Goodbye and Hello!

Uhmm.. I didn't say, did I... why vet? As with all important great things in my life... it just happened! Of course, I always loved animals and wanted to have a little dog or kitty (or horse, lizard, panther, giraffe and many others), but becoming a vet never crossed my mind until 12th grade. And there I was, 12th grade, April or so - when all my colleagues had been preparing for a long time already for admission exams to university - refusing to take a decision that would affect the rest of my life. Then, because my mother insisted repeatedly, I bought the brochure with all Universities and I started cutting one by one all I thought I'd hate. I was left with architecture and vets, and architecture required good maths marks during high school (my average was around 5!)... so here I am!

I remember as if it were yesterday how it felt, the first day at the University, when right after the opening festivity I had to rush to get to the Histology lab; I didn't want to be late (as I was almost every day back in college years ;)) and as I was trying to find my way to the building situated in the opposite corner of the yard, I was thinking it seemed enormous and labyrinthic...

I also remember clearly how was the first lab exam (colocviu?) - anatomy - the bones! with Georgescu; a whole week of studying like crazy, determined not to miss a single exam and to be a model student... off course I failed! Almost all of us did.. that was the first from a long stream of deceptions.

Then better days followed, I started getting used to it, understand how it goes and what needs to be done to be all right.. but still I remember I couldn't wait for it to be over and done with, finish the faculty and escape from that sickening environment.

And then, in the very last day, right after the presentation of my work license, i was overwhelmed with a bunch of contradictory, surprising feelings: some sorrow that I didn't study more, that I didn't take advantage of all opportunities, that in my rush to finish faculty I didn't stop to enjoy it more, like I should have.. but also gratitude to my parents who supported me and kept me going so many years (..another 7!), and a huge gratitude for the Pathological Anatomy team of teachers, who helped and supported their students in a way I think no other teacher did (and a special big THANK YOU for Teo Soare who was absolutely great all the way!).




So I guess I bored you enough with this sentimental stuff, but I just felt I gotta let it all out so I can say GOOD BYE COLLEGE YEARS! and HELLO to what I hope will be an exciting great VET LIFE!
I'll get back to you soon with a brief from Great Little Britain,
Miss you all out there very much!
Irina

Memories

Ioana's loss brought back memories. And they were not great memories.

Memories from University. The famous Uni from Bucharest, where our horse vet chief surgeon, still preached about the benefits of firing horse tendons, when the rest of Europe had already banished it by law and classified it as animal cruelty.

The time when we were sneaking in as students trying to give a very dehydrated horse, lodged in the large animal hospital, more then the prescribed 1 L of IV fluids. One whole litre!!!

I could dig back dozens of such memories. I could also dig back the endless amount of unnecessary information, from the 60's if not sooner, that we had to memorize as students.

I could remember the times when I watched in amazement how, in the small animal clinic surgery, the reputed ortho surgeon repairs a fracture without gloves. "I can't feel the structures just the same with gloves" was the running excuse. Hello??? This is not like wearing a condom, optional! Performing surgical acts with sterile gloves on is mandatory nowadays!

Or speaking on his mobile during surgery, closes the phone and then goes back into surgery. For the next surgery, the same instruments were sprayed with alchool a few times, and reused again without blinking. And all these in the main teaching institution, that should set a good example to everybody else.

I used to feel guilty for not spending time in the university's clinics and see "practice". Another "rebel" vet colleague, who is probably abroad as well now, told me once "I don't want to hang around, just in case I get some bad habits". Too right!

Still, while a student, I never really comprehend the full extend of the lack of professionalism and diagnostic errors that occur in veterinary practice in Romania. I had a vague idea, thinking that even for the most reputed clinician, lacking lab tests, X-rays, cages to keep animals hospitalized, etc., life would be pretty impossible.

And then I finally graduated, and found an opportunity to work abroad in a vet practice abroad. It was in Cyprus, the influence was very British in the practice...and that's when everything started for me personally; it wasn't anything by any stretch of imagination extraordinary, just a regular small animal practice at European standards. I learned in the first year there more about small animal practice then in the whole years spent in the university. It wasn't easy, but before every new surgery I would see the next day, I got books at home and red in advance. And by books, I mean updated, large, reputed small animal textbooks,....not the leaflet i received in university as my small animal surgery book.

After a year and a half spent abroad, I decided to return and practice in Romania. That's when it hit me, the huge gap between what could be and what really is happening.

I watched my colleagues doing surgeries on half awake animals (full deep anesthesia is very dangerous). I watched everybody taking surgical instruments off the shelf, rinsing them in alcohol, if that much, and getting to surgery. I watched very simple and basic ideas of surgery being slayed, just as plain skin closure techniques, that in view of most Romanian vets, need to be done with the thickest suture available and as tight as possible "to hold well".

I also saw the other side, of being employed in a small animal practice and getting a salary of 400$ monthly...and sometimes not getting that at all.

I saw, in 2007!, 2 great value products being used on animals...tarantula venom that is meant to help in localising the abscesses, and moth ball powder sticked onto fresh wounds to keep parasites away. I saw many medieval concepts. I also saw it's a battle to change the old ways, and certainly, should I ever feel like changing the ways and opening a practice in Romania, it would have to be either on my own, or together with some other open minded other vets with some years of experience of practising abroad.

Because a sad reality is...Ioana speaks about referring the cases. Well, my sad Romanian conclusion is ...apart from 2 places I could think of where I would refer my animal in Romania, (and both of them away from Bucharest), all else is silence. One is a vet that moved out from Israel, and has a practice in Arad. The other one is our very own Ricky, that despite just having started the practice 6 months ago, is growing it into a nicely equipped practice, and compensates with his solid theory knowledge all else. They both lack something essential thou...a serious Romanian lab for accurate hormone dosing, biopsies, cultures. I mean, seriously. Where would you sent a thyroid panel in Romania?? And mostly, how many Romanian vets would see the necessity of the exam?

Anyway, sad but true, the romanian reality in vet medicine is very sad. I think there are some very big hearted people out there. But the lack of proper training, the "books are written from books" concept and the complete lack of basic equipment leads to some serious errors.... and I hardly see things changing anytime soon.

From the other end of Europe, which happens to be an island :)

It wasn't my graduation ceremony, but to me it was as important as mine... This moment seemed so far away 4 years ago when I met Irina while cleaning the stables of our rescued gipsy horses from the Uni. This moment seemed even further away 5 years ago, when I asked Ovidiu to help me clean up the poo of new-born mutts in a dog shelter. And here they are... They are no longer 'the kids'... They are finallyyyy, laaadiiies and gentlemeeeen, VETS!!!!


And straight after graduation Irina found the time to come and see me in old Britain before she starts the hard vetting life. Here we are :)



Nine days have flown by and now we have a few more things to remember when we'll be pensioneers :p Like...some long walks on the canal in the green county of Surrey, consulting on Saturday morning in a small brit veterinary surgery and clubbing in London on Saturday night near Picadilly Circus. And of course, the one morning that we spent together at the surgery where I regularly work, that was meant to be just the beginning of a whole week of work experience for Irina. This was brutally interrupted by a manager much too worried about 'insurance issues' and very determined to keep Irina away from any British animal or owner. After one afternoon of typical Romanian anger I reminded myself Dr Jeff Young's favourite saying, 'All British people are pussies!' and I reached the conclusion it was their loss anyway. Therefore, I went on by myself with our endless consults for bunnies and other little creatures and I encouraged Irina to explore London by herself. Which she did and which she'll tell you about very soon...

FOR ALL THE VET WANNABES OUT THERE!!

OK, so I have 2 things to write about, and I have no idea why the hell I am writing now, a bit more than 24 hours away from my private pilot exam, with about 1000 pg left to review. BUT I am in the same time excited and pissed off.

The single good thing that happened to me lately is that today I was accepted to the EAZWV Summer School. Ovidiu too. Of course the rest of the students accepted are either German, Swiss, or anyway German speaking. The courses will be in Germany. So more German…joy… not that is bad…I just wanted to hear some English for a change. Or French…French would be nice too.

Now for the pissed off part. I don’t know if I should write this in English or in Romanian, so that all the “language impaired” Romanian vets could read this.

My dog died last Sunday (Dona, for the ones who knew her), and it was mostly because of poor (or totally inexistent) medical training or professionalism. Partly because the owners (me included) reacted waaaaay to slow to the symptoms.

To make a long story short: at one moment or another (I was in Vienna and my parents couldn’t tell me exactly when) Dona started to show a mild apathy (my parents thought is was because of the heat). It continued to develop into moderate apathy and inapetence (?!nu stiu daca exista cuvantu in engleza), up to a point, after about 2 weeks or so, when the situation aggravated. I urged my parents to take her to a vet (suggesting to go to the faculty).

Well, they finally took her to a so called vet, recommended to them by an aunt. I have no idea what kind of clinical exam that vet performed, but the diagnosis was warm infestation and treatment was of course antihelmintics (don’t know which one…). Apparently, after that Dona eliminated some parasites (again, don’t know which kind or how many).

However, after a few more days, Dona’s state was getting worse. She stopped eating. No defecation, no drinking, no nothing. My mom tried to force feed her, but Dona vomited on the spot all that was given to her.

So they tried their luck to a second vet. This one had a more elaborate diagnosis: chronic bronchopneumonia. Injected her with some fluids and drugs (couldn't find out what they were)., and sent my folks home with the following treatment (please sit down while you read): PROPOLIS TINCTURE!!!! That was all...

Guess what... a few days passed and the dog got worse and worse. My folks went to the countryside, took Dona with them, and found a third vet in Ramnicu Valcea. The vet they found was a very well intentioned nice man, but his knowledge was a big zero. He is a 3^rd age formerly cattle vet, recently reoriented on small animals. He spent 4 hours examining her, searching and trying to understand what is wrong with her. But how?! Using med books dating back from the 60’s?! Reading on the medicine packages?! With only a stethoscope and a thermometer?! He dismissed from the start the possibility of doing some blood work, stating that he doesn’t trust blood analysis in animals (!!!!) He refused to place an IV line, allegedly because Dona had a heart problem and he was afraid that he would stress the heart even more, and the veins were too small anyway!! What he actually heard was the stress tachycardia she always had at the vet. But she was too weakened to react; she couldn’t even raise her head. So he injected her according to my father 8 times, out of which 2x20ml IM!! The treatment was purely symptomatic, and that is I think what kept her alive a few more hours till I arrived.

When I found out about this odyssey I literally rushed the 1100 km back to Romania (thank you, Adrian!), 2 days before schedule, and found her in a heart breaking state. I took her to Bucharest, and because it was Sunday, and there was nobody at the vet school (at it was 6 a.m. anyway), I took her home, made a quick exam (she was subfebrile, bradicardic, weak arrhythmic pulse, pale-slight cyanotic mucosa, severely dehydrated and some neurological symptoms: late pain reaction in her extremities, no support reflex in either feet). She still had some strength in her left and she wagged her tail. I placed 2 catheters (call me paranoid, but I learned that when shock is suspected or anticipated both fore feet should be catheterized). I had only some 5% glucose left in the house, until I went to the pharmacy to buy a whole list of drugs.

I asked myself what may have caused this all? I reached absolutely no conclusion. Heart was of course weakened, but still ok, lungs were indeed mittelgradig verschärft vesiculär (raluri umede moderate?!-> edema?), but all the symptoms were consistent with her not having eaten for 3 weeks. And the neuro symptoms? She had 5 kg instead of 7-8kg. What the hell caused that in the first place?! Poisoning? A chronic condition? Both??! She was actually developing signs of shock. So I came up with a treatment plan for the next day until I could get her to a real doctor. This involved all sorts of IV fluids (from ringer and glucose to dextran and HES. Ovidiu helped me with the doses and combinations. I even started considering finding a blood donor dog) + electrolytes and vitamins; ranitidine; minimum dose of furosemid or spironolactone and even a urinal catheter, because she had no urine output in days & renal function must have been a mess; I also wanted to use a human urinal catheter as a naso-gastric tube, for artificial feeding. This was the “support” part of the treatment. On VIN I found that in the case of septic patients is safest to use a combination Ampicillin+2^nd/3^rd generation cephalosporine (they’re plenty for human use). I found cefoxitine. As for an antiinflamatory I couldn’t find anything injectable at the pharmacies around me. I started making a quick check up with a chart with vital parameters every hour. I tried my best to make out of my bedroom an improvised ICU. I know, basic treatment. Nothing fancy. I didn't want to risk making any more damage. But is guess it should have been enough for one day, until we had access to some blood/urine tests, ultrasound or eventually Rx, to find out more and set a diagnostic…

After 1.5h on the glucose she seemed to be a bit more energetic (but it can be of course my sick mind after 30h of not sleeping trying to convince itself that Dona was going to live). After I returned from the pharmacy ready to start with the aforementioned treatment, she became more and more agitated. She developed abdominal spasms and eliminated a dark reddish-brown, viscous paste (fecals, blood, intestinal mucosa?...), with a putrid smell, and in great quantities for such a small dog. She relaxed immediately. For one more hour she just stood still, probably tired from the spasms. But she started having them again, this time not eliminating anything, and she died in my arms, without being able to do anything.

So, for all the Romanian vet wannabes out there: YOU ARE NOT DOING MEDICINE!! YOU JUST ARE PLAYING DOCTOR! BADLY!!

The lack of knowledge is unacceptable, and nobody should blame that on the lack of money, the fucked up university, the lack of equipment, or the stars in the sky. Good books actually DO exist, information IS really there, if you can spare some time to find it and learn it. Lives can actually be saved, and you don’t need some fancy equipment to make an assessment. And when you’re over your head, don’t send the owner home with some pills and pray that everything will be all right. REFER! There are other doctors who know what they are doing!! And YES! Modern medical technologies REALLY DO EXIST FOR ANIMALS TOO!! Nobody will ask a neighborhood vet to perform a phacoemulsification or a TPLO, but taking a shitty blood sample won’t kill you! Might kill the patient if you don’t!

I am so sorry there is no malpraxis law in Romania…

PS I know, I made a long story even longer.

[in work]

Costa Rica report

It’s a small country with treacherous, narrow roads, and with lovely people that don’t care much for road signs, but that will guide you gladly, in Spanish, to wherever you want to go. About 20% of the country surface is a national park, and rightfully so, as they host many microclimates, and rare species of plants and animals. Everything is hilly and abundantly green. There isn’t a single tree that is a separate entity, but rather a tree supporting a vast number of other epiphytes that cover a lot of it’s trunk. There are orchids, butterflies, monkeys and lots of birds. (I was expecting to see macaws flying like sparrows. I was wrong there….there are lots of them in the wild but not as abundant.)





It’s a very tourist friendly country, with lots of nice and reasonably priced accommodations.
Stranded between 2 oceans, there are lots of beaches. We weren’t very bothered with them. There are lots of beaches in the Caymans. Instead, I was keen to see the whole rest. The volcanoes for instance…they host Arenal volcano, that at about 1600 m high is the 3rd most active volcano in the world. The smoke that you notice around the peak it’s actually smoke coming from the crater.

Another feature of the volcano are the Tabacon thermal springs, which is a luxurious resort that combines the green of the jungle and the hot thermal water into a natural spa. Walking at night in the discreet lightened jungle park mix with lots of waterfalls and natural Jacuzzis while a misty rain was falling was an experience of a lifetime.

Talking about weather, the country is very close to the Ecuador, in july they are in full rainy season and there were a few hours of warm rain every day. It was dark at 6 pm every day, which made the starting hours very bright and early….also because there were so many things to see and time was, alas, far too limited.

The rain forest is an experience in itself, tall and dark, abundant, green and noisy. They came up with 2 eco friendly experiences for a better observation of the forest, and they are called canopy tours. One kind are a sort of suspended, fixed series of bridges, hanging at about 40-50 m at the forest level, which gives one the chance to see the tree tops, and the upper levels of the forest. The other sort is a zip line, and with a harness and a trolley, one makes his way around the forest from one platform to the other, in a Tarzan style. The zip lines can be stunningly long; I went across one of about 500 m, crossing an entire valley. It was the closest I ever got to flying, and it was pretty magical.
Normal hikes are also a must in the forests, but likely they have pretty organized trails in the forest,…that also makes eventual snake spotting very easy. I never saw one but in a snake garden, but it was good for my paranoia.

The cherry on the cake was the last hotel, for the last night, only a few km away from the aiport (we figured, rightly so, that it’s best to be as close as possible to the airport in a country where the Panamerican highway, road number 1, is a strip of asphalt with two lanes and no markings and the incidental pothole…not that I complain, knowing our own national Romanian roads, but..). So, the last hotel was reproducing a 17th century multi columns hacienda, with an inner patio and overlooking a coffee plantation.





All a bit too rushed, a bit condensed, but what memories, looking back! Back to work, back to the sick animal kingdom, and dreaming of future holidays. Nevertheless, Costa Rica does come highly recommended and I can only hope future roads will take me there again, as there are still many things to explore….