Week 13: ADF, Bill 1399 and SLO!
Another week in the books! This week started off with our second exam for the heme, lymph, and coagulation block. After the exam we had some lectures on platelets and learned how to assess them in a clinical setting. The afternoon consisted of two lectures; one on hemic neoplasia and the other on assessing bone marrow. I then had an awesome Zoom call with Dr. Natasha Lilly who I had met in SLO during my time at Cal Poly.
Dr. Lilly is an amazing veterinarian that has dedicated herself to finding ways of improving the health of animals through holistic methods. She is the co-founder of the Animal Diet Formulator, director and owner of the College of Integrative Veterinary Therapies, and UC Davis graduate! During the Zoom call she got me all set up on the Animal Diet Formulator software (which she made FREE for vet students!) and helped me formulate a diet from scratch that met all of Churro’s nutritional requirements and was only 9 ingredients! This diet was perfectly crafted to fit Churro’s needs and even had extra antioxidants because of his active lifestyle. It is way more personalized than any diet that I could ever buy on the shelves of a pet store, and she also made sure to make it accessible for a vet student, meaning it was not going to cost me an arm and a leg to make his food! It was awesome learning from someone with similar goals and I am super excited to continue to explore this side of veterinary medicine.
Tuesday started off with two lectures focused on assessing bone marrow followed by two lectures on hypersensitivities. The afternoon had a lab focused on platelets and how they function when the animal is in a diseased state.
Wednesday followed a similarly lecture-heavy flow with a lecture on blood groups followed by two on hemostasis and one on immunodeficiencies.
During lunch we had an awesome talk from Dr. Grant Miller who explained Bill 1399 that is scheduled to take effect in January 2024. This bill addresses Telehealth in a veterinary setting and would allow a veterinarian-client-patient relationship (VCPR) to be established remotely. This bill was initially met with a lot of opposition but slowly, and due to outside pressure and many amendments, the big players; the California Veterinary Medical Association, California Veterinary Medical Board, and the American Veterinary Medical Association began to take a more neutral position. Telehealth in veterinary medicine originally begin in Ontario where it appeared to be successful and this success began to cause curiosity in the states. There are already 5 states (Idaho, New Jersey, Vermont, Arizona, and Virginia) that are legally allowed to practice telemedicine and California will be joining them in January. As veterinarians, there are a few things that you should consider if you want to add telemedicine to your toolkit or practice.
1. The level of care is expected to remain the same meaning that veterinarians are held to the same standard whether they are seeing the pet in person, or online.
This is super important to consider especially since veterinarians use a multitude of senses while examining their patients. Smell, touch, taste, and hearing (specifically auscultation) are out of the picture while practicing through an online platform. Taking away these vital senses gives you limited options while doing a “physical exam” virtually.
2. Prescribing medications
Bill 1399 allows for antibiotics to be prescribed for up to two weeks while other medications can be prescribed for up to 6 months. Controlled drugs cannot be prescribed via telemedicine.
3. Practicing telemedicine is not a “get out of jail free” card.
Since veterinarians are still expected to be held to the same standard of care, using the excuse that the exam was done through telemedicine and was not an “actual” or “thorough” exam will not stand against board complaints.
With all that being said, I personally do not feel like I will be practicing telemedicine, especially straight out of vet school. While it may have been successful in human medicine, veterinary medicine is a different ballgame and should be looked at through a different lens. We cannot just call-in lab work for our pets because unlike on the human side, Quest and WestPac labs are not pulling blood on animals. It is also important to consider that telemedicine was deemed inappropriate to use in children under 2 with the main reason being that they cannot talk. If you think about it, all of a veterinarian’s patients are basically always “under two” and cannot communicate with us regarding what is wrong. There may be a time and place where telemedicine will be beneficial in a veterinary setting but it is important to understand the limitations and risks that can be associated with practicing this way.
Thursday started off with a lecture focused on assessing clotting disorders. It was very interesting to learn more about these testing modalities. I have done a lot of these tests in different clinics so it was great to understand exactly what we are testing and why we are testing it! The day continued with another team-based learning session on hypersensitivies followed by a lab on assessing hemic neoplasia. Churro and I then jumped into the car and headed down to San Luis Obispo for the weekend.
Friday started off with coaching the Cal Poly Master’s swim team. It was SO nice being able to swim with them all and run a workout. All their smiling faces bring me so much joy and it was the best way to start my long weekend in SLO. After practice I helped Dr. Jenn Staniec with a laceration repair. Jenn and I used to work together all the time during my time at Cal Poly so it was awesome to be back in the same setting! In addition to working together, we also did a lot of running and this weekend we had a half-marathon which was the main reason I was in SLO.
The rest of the day included Churro and Remi (Jenn’s dog) running around all afternoon and then the day finished off with a meeting with Gretchen. Gretchen was my incredible discipleship leader during my time at Cal Poly and to top it off, Gretchen’s pup, Booker, is also one of Churro’s BEST friends! It was so awesome to see them get so excited to see each other, they were both so bouncy and could not wait to play. They got ran around for about two hours while Gretchen and I got to catch up on life.
Saturday was filled with more SLO activities sprinkled in with some studying. Churro and I went to the beach and then Jenn and I went to pick up our race packets. The rest of the afternoon was filled with more studying and catching up with another awesome vet, Dr. Lyons! Dr. Lyons and I had worked together closely during undergrad and she was the main reason I was able to get so much awesome large animal experience! We went up to Cuesta Ridge for sunset and had an awesome time catching up on everything! That evening Jenn and I did an awesome stretching routine and got ready for the race.
Sunday morning began bright and early in downtown SLO and 13.1 miles later we were in Pismo! The race course was beautiful with ocean views and the weather couldn’t have been better! Jenn and I ran the whole race together and she absolutely KILLED IT, finishing right over two hours which was roughly 7 minutes faster than her goal time! It was so fun racing together, and I also saw a ton of other people I knew! Endurance races always reminds me just how awesome and capable our bodies are and I'm so grateful I have the ability to train and compete in them with such great people! After the race I packed up and headed back to Davis where the rest of the evening was filled with studying!
The whole weekend just reminded me how fortunate I am to have such amazing people in my life and it also reminded me of how important relationships are and putting in the effort to maintain these relationships is key. I think it is really easy to forget this or feel guilty for taking time to do things like this instead of study, especially while in vet school, but life doesn’t stop just because you’re in school and making time for the people you care about far more important! This can also apply to any phase of life you are in, there will ALWAYS be more… more things to study, more work to do, more emails to check, more things to learn, more [fill in the blank] and we can’t just wait to live life until these things are done because most of those things are cyclic never end! Balance is key and spending time doing things that fill you up absolutely necessary.
Quote of the week: “You have to trust me, I’m a doctor.” Dr. Vernau
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