarian came into our classroom to describe the work that they did. My take away from that visit - veterinarians kill animals. Being an animal lover, growing up on a farm, tending to lambs that were less than hours old, I couldn't think of having to do that. There was a story about how they had to inject animals with toxins, and then try to determine what the toxin was to safe this animal (maybe I was dreaming about this as a child, but having gone through Veterinary Toxicology I know what those old videos look like - horrid). So from that day forward, I didn't want to be a veterinarian anymore. Fast forward to 2005, I graduated with a BSc in Biology with a minor in Psychology. I had an interest in animals and social evolution, as well as reproduction. But when I graduated, all I knew was that I wanted to work with animals. I applied to a job ad as a Zookeeper. I didn't get that job, so I took a job as a laboratory technician. I actually took a HUGE pay cut to go to work as a laboratory technician in an environmental toxicology lab. But I loved it! I was previously working as a junior accounting. Punching numbers into a computer, balancing bank statements, balance sheets, running accounts receivable/payables, real boring stuff - which I now use for assisting with my hubby's company Green Ghost Media. Anyway, the contract work that I signed on for as a laboratory technician was a set 3 month contract, and since I needed to have something else, I saw yet another ad to the same zoological facility, and sent another updated resume. This time, I got hired! Becoming a Zookeeper can be difficult. In the U.S. it requires a BSc in an animal related field, as well as externships/internships as a junior zookeeper. I am not in the U.S. and while I didn't have an internship at a zoo, I worked on a hobby farm with sheep, swine, and cattle, which really are domesticated versions of Bighorn Sheep, Red River Hogs and Yak. I wasn't satisfied with *just* being a zookeeper. If you think about the pay structure for zookeepers, you are hardly going to make a living. So unless you have the ability to live with your parents forever, or have a spouse who makes a lot of money to support the both of you, it's not really sustainable, at least in the privately funded zoo that I started out in. Not that I want to discourage you from pursuing Zookeeping as a profession! Just make sure you know what you're getting into! A few months into becoming a Zookeeper, I revisited my childhood dream of becoming a veterinarian. At this time, I'm 25 years old, 15 years wiser than my 10-year-old self. I started volunteering at a local wildlife centre. Initially thinking that I wanted to be a zoo and wildlife veterinarian - who doesn't?? But it was at the wildlife centre working with a veterinary technician that I learnt the analysis of euthanizing an animal. It was a raccoon. A young male raccoon that had fractured canine teeth, and a broken bone. The technician discussed with me that she was going to euthanize this one. There was too much damage, and for him to be rehabilitated to go back into the wild, he would not be able to compete with other male raccoons for resources and mates, and may not survive. Going through this weighing of costs/benefits for the animal, including the time for rehabilitation, the resources needed from the centre, while it was sad, things started to make sense on why we couldn't save them all. Fast forward to today - 30 years after my divergence away from veterinary medicine. I am now a veterinarian that works in Urgent Care. I see a lot of death. I've posted about it recently on my TikTok if you have been following me over there. But contrary to popular belief, I will not euthanize every single pet that presents for euthanasia. I have a heart and a mind that has to live with the decisions that I make, and I do not take these decisions lightly. I weigh out all the options in my head. Who is benefiting from the death of this animal. Does it benefit the animal to have its life taken from them? We are allowed to say No. Does that mean that the pet parent goes elsewhere to get their pet euthanized? Yes. Does that also mean that my colleagues have to euthanize the ones that I will not? Yes. But I need to be able to sleep at night. So, I'm sorry I won't euthanize your otherwise healthy pet when you bring it in for me to "put to sleep". I have had pets present for euthanasia, having never met them or their pet ever, and I ask if the pet parent can try one more thing - I give them one easily attainable task that does not require spending endless amounts of money on diagnostics or treatment. I just ask that they try. If I ask them for one thing, and it doesn't work out, then I can at least feel better that we tried. I may not be able to save them all, but I have saved some from death by tasking one thing to the pet parent. So the ones that I have saved I will cling to. For all of the veterinarians or future veterinarians out there that think that death and euthanasia are the hardest parts of the job. It isn't. You just need to be able to stand up for what you believe in. It is not black and white. The reason I decided to blog today was due to an angry TikTokker. I shouldn't let them get to me. I have a right to decline euthanasia. So, to those of you sitting there thinking "Not another one of those vets" you can go ahead and wash the blood off of your hands, because I'm not doing it. For more topics on Veterinary Ethics, I highly recommend you pick up a copy of Bernard Rollin's book Rollin, B.E. (2006). An Introduction to Veterinary Medical Ethics: Theory and Cases.

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National Infertility Awareness Week

National Infertility Awareness Week

Raise your hand if you have been trying to conceive (TTC) and you don't feel understood. How about those of you who are afraid to talk to anyone? How many of you have joined a TTC social group? Strangers come together on these platforms with one common goal - to have a healthy baby. Now, to those of you who have healthy babies, those of you who had no problems getting pregnant, maybe getting pregnant on your first try, or without trying - it's not that we aren't happy for you. It is that the sadness of our own lack of success hurts more when we see new pregnancy announcements. No offence, we don't really want to talk about our infertility issues with you, because we think you do not understand. I felt that I should join my fellow members of the TTC community for National Infertility Awareness Week (April 19-25, 2020). First of all, what is infertility? From a medical perspective, it is a term given to couples that have been trying to conceive without a successful pregnancy for greater than 12 months for women under the age of 35, and greater than 6 months for women over the age of 35. Roughly 16% (or 1 in 6) couples in Canada experience infertility. This number has doubled since the 1980s. Part of the reason behind the increase in infertility is that women are delaying having their children until later (see the graph below). If you haven't read my previous posts on advance maternal age and AMH, please feel free to gain some more information there. For me in particular, it was a focus on my career as a veterinarian. In the early 2000's you can see the upward slope of the cohorts of women from ages 30-34, 35-39, 40-44; as well as a downward slope of the cohorts of women from ages 20-24, 25-29. This pushes the average age for women bearing children to be over 30 in Canada over all. In both British Columbia and Ontario, the average age of mothers at birth has been over 30 years since 2004. During COVID-19, all non-essential businesses have closed their doors. They may still offer services over the phone, or during emergencies. However, fertility clinics are non-essential. Some women in the TTC community have had their IVF cycles cancelled, which to say is stressful is an understatement. Number one above all is to take care of yourself. Make sure that you find your support system. This week, I will be posting daily. I am going to talk about cycle monitoring to help you conceive. I'll talk about my own struggles with a short luteal phase. I will go into stress and its physiology and how it relates to trying to conceive. I will also briefly discuss natural supplements and treatments for infertility. Just remember, this is my journey. You tell your story. #MyInfertilityStory #TTCjourney #NIAW #NIAW2020

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Our Feathered Friends

Our Feathered Friends

When I started at the new clinic, I knew that there were going to be some wildlife and exotic species. What I didn't know was that some days, 60% of my patients are not dogs or cats. Who knew?? We are not specialists. This is something that we need to say. We are not reptile specialists, or avian veterinarians. We just happen to be in a location that is the closest veterinary hospital that will see birds, pocket pets and reptiles. There is a lot of learning involved on our part. Did you know that just like mammals, not all birds are created the same??? Our feathered friends are as diverse as our mammalian friends?? When do we learn about Taxonomy? Let's see: Kingdom: Animalia, Phylum: Chordata, Class: Mammalia, Class: Aves, Class: Reptilia - that's dusty, isn't it? Cats and Dogs are at least under the same Order of Carnivora. Not all of the bird species that come in to see us are in the same Order! On our EMR (electronic medical record), did you know we have a list that says Species... then under the Species there are options: Feline, Canine, Avian?? Marsupial?? Rodent?? Ouch... Why is this important? I submitted blood work for a reptile and an avian last week. Sadly, there are no reference ranges for these species. *sigh* Because when we submitted the sample, the computer system read Species: Reptile and Species: Avian *facepalm* Not helpful. Someone needs to explain Taxonomy to our IT personnel! That being said, there are general categories of pet birds that will come in. Similarly, there are categories of pet reptiles and pocket pets. Most of the birds that we see as pets are Psittaciformes (that's the order in case you have forgotten). The phylogeny after this can get more complicated, because the original phylogeny was adjusted as new information was added. So, we end up with Families (i.e. Cacatuidae, Psittacidae, Psittaculidae, Strigopoidae), SuperFamilies (Psittacoidea - true parrots; Cacatuoidea - Cockatoos from mainly Australasia), SubFamilies (Psittacinae - Old World or African parrots; Arinae - New World or South American parrots) - all before we get to the genus-species level!! Ack! Have I confused you? I may have confused myself! Why is this even relevant?? Because the health of the individual bird will be dependent on how far removed they are from their natural counterparts i.e. are they doing what they would normally do in the wild? Consuming the foods as close to what they would be eating? Behaving, interacting or foraging as if they were in the wild? The healthiest captive birds are given the opportunity to eat, behave and just live as if they were in their native environment. Captive parrots are more related to their native counterparts than dogs are to wolves. And people think they need to feed their Pom and Chi like a wolf... But they don't think they need to feed their parrot, like a - parrot? Target Audience: Veterinarians and Vet Students who wish to include feathered friends in their care! This blog post is really for those veterinarians or vet students that are seeing or wish to see our feathered friends. It is also the opinion of a general practitioner that wants to be able to help where no one else is willing. This does not make me a specialist. Every time my reception team comes to me and says, there is this cockatiel that is doing X. I think, oh no... oh no, no no... (insert fancy TikTok video here). But then I also think, yes, I will help this patient, because I know that no one within four hours drive will! Our feathered friends deserve care too. So do the scaly ones! You as the veterinarian and veterinary student, you have skills! You know how to educate yourself, and the basic principles of medicine and working towards a diagnosis are the same. Form and Function in the avian patient may be a little different, and it's likely to be out of your comfort zone if you haven't handled am avian - but you may have a willing technician to help you! Ok, so what do you do? You get the call, you get on Google and see what the natural history is on this species. Temperature, humidity, daylight hours, natural diet and behaviour. It's all biology. All veterinarians have had university level biology!!! This is more than the average person has had! You can do this!! In addition to that, if you have your signalment, you can look up the average weight of what that species should weigh, what is the lifespan of that species, is there sexual dimorphism? Now you already have a little bit of information even before seeing the patient. When our little feathered friend arrives, get a history! Just like you would for your dog and cat patients. In addition to the usual questions of V/D/C/S, you will want to know: what the bird is offered for food AND we want to know what it actually eats. If it's offered a mix, does it just pick out all the peanuts or just eat the millet seed? If they bring a sample, you can usually watch to see what they eat in the clinic. But I will ask "What are their favourite food items, and are they free fed?" "How often do you change the food out completely" and is there opportunity for foraging/feeding toys? Does the bird get any vitamins or mineral supplements? the habitat (caged, free roam in the house), type of cage and size of cage for the bird size; do they live with another of its species? Are there more birds in the house? How much handling does the bird get? toys (mirrors can cause reproductive behavioural issues - so we want to know these things), anything with lead/zinc that they could consume? photoperiod (day-night cycle) and access to any UV light, any outside time with direct sunlight? Reproduction: especially important if they know they have a female bird. Has it previously laid? When was the last clutch? This is not a complete list, but a good start! Now, we need to be the detective and take all that history and pull out the important things that are deficient. Typically it will be diet. I would say 90% of the time the bird isn't eating a well-balanced diet. Common Pet Bird Problems: Diet: A poor diet or eating too much seed and not enough well-balanced foods can lead to: obesity -> fatty liver disease hypovitaminosis A -> nasal or ocular discharge, poor digestion cardiovascular disease -> atherosclerosis or hardening of the arteries from diets too high in fat Egg-binding - a common emergencies in the female avian, so check that coelom for distension. This may be a combination of problems in the history. It could be due to poor hydration (low humidity) + lack of calcium + excessive stimulation to lay +/- diet Feather-picking: This could be ectoparasites, endoparasites, nutritional deficiency, pain due to any number of issues - arthritis or other, and/or behavioural. Sometimes you have to treat the behaviour, in order to give you time to determine the underlying cause because you don't want them to get worse! There are these awesome felt e-collars that protect the bird from causing more damage to itself. Choosing the size of e-collar is the tricky part. This is not an exhaustive list... again, just somewhere to start! The Work-Up: Ok, our patient has arrived. Here is a little caveat. If you have a really sick exotics patient, you may just want to do a quick assessment, put them in an incubator with the appropriate temperature and humidity, and watch to see what they do. They may be stressed from the car ride over and you do not want to rush into an exam in case they are too stressed from the trip. I often have the pet come in and sit for 30 to 60 minutes. This gives me time to look through the history and get a distance evaluation. Are they stable enough for me to handle them or are they going to get too stressed and arrest from just the handling for an exam? Your patient has survived the initial transport to the hospital. You will want to first mention to the owners that handling causes stress and some exotics patient can enter cardiac arrest. I ask owners if they are ok with me giving a mild sedative/anxiolytic to help with this. Especially the ones with respiratory issues - just like your dog and cat patients that come in dyspneic, you given them an anxiolytic before doing anything else, right? The one thing that I have learnt, not just with time, but I learnt in school, lucky for me, is to not be afraid to use anxiolytic injectable medication to help facilitate the physical exam, radiographs and blood collection. This is not just a promotion of fear-free handling. It makes it safer for your exotics patients when they are handled, as they are not scared. Often we will include some pain medication in there. Think about pain and shock and what that does to the cardiovascular system. Some of these pets are not used to being handled. If they are very sick, the stress of handling for an examination can contribute to worsening of disease, sometimes leading to cardiopulmonary arrest. You have access to specialists, so use them! There are exotic formularies available. I always use reversible sedatives. As time progresses, you will have a protocol that you feel comfortable with. If you have a tiny patient, you will want to dilute your sedative medications. I draw up the smallest volume into an insulin syringe, and then dilute this with saline. Insulin syringes are just easier to get a small volume as accurate as possible, as well as not wasting your controlled drugs. It really doesn't make sense if you have drawn up a large volume relative to a tiny Budgie. But again, this is my preference. I'll give the mild sedative, and put them back in the incubator to relax. Then I come up with a plan. We want some diagnostics. What are we going to be able to realistically get for this patient? How big is it? Cockatiel or Cockatoo? Or a smaller Budgie? A lot of the differentials of the health of your avian patient can be divulged from the history alone. However, you may wish to get some imaging and blood work while the patient is in hospital and under sedation. Radiographs and a chemistry/CBC would be a good place to go to next. Even if everything comes back normal! Now you have a baseline for that patient. Some of these parrot species live 50 to 80 years! If you have offered diagnostics and the owner declines, at least you know you have tried. Someone once told me that you are only 33% responsible for the outcome of the pet's health. The owner takes 33% and then the pet takes 33%. It's not all that equally weighted, but it just means that you cannot take 100% of the responsibility of the outcome. Another mentor said to me, you cannot care more about the patient than the owner does. I know, it can be hard to go home knowing that you were not able to do everything that you knew you could for that patient. It's a tough gig and hard to live with sometimes, but you will get burnt out of this profession if you hold on to every case that you wish you could have done more. I digress, as I so often do!! OK, our work-up! My staff like to do the radiographs first, as they wish to take advantage of the hands-free radiology while the bird is the sleepiest. The sedative protocol I use works well when they are not stimulated, but they tend to wake up when stimulated. They will go back to sleep easily though so do not get frustrated if you feel like your sedation isn't working. You just will not be able to predict it like in your cat and dog patients. I learnt to do lateral and VD rads for birds using Micropore/clear medical tape while they were sedated. I also personally like to have the wings superimposed on the lateral view, but will stagger the pelvic limbs. This will be different if you are doing a check for fractures (we learnt to do a drop wing radiograph for these. Essentially the Cr-Cd view, but I won't go into details here). Once the x-rays are taken, we will collect the blood sample. Make sure you know what the laboratory needs for your blood sample. You may wish to contact your lab beforehand to ensure you have collected the blood in the correct manner. Ours likes two slides for a CBC with a hematocrit tube and a green top (I think the microtainers are 'mint top') with a gel separator for the chemistry and bile acids. No purple top tubes as the EDTA does something to the nucleated red blood cells for avian and reptilian blood. What that something is, I cannot recall, but it's something to do with the fragility of the cells. Either way, it is important to check with your lab before you collect the blood. As a rule of thumb, you can draw 1% of the body weight of your patient without disrupting the hemodynamics too much. That is 1 ml for every 100 grams of body weight. (It's actually 10% of the blood volume so it is a bit of a guestimation). See LaFeber's website for more information on how to collect from birds. As noted, sick patients also may not handle the blood draw as well as your stable patients. They may be dehydrated and cannot handle you taking more of their blood volume. Even if your mind wants to do the basic workup. You have to weigh those pros and cons. I like to draw from the jugular vein, but I like to hold the head and draw with the needle directed towards the heart (it's the opposite direction that most people use for cats and dogs). Again, everyone will have their personal preference, and mine comes from working with the exotics interns over the few years I was in veterinary school. One thing that I always have to remember, which I thought I would mention here is that you need to draw slowly, don't get too excited when you hit the vein and attempt to draw quickly. The needle is a small diameter and the vein is not as resilient as a mammalian vein. If you draw the plunger back too quickly you create too much suction and don't get the blood in the syringe. We can get some tiny patients in. The average Budgie patient is around 30 grams, that is 0.3 mL of blood. When you're used to drawing 3 mL from your dog and cat patients, this tiny amount seems like it isn't going to go a long way. There are pediatric microtainers that we can use for our small patients. However, when you look at what the minimum draw volume is for the gel separator heparinized tube, you need 400 uL (that's 0.4 mL). That is not all that helpful for a patient who is tiny! Depending on the length of your micro hematocrit tubes, you may be using 50-75 uL (0.05-0.075 mL) of your blood for the PCV, as well as a couple of drops for the slides. For Cockatiel patients and larger, you can safely draw enough blood to get your CBC and chemistry. You have done your work up, you got your x-rays and your blood sample. Use an external radiologist or avian specialist to help you read them! What you do next will depend on how stable the patient is. Does the bird need supportive care (fluid resuscitation, gavage feeding, injectable pain medications?) or is it stable that it can go home and be monitored at home while you wait for the results? That is where the art of veterinary medicine comes in, for all of our cases regardless of species. Just as with our cat and dog patients, we have to use some clinical judgement while we wait for our diagnostics to be run. This also comes from experience. There is nothing wrong with offering hospitalization (as long as you have the staff to support the pet overnight). If your feathered friend is fluffed up at the bottom of the cage and not responding to supportive care, you may have to have a heart-to-heart with the pet parent. Sometimes being realistic about the outcome is more valuable than getting all of the answers first.

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ABC’s of Vitamin Deficiencies: Vitamin C Deficiency

ABC’s of Vitamin Deficiencies: Vitamin C Deficiency

The poster child in the veterinary world for a Vitamin C deficiency is the guinea pig. The Caviidae family of rodents (also see the largest rodent a Capybara!) do not have the ability to synthesize Vitamin C in their bodies, like humans! This is because Vitamin C cannot be formulated in the body due to a lack of a specific enzyme (gulonolactone oxidase, if you're interested). Since I have been seeing a lot more exotic pets, I have seen a few clinical signs of Vitamin C deficiency in the guinea pig. You may see lameness and/or curly nails. Nasal discharge and dental issues, muscle wasting despite a chubby belly, poor digestion, necrotic penises. Just with every veterinary visit, a history of the animal's nutrition is important. I ensure that I check to see what the guinea pig is consuming. Not just what it is being offered! Inappetence, or a reduction in the amount of food that your guinea pig is eating, is a very non-specific clinical sign. It really could mean anything. The history you collect from your pet owner is going to be the ticket along with your physical exam. Guinea pig pellets are fortified with Vitamin C. But the Vitamin C degrades over time, so really, if your guinea pig doesn't consume that bag of pellets within 90 days, it's not good enough. The Oxbow Vitamin C chewable treat is 25 grams of Vitamin C. So if you have a 1 kg guinea pig, then one of these chews should suffice (if they are healthy and have no nutritional deficiency). For the ill guinea pig, or those that were deficient, they will need more vitamin C. As a rule of thumb, it is 10 mg/kg/day Vitamin C for a healthy adult guinea pig, and 30 mg/kg/day for a growing/young or pregnant/lactating guinea pig. Bump that up to 50 mg/kg/day for while they are ill. If your guinea pig does not enjoy the chewable treat, then ensuring there is enough vitamin C in their daily salad will be important. See this handout on the amount of Vitamin C in some food items that you can feed your guinea pig. BUT one thing to note is that you also do not want to feed a low of high oxalate vegetables to your guinea pig, as this can lead to calcium oxalate bladder stones. This is a good list of veggies and their oxalate content. Choose things that are lower on the list to feed your guinea pigs (cilantro, kale, pepper) and limit the amount of high oxalate foods (spinach, parsley, beet leaves). If you're not really interested in exotic species, then Vitamin C won't be that interesting for you, because dogs, cats, horses, cattle and pigs can all make Vitamin C. However, if you see a question on your board exam about guinea pigs, you may wish to remember this one.

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ABC’s of Vitamin Deficiencies: Vitamin D Deficiency

ABC’s of Vitamin Deficiencies: Vitamin D Deficiency

Some of the vitamin deficiencies are fairly straight-forward. Vitamin D is not the case. Most people in the northern hemisphere know that the further north you live, the less sunlight you get. Less sunlight is less UV light and UVB is responsible for converting inactive Vitamin D into a metabolite that can be used by the liver/kidney. We learn a lot about calcium homeostasis in vet school as calcium is extremely important in the normal function of the body. Vitamin D is required for this homeostasis as it increases calcium absorption from the gut. In short, a Vitamin D deficiency leads to a deficiency in calcium. When I think of Vitamin D deficiencies, I think of reptiles first. There is a condition called Metabolic Bone Disease, which is most commonly secondary nutritional hyperparathyroidism. Since Vitamin D is needed for calcium homeostasis, a deficiency in Vitamin D leads to a deficiency in calcium, because even if you are consuming calcium, you need the Vitamin D to absorb it from your diet. Reptiles that do not get Vitamin D3 in their food and/or do not have UV light exposure (that isn't blocked by glass), will be calcium deficient. Since calcium is required for bone structure, the deficiency in Vitamin D leads to osteoporosis, osteomalacia or fibrous osteodystrophy. Calcium is not just important in bone structure, it is important in the contraction of muscles as it regulates sodium channels in depolarization of the neurons and can cause paresis/paralysis of the limbs (something we see in sugar gliders - as an aside). For humans, a lot of dairy products are fortified with Vitamin D3 to prevent rickets (poor bone formation in children). Humans can get Vitamin D from conversion in the skin from direct exposure to UV light and from consumption in their diet. More on this later. If you're in second year veterinary school, you may be asked to write out the pathophysiology of this condition. If you're studying for board exams such as the NAVLE, if you get a case of a reptile with deformities, think of Vitamin D deficiency. In brief, when there is low Vitamin D, you get low calcium absorption from the gut, and this causes hypocalcemia. Hypocalcemia leads to an increase in parathyroid hormone release from the parathyroid glands. Parathyroid hormone signals to the bones to cause osteolysis by osteoclasts. Eventually there is not enough calcium in the bones to hold them together, causing deformities. Parathyroid hormone also signals to the kidneys to convert more Vitamin D into the active form (1,25-dihydroxycholecalciferol) signaling to absorb more calcium from the gut. Along with an effective hypocalcemia, a lot of the foods offered to reptiles are higher in phosphorus. Phosphorus binds with calcium, contributing to poor absorption of calcium from the gut. Another condition that is important in calcium and phosphorus regulation is chronic kidney disease, but I won't get into that here. You have to be careful with Vitamin D3 supplementation, as you can get the opposite, Vitamin D toxicity. Unlike Vitamin B's and C, Vitamin D is fat soluble and excreted from the liver into bile and out in the feces. If they patient is over-supplemented, the Vitamin D will contribute to mineralization of soft tissues. Have I confused you enough?? Ok, Vitamin D3 is the supplemental form of Vitamin D also called cholecalciferol. Cholecalciferol is not active in the body until it is converted by the liver to 25-hydroxycholecalciferol which is then converted to 1,25-dihydroxycholecalciferol by the kidneys - this is the active form of Vitamin D, in a nutshell. UV Light and Vitamin D So where does sunlight or UVB light come into play? There are species differences in the ability to convert pro-vitamin D into Vitamin D3 (cholecalciferol) in the epidermis (skin), which seems to be show that more carnivorous species get their Vitamin D3 through dietary intake, and the more herbivorous/omnivorous species getting it through UVB light conversion in the skin. In the skin of these herbivorous/omnivorous reptiles (adult bearded dragons and iguanas for example), the compound 7-dehydrocholesterol is converted to cholecalciferol (which is then converted as above). I told you it was complex. When the reptile hobbyist comes in and says, they have a UVB light therefore, they don't supplement Vitamin D3, check to see that the UVB lamp has been replaced often enough. The rule of thumb is to change the UVB bulb every 6 months. So if they say they change it when it burns out, that is not sufficient. Additionally, the mesh will block some of this UVB light, and glass/plastic/plexi blocks UV light. A few reptile breeders may have a UV light reader, while most reptile owners do not, so unless they are measuring the UV light at the spot where their reptile basks, it will be difficult to know how much UV exposure they are getting. Ideally, they are not using a material that blocks UVB between the lamp and the basking spot for their reptile, and that the reptile is both not too close and not too far from the UV light. A basking spot that is about 12 inches (1 foot) from the lamp is a good measurement. Greater than 18 inches is too far, and less than 6 inches can lead to UV burns (sunburn essentially). The bonus of using UVB light to convert Vitamin D is that excessive exposure will not lead to Vitamin D toxicity, so wherever possible, having a UV light for reptiles is ideal, even for the crepuscular/nocturnal species of reptiles. I have some folks say that the enclosure is close to a window, so they don't supplement UV light. However, windows are impermeable to UV light, and there is reduced metabolism of Vitamin D in the skin because of this. Air permeable mesh is probably the best option for containing your reptile, and allowing the UV light to access their basking spot in an amount that is ideal.

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Allergic skin disease in dogs

Allergic skin disease in dogs

I was looking up stay sutures this morning, but came across this quick and dirty summary of allergic skin disease management for dogs. We also call it atopic dermatitis, if you are looking for the medical terminology. It’s written by The Derm Vet, and if you aren’t aware of Dr. Ashley Bourgeois, check out her Instagram and podcast. As the article says, it is not a one size fits all treatment protocol for allergic skin disease in dogs. It can be one of the most frustrating things for pet owners because it is not always easy to manage, nor is it inexpensive. But when you get a dedicated owner it can be one of the most rewarding outcomes. My most memorable was an owner coming in for a QOL (quality of life) discussion asking me if she should put her dog down because he was suffering. Six months later the owner tells me I am the dog’s godmother. I saved his life. He was the saddest little white foo-foo with severe redness, lichenification and crusting from the tips of his toes to the hocks and elbows. He was bleeding in his skin folds. He just lay on the exam table while I scrubbed the crusts out from between his toes. We agreed to a short course of steroids because it was this or a dose of euthanyl. I managed to talk the owner into trying Cytopoint, despite its expensive price tag. Then the owner was diligent with shampooing daily. I love the Douxo Pyo products for the pro-ceramide in it. But also use the DermaChlor 4% chlorhexidine shampoo, and the DermaChlor conditioner spray for spot treating. The key is contact time. Everyone should know now in the days of COVID, you need to have the soap on your hands for a minimum amount of time to address any infectious organisms. The owners need to lather up those problem spots and then set a timer for 5 to 10 minutes before rinsing. Do not forget to dry them thoroughly! Yeast and bacteria love a warm moist environment! The last time I saw my ‘God son’ he was in a stroller, tail-wagging, coming in happily for his Cytopoint booster. He looked white and fluffy, no longer red and greasy. If you are a pet owner with an atopic dog. My sincerest condolences. You are not alone!! The key is to understand that it is multimodal therapy. To the veterinary students. The one thing that I need to say is… do not try one thing, and then tell the owner to come back if it doesn’t work. Start with multimodal therapy and wean down or off the ones that aren’t needed. 1) Control the itch. This is a vicious cycle. Itchy skin leads to the break down of a healthy skin barrier, more allergens, bacteria and yeast move and penetrate this barrier causing more cytokine release from inflammatory cells. More inflammation and itchy skin. Repeat. I have seen allergy tests for dogs where they are allergic to Malassezia, a yeast organism that naturally occurs on the skin. We need to break that itchiness pathway to give the skin time to heal. Even if you can get the owner to commit to a short course of Apoquel. Yes, there are other less expensive options. You just need to ensure that the owner is aware of the risks and side effects of your prescriptions. 2) Treat the infections. While you may want cytology to confirm infection, using topical 3-4% chlorhexidine is helpful for those crusting pyodermas. I like topicals if the owner can do it. Then I know I’m being diligent with my antimicrobial use. In severe cases, or cases where the owner just cannot bathe the tail crusting off their angry maltese cross, I have prescribed a first-generation cephalosporin. The last thing the dog needs is a multi-drug resistant bacteria. 3) Rule out fleas and mites. Even if you cannot see fleas, they may be allergic to the saliva in a fleas mouth. Skin scrape, cytology, treat accordingly. 4) Diet. I have clients fight me on this one. This is the hardest one for me to convince owners on. They have read on X forum that kibble is bad. They have read on such and such blog that raw is better. When I ask dog owners the reasoning behind their decision for raw #1 is allergies, #2 they thought it was healthier. The one thing that I can convince them on however is increasing the DHA/EPA content of what their dog consumes. Omega 3 fatty acids, fish oils (not flax) are both anti-inflammatory and help improve the phospholipid bilayer of the skin. It should be given at a higher dose than is provided in commercial dog food diets. The veterinary prescribed skin diets are meant to have these in higher levels. There are a lot of products out there. I usually use Eiocosaderm which comes with a convenient pump. I have seen a lot of recommendations on the Nordic Pet Omega product as well. Check for quality control. We want low heavy metals/mercury and toxins. You do want to check for concurrent food allergy. You cannot use a raw diet as an elimination diet, but you can use a home cooked elimination diet. Try looking at the recipes on BalanceIT.com go to the EZ balancer for vet patients and select skin conditions. Try a pork based diet as it seems to be one of the least allergenic proteins. The page should look like this… Just let the owners know that they will have to send your clinic a request for approval. Then you can log in, adjust the calories that the pet should be consuming, and approve the supplements. As always, the opinions in this blog are my own! I do not benefit from any of my product recommendations in this post. They are for your knowledge and for you to understand the wide array of treatment plans to address atopic dermatitis.

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ABC’s of Vitamin Deficiencies: B1 or Thiamine Deficiency

ABC’s of Vitamin Deficiencies: B1 or Thiamine Deficiency

Welcome back for this post in my series the ABC’s of vitamin deficiencies. There are a lot of Vitamin B’s. Today we’ll focus on Thiamine deficiency or Vitamin B1 deficiency. Again, I’ll be focusing on those food producing animals. It can happen in your cat and dog patients, but I have not seen it. I did see it in a dairy calf. Clinical signs in calves are neurologic, maybe ataxia (stumbling), opisthotonos (the head being craned backwards), head pressing, and blindness, leading to anorexia, severe dehydration, collapse and death if not treated quickly. Thiamine deficiency is one of the causes of polioencephalomalacia. Say that ten times fast! If diagnosed early, treatment with thiamine can reverse the signs. It is most common in young ruminants that do not have a well-developed rumen. They depend on thiamine in their food, not as in adult cattle where the rumen microbiome contributes to the thiamine needed for life. Bacterial organisms that have thiaminase can also cause thiamine deficiency if there is overgrowth in the rumen. Remember, vitamins are cofactors for enzymes. Ahhhh good ol’ biochemistry! I’m having flashbacks from my biochem course. It’s a tough subject. Regardless, it’s something that you should know for your board examinations. Oddly enough, I also remember, both during my zoo keeping days and in my vet school days, injecting thiamine paste into herring to feed to pelicans. Freezing, storing and thawing fish can cause a decrease in thiamine, so thiamine needs to be supplemented for piscivorous animals in captivity.

Back to calves, thiamine is a cofactor for many enzymes in cellular metabolism. Well, for all animals, not just calves. The bolded enzymes in the diagram require thiamine. If the enzyme pyruvate dehydrogenase is slowed due to a lack of cofactor then pyruvate cannot be converted to Acetyl CoA. This kicks in anaerobic metabolism creating lactate from pyruvate. An elevation in lactate leads to an increase in acidity of the blood taxing the acid-base balance of the body, eventually leading to cell death.
Fun. Thiamine deficiency is not just a matter of making sure your cattle get enough thiamine. You have to watch that the cattle are not consuming plants with thiaminase or high sulfur (Brassica), as this also affects thiamine absorption. Thiamine can be given by injection, or by oral drench. Calves with minimal signs may recover 100% within 48 hours. Water soluble B vitamins will get flushed out in the urine if you have too much thiamine, so unlike Vitamin A, you won’t overdose your patient on Vitamin B1. That’s it for now. Stay tuned for more ABC’s of Vitamin Deficiencies!

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ABC’s of Vitamin Deficiencies: B3 or Niacin Deficiency

ABC’s of Vitamin Deficiencies: B3 or Niacin Deficiency

A niacin deficiency can be caused by an amino acid deficiency, called tryptophan. Again, we’re talking about poultry, though chickens are less affected than turkeys, ducks and geese. Most supplemental feeds for poultry will have sufficient niacin (or tryptophan). Niacin is also converted to niacinamide. Niacinamide is used in part of the treatment for discoid lupus and lupoid conditions. I had a few cases of suspect lupoid onychodystrophy which I can maybe go into here. I say suspect, because it's based on clinical judgement. The diagnosis is made by histopathology - which requires amputation of P3. The cases were young dogs around the age of 4-5, that came in for "broken nails". Broken nails itself is not the issue, but how the nail looks and sloughs off with inflammatory exudate between the nail and the nail bed. It's more common than I expected and really reminds me of laminitis in horses. I tried to do a Google Scholar search once to see if there was any relationship between lupoid onychodystrophy and laminitis and there isn't much, other than they are both inflammatory conditions of the "nail". Maybe you know of a pathologist who can look into that for me?? Either way, I start those patients on high doses of EPA/DHA, niacinamide and possibly tetracycline/doxycycline. And sometimes pain medication. Back to chicks and ducks! The condition in chicks is called "black tongue" and it causes decreased egg production in hens. Here's a little blog post from a hatchery on niacin deficiency which has a few images for you to browse. The chickens and ducks may have issues with their hock joints where they will have splayed legs. There is also the PoultryDVM site for more information on chickens! Again, I don't have any personal stories about chicks or ducks to share, but niacin seems to be fairly easy to supplement for those poultry farmers. Also note that a chick with leg issues, may have differential diagnoses to think about!

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COVID-19: Cytokine Storms

COVID-19: Cytokine Storms

Last updated March 30, 2020: Cytokine Storms It's also good to note that both COVID-19 and the highly pathogenic influenza virus can cause a 'cytokine storm' (the immune cells, macrophages and neutrophils, releasing particles called cytokines to signal to other immune cells to come in to help). This is a hyper-response of the immune system. SARS-CoV also demonstrated immune hyperactivity. Edit: you can check out Dr. Rutland's insta for some more information in immunology. In veterinary medicine, we have a condition called SIRS (in humans it occurs too, but I have no personal knowledge from it). SIRS, severe inflammatory response syndrome, is essentially that, a cytokine storm. Call the neutrophils "storm troopers" coming in to battle guns blazing with their cytokines in the hundreds of thousands of numbers. It just means massive death and destruction of the infected cells, all at once, causing a gooey matrix. ARDS (acute respiratory distress syndrome) is what occurs in COVID-19. In this regard, treatment for COVID-19 should incorporate anti-viral medications to reduce viral replication, as well as anti-inflammatory measures to slow the hyper-responsiveness of the immune system. This is of course in addition to supportive care with IV fluid therapy, supplemental oxygen and maybe antibiotics to address any secondary bacterial infections. Anti-inflammatory medications including janus kinase inhibition or blocking of interleukin-6 receptors using monoclonal antibody therapy may be the chosen anti-inflammatory modalities, leaning away from corticosteroids. The anti-malaria medication, hydroxychloroquine, which also has been used in treatment for rheumatoid arthritis - another inflammatory condition, is seeing a wave into the treatment research for COVID-19, likely due to anti-inflammatory properties. Ultimately, like with most viral diseases, development of a vaccine will be proven to be the most effective measure of preventing infection. Also similar to most other viruses, there will be no one shot cure, only preventative measures (washing your hands after touching people or surfaces that other people have touched) and management of the disease if a person gets infected. If we can lower the R (number of infected individuals infecting other people), slowing the transmission rate, the curve will peak and start to drop. If you neglect to reduce your exposure, then the curve will continue to be exponential. So let’s try to do our part! For more on COVID-19 issues go to the In The News category

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How I Became a Veterinarian - Part 2

How I Became a Veterinarian - Part 2

I left off with 2008 - wow! That's 12 years ago?? Hey-zus! Anyway, in the spring of 2008 I took the leap and left the GV Zoo headed towards Calgary. I was determined to establish residency in Alberta. I didn't have any family or friends in Calgary, but I connected with the owner of the Calgary Aradia Fitness studio. I did a quick transition from working in the Vancouver and Cloverdale Aradia locations to working at the Calgary locations. Soon after my arrival in Calgary, I saw a job posting for a relief keeper at the Calgary Zoo (I think at the time they called them Zoo Labourers because they were employed with the City of Calgary and unionized). The gentlemen that interviewed me in Calgary said they were waiting for me - I suspect that word from GV Zoo traveled to them that I would be in the city, and perhaps looking for a new job. Between my part-time work as an instructor at Aradia Fitness and working summer hours as a zoo labourer I got by, so that by the time I was ready to go back to school I was settled into this new city. I made some friends in Calgary, while I don't chat with them often, I would consider them life-long friends. Both from Aradia and from the Calgary Zoo. In 2009, I started full-time schooling at the University of Calgary. I took courses towards a degree in Zoology, because I didn't want the school work to be going towards nothing. After my first midterm in Biochemistry I had a meltdown. It was a mini panic attack. Imagine blasting through a midterm exam that has two instructors, two booklets in 90 minutes. Each instructor wrote enough questions for that alone! I vaguely recall the count down when we had 15 minutes left. I hadn’t even started the next booklet! Yikes! So I flipped to questions I knew I could answer right away, tried to calm my brain from freaking out during the exam. The instructor called the clock. I look around, no one had left early, the guy in front of me hadn’t even started the second booklet. This was awful! How was I supposed to boost my grades for vet school when I couldn’t even complete a biochem midterm?! When I got outside that cold fall night I just bawled. I was so upset. I felt like I knew the material, but didn’t have time to finish! I immediately emailed the course coordinator in a panic. She was lovely. She said if I could wait until they had graded the exams and then meet with me afterwards. I ended up with an 86% on an exam I didn’t finish writing. That’s probably a problem in many classes where there are multiple instructors. Then, they are forced to bump the curve up a notch because they can’t have everyone fail. From Sept 2009 to April 2012 I was in Calgary completing another Bachelor of Science degree. I knew I was missing a prerequisite for the UCVM (Calgary vet school) which was an English class. I also knew that I needed a full course load of a minimum of 8 courses for the school year. This was all by the guidance of the UCVM admissions office. I couldn’t get into an English class that fit with the rest of my schedule until January. So I took 3 courses in the fall and 5 in the winter semester. Turns out that 3+5 is not the same as 4+4 (who knew?!) and my application got tossed aside. I was so frustrated that this small detail prevented me from getting an interview. I cried, again: But WCVM was willing to give me a chance! I got a second round interview for spring of 2010, my first vet school interview! Unfortunately I was so nervous with the interview and felt ill-prepared for it, I definitely cried during the interview. Well, the outcome is simple if you know basic arithmetic, knowing I graduated in 2016 from a four-year program. Anyway, I was determined, persistent and a bit crazy. I did some more volunteer work at a small animal clinic, as well as a hunter/jumper stable. I tried to contact some folks with cattle to get that experience, but no one replied. I fixed up my full time schooling to four classes per semester, and in 2011 I interviewed at BOTH schools. My mom was visiting during the week I had my UCVM interview. At the advice of the WCVM interviewers, who suggested I go for a run before to get out my energy so I wouldn’t be so nervous, I prepared myself by going to a yoga class the night before and got up early to get my sweat on by dancing around the living room. I felt much more relaxed going into the UCVM interview than my interview the previous year. So for any of you with up-coming vet school interviews, I would highly recommend to sweat it out before you go in! Read Part 1 of How I Became a Veterinarian

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Veterinary Student Blogs

Veterinary Student Blogs

These days, many veterinary students are turning to blogging, and I can see why! It's a journal. It's a way to feel like you can be accountable, to yourself, to your vet school family, and to aspiring veterinarians. Journaling daily is also therapeutic. If you read some of my blog posts, you can tell that some of it is ranting! Back in my youth, I didn't have a computer, but I had paper. I would write my thoughts down as a way to express myself. But a diary or journal is so personal! It is your own personal therapist. Blogging or Vlogging (the video form of a blog) is a way to public journal. An account of memories for yourself, but you also hope that what you put out there is going to be helpful for someone else! Not every veterinarian enters their profession with a passion to educate. But I love it! I may not be a talented writer, but I can say from my own self-observations that I can write a lot better than I can speak on video (see my YouTube for examples). I am going to compile a list of Veterinary Student Blogs. I'm hoping that one of these blogs will help future veterinarians. As time goes on, veterinarians will start feeling more distant from the future generations of veterinarians. Even now, I feel distant from the current millennial graduating class. Getting into veterinary school is more challenging than ever. The financial debt that veterinary students accumulate is astronomical. The debt to salary ratio upon graduation is equally so. Most veterinary students already know this, most clients do not. Applying to veterinary school should never be taken lightly, or done on a whim because you love animals. You need to be prepared for the mental stamina required to fulfill this dream. Please peruse the below links! I will try to keep updating the list as time goes on. I will make it numerical based on graduating year to try to keep it current, and alphabetical based on veterinary college so that it is not listed based on some subjective merit for good or bad. You can email or DM me on my Instagram page if you would know of a great blog that should be added to the list, or if I need to edit your information below. Please do not be offended if I haven't included you yet, as it will continue to evolve! I will include written blogs only, so please feel free to link your Vlogs or Instagrams to a written blog page. Thank-you! Veterinary Student Blogs Class of 2024 Class of 2023 Going to be a VMD - Grant G - University of Pennsylvania School of Veterinary Medicine, U.S.A. Chronically POTSitive - Jessica Hirsch - Cummings School of Veterinary Medicine at Tufts University, Massachusetts, U.S.A. Class of 2022 DogtorSoph - Sophie Chavez - Lincoln Memorial University College of Veterinary Medicine, Tennessee, U.S.A. XOXO, Cierra - Cierra Geyer - Midwestern University College of Veterinary Medicine, Arizona, U.S.A. DogtorLindsey - Lindsey - Purdue University College of Veterinary Medicine, Indiana, U.S.A. Class of 2021 Traveling Dogtor - Shelby - University of Georgia College of Veterinary Medicine, U.S.A. The Best is Vet to Come - Lindsey T - University of Illinois College of Veterinary Medicine, U.S.A. Exotic Pet Vet - Rachel Ellerd - Texas A&M College of Veterinary Medicine & Biomedical Sciences, U.S.A. The Sustainable Vet - Jaclyn Wilson - Western University of Health Sciences, College of Veterinary Medicine, California, U.S.A. Class of 2020 Life in Vet School - Lauren Pangburn (with Class of 2014 Sharon Ostermann) - University of California, Davis, School of Veterinary Medicine, U.S.A. Veterinary Adventures - Marlena Lopez - University of Melbourne, Australia (California, U.S.A. transplant) BellaVet - Rachel - Michigan State University College of Veterinary Medicine, U.S.A. Why do I want to be a Veterinarian? - Sabrina - Ross University School of Veterinary Medicine (Clinical at Kansas State University College of Veterinary Medicine), St. Kitts-Caribbean/U.S.A. Vet School Diaries/Diary of a Vet (Student) - Charlotte Harris - University of Edinburgh, The Royal (Dick) School of Veterinary Studies, Scotland Dr. Moore Student Vet - Trusten Moore - Western University of Health Sciences, College of Veterinary Medicine, California, U.S.A. Class of 2019 Beyond the Blue Coat - Paula Simons - University of Guelph, Ontario Veterinary College, Canada (Philadelphia, U.S.A. transplant) Class of 2018 Shannon Finn: Student Veterinarian - Shannon Finn - University of Guelph, Ontario Veterinary College, Canada Class of 2017 Life of a Vet Student - Brooke Schampers - James Cook University, Brisbane, Australia Class of 2016 How I Got Into Veterinary School - Diana - Ross University School of Veterinary Medicine (Clinical at ???), St. Kitts-Caribbean/U.S.A. Serena Vet 2016 (this blog) - Serena - University of Saskatchewan, Western College of Veterinary Medicine, Canada Class of 2015 Canadian Vet Student - K? - University of Guelph, Ontario Veterinary College, Canada the 4th Year of Vet School - Morgan - ???, U.S.A. Class of 2011 Cody Creelman, Cow Vet - Cody Creelman - University of Saskatchewan, Western College of Veterinary Medicine, Canada Class TBD Vet to Be - Benedicte Garmann - Norwegian Veterinary Student, Unknown Updated: July 2, 2020.

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