clinical procedures

  • Attending to me when I walk into OR4: What are you doing here?
  • Me: I'm here to intubate!
  • Attending: Well how many have you done so far?
  • Me: Approximately.... zero...
  • Attending: Meh. Here's the Mac blade. Don't knock her teeth out.
Stages of Masters in Counseling


Theories of Counseling - Psychopathology - Ethics Courses

Pre-practicum - Clinic Procedures - Basic Counseling Skills




Comprehensive exams


Licensed Professional Counselors Board of Examiners is just like

After completing your hours for licensure

okay so! i’m married now! wow!

anonymous asked:

Hello! I was wondering if you've ever heard of organ transplants for dogs or cats; or any other animal really. My dog's been having breathing issues these past few weeks (no worries! He's been to the vet, diagnosed, and started treatment) and lungs have been on my mind. I suppose it would be hard to ethically source organs, since someone might try breeding specifically for that purpose... but would it be worse than breeding animals for food? Discuss please!

Not for lungs, because lung disease is relatively rare in small carnivores compared to humans, and the whole support system required to keep your patient alive at that point is a significant cost.

But kidney transplants for cats were developed. Approximately 30% of cats will develop kidney disease, and there are several genetic ones too. So there is a significant demand… and there are lots of unwanted cats in this country. I think one or two clinics were offering this procedure for a while, but I’m not actually sure if any of them still do.

The main difficulty we as veterinarians face with kidney transplants in cats is where do we get the kidneys.

Health and viral screening aside, selecting a ‘donor’ cat to harvest a kidney from is ethically dicey at best. I can can’t consent to giving up one of its kidneys, and removing a kidney from a currently healthy cat is not in the best interest of that cat.

So we have a few hypothetical options for selecting a donor cat.

  • Shelter cat which is harvested and euthanised.
  • Shelter cat which has one kidney harvested and then adopted by the recipient cat’s owner
  • Owner’s second pet cat donates kidney to it’s housemate.

There are some pros and cons to each of these.

Euthanising the shelter cat means there’s no after surgery care required for that cat. But, you have then actively shortened the life of that individual cat, by up to 18 years if it was a young cat, when that cat could have been adopted and lived a normal life. And this may only extend the life of the recipient cat by a couple of years.

If you’re going to force the recipient cat’s owner to adopt the donor cat, then you have to hope those cats will get along, hope the owner will actually keep the donor cat, provide after care for two cats and you have most probably shortened the donor cat’s life expectancy.

If there is already a second cat in the household that can donate a kidney, then you’ve still shortened the life of one cat to extend the life of the other.

You might think adopting the shelter cat looks like a good option, but you then prevent it from being adopted with both its kidneys, and the question we ask ourselves as a profession is why not just adopt the shelter cat as is, and let the kidney failure cat live its otherwise natural life.

Are the cats potentially worse off by veterinarians performing kidney transplants than if we don’t?

Quite possibly.

Because cats can’t consent, there’s not necessarily an easy answer for this conundrum. There’s a level of individual choice involved, but for many of us it’s a question of should we do this, more so than can we do this.

a final goodbye
we abandon the world for you,
I lack the capacity to describe
the sensation
of heavy feet on concrete
a world draining of colour
a grey sky for dread
the green drips off the trees,
red lipstick melts
like blood on ceramics.
Clinical procedure
it all tastes metallic
where are we?
our grasp on time has perished
a second too late is just too late-
when it’s between life and death.
running through scenarios
each one heart-breaking.
But we step back from the door
in fear of what’s behind it
we are asphyxiated
my throat tightens
hold on,
whilst I tell you
how much I need you.
—  if i told you, would you believe me?
Since everyone else has listed books for their field, I figured I'd share the vet tech-related titles on my shelf :)

• All Creatures Great and Small — James Herriot. This book has inspired generations of vets and vet techs! If you read any “pop culture” book on vet med, this is it! Treatments may have changed, but people certainly haven’t lol we’ve even got a client we refer to as “our version of Tricky Woo’s mom”!
• Tell Me Where It Hurts — Nick Trout. A glimpse into life at a very large veterinary emergency and referral hospital in New England.
• Disease: The Extraordinary Stories Behind History’s Deadliest Killers — Mary Dobson (Human focus, but many are zoonotic)
• Woodsong — Gary Paulsen.
• My Life in Dog Years — Gary Paulsen.
Paulsen isn’t veterinary focused, but he captures perfectly the bond between people and their dogs, both pets and working animals.

And for technical reference:
• Anatomy of Domestic Animals: Systemic and Regional Approach — Pasquini, Spurgeon, and Pasquini
• Applied Pharmacology for the Veterinary Technician — Boyce P. Wanamaker and Kathy Lockett Massey
• Cattle Health Handbook — Heather Smith Thomas
• Clinical Anatomy & Physiology for Veterinary Technicians — Thomas Colville and Joanna M. Bassert
• Clinical Laboratory Animal Medicine: an introduction — Karen Hrapkiewicz and Leticia Medina
• Clinical Textbook for Veterinary Technicians — Dennis M. McCurnin and Joanna M. Bassett
• Common Diseases of Companion Animals — Alice Summers
• Developmental Biology — Scott F. Gilbert
• Exotic Animal Medicine for the Veterinary Technician — Bonnie Ballard and Ryan Cheek
•Glossary of Agricultural Terms: English-Spanish/Spanish-English — US Peace Corps
• Large Animal Clinical Procedures for Veterinary Technicians — -Elizabeth A. Hanie
• Living with Chickens: Everything You Need to Know to Raise Your Own Backyard Flock — Jay Rossier
• Merck Veterinary Manual
• Microbiology — Joanne M. Willey, Linda M. Sherwood, Christopher J. Silverton
• National Audubon Society Field Guide to North American Mammals
• Restraint and Handling of Wild and Domestic Animals — Murray E. Fowler
• Saunders Comprehensive Veterinary Dictionary
• Small Animal Surgical Nursing: Skills and Concepts — Sara J. Busch
• Smithsonian Handbooks Birds of North America, Eastern Region
• Storey’s Guide to Raising  Rabbits — Bob Bennett
• Veterinary Anesthesia and Analgesia — Diane McKelvey and K. Wayne Hollingshead
• Veterinary Clinical Parasitology — Anne M. Zajac and Gary A. Conboy
• Veterinary Hematology: Atlas of Domestic Species — William J. Reagan, Teresa G. Sanders, and Dennis B. DeNicola
• Veterinary Technician’s Daily Reference Guide — Candyce M. Jack and Patricia M. Watson
• Where There is No Animal Doctor — Maureen Birmingham and Peter Quesenberry
• and a myriad of booklets (ex. “Quick Reference Tick Guide” by Bayer Animal Health, and “Pet Emergency Care: What to do When Emergencies Happen,” by Southpaws Veterinary Specialists and Emergency Center)

kisforkarol  asked:


There are so many embarrassing stories with cats. At some point every veterinarian will attempt to Spey a male cat. This is the story where that almost happened.

At my first clinic we would often do desexing for the local shelter, typically just before the lucky creature was adopted out.

Once upon a time, a lovely black cat was brought to us for a Spey. Midnight, as it was called,was going to be picked up by the adoptive family from our clinic once the procedure was done. Routine, basic, every day sort of thing.

Before knocking the cat out we had a lovely little cuddle on the treatment table, where he proceeded to lift his tail mid scratch, as cats often do when they’re enjoying themselves, to reveal two enormous testicles ripe for the picking.

Glad I had noticed this early, but concerned we may have the wrong cat, I phoned the shelter to check.
“Did you know Midnight is a boy?”
“Oh no, she’s definitely a girl.”
“… Nope, definitely a boy.”
“But she had kittens at the shelter!”
“… Then I hate to tell you this but I don’t think you sent us Midnight!”

As you would expect, the shelter quickly set about trying to find out how such a confusion should have happened, only to find no answers. As far as they could tell, the cat they had sent us was definitely Midnight. As far as his testicles were concerned, this was not the cat that gave birth at the shelter. Embarrassing on the shelter’s part.

I called the would-be adopters. I had to, there was a possibility that the shelter had misplaced their new cat. I explained the situation and they were perplexed as well.

I asked them to come down and conform whether the cat sitting in our hospital with nuts was the one they thought they had adopted. Fortunately they confirmed that Midnight was the right cat, even if he wasn’t the Midnight he was supposed to be, he was uneventfully castrated and went home.

I don’t know how the shelter managed to confuse a lactating queen with an intact tom (the smell alone!) but they were certainly embarrassed.

anonymous asked:

Fun fact that your latest reblog reminded me off: when i was leaving bpas (uk clinic) after having my procedure I got screamed at by a catholic women and had graphic images shoved in my face, I just told her "too late" and walked off, I have never felt more powerful than taking her anger and just ignoring it.

ohh my god that’s hilarious. If I ever got an abortion I’d do the same thing.

Portfolio is the bane of many junior doctors’ lives. And every year the goalposts get moved.

For example, last year, CMT1s (first year Physician trainees) were expected to attend 12 clinic to pass their ARCP. This year’s intake now have to attend 20 clinics in one year. We have 120 competencies to provide evidence for over the next 2 years, and many of my friends have found themselves having to come in on their days off just to achieve this, lest they be given a poor outcome at ARCP.

If you find yourself plagued by portfolio, with insufficient opportunities for clinics and procedures, then please reply to this survey.


Don’t tell me you used a body double with Ygritte!
[Laughs] No, not with her. Mainly, early on, when my foot was still bad, for the wide shots, when there were running scenes. But apart from that, I could do everything. And that was a lovely scene to film, with Rose Leslie. It’s one of the rare moments in the series where you get quite a tender, happy moment between two people. We were looking forward to filming it, because it was so beautifully written, and then when we did it, it’s so beautifully lit. I enjoyed it a lot, and it wasn’t too awkward. I think Jon’s the only one on the show who hasn’t had sex yet, it seems to be, so that was nice. You’re rooting for him to finally, for want of a better word, get laid. So it was good to get that on the show, as it was.

How did you prep it beforehand?
Rose and I had some spooning practice in the second season, with that scene on the top of the cliff. And you obviously talk it through beforehand. But it’s also a very clinical procedure, you know? It’s very strange. I’ve never done a love scene before, and especially a nude scene, so it’s very strange being naked in front of a hundred or so people. So we obviously rehearsed it a few times — fully clothed, mind you! But this wasn’t sex for manipulation. There were no power games going on. And it’s not just lost. It’s a love scene, and I think that’s important to identify, for this show. There are very few love scenes [on Game of Thrones], so we wanted to do it justice. It was important that we didn’t screw it up. Hopefully it worked. - Kit Harington 2013

The Little Mermaid MBTI

ISFP [The Artist]

The ISFP is the astute observer of life, quiet, introspective and kindly. Harmony and respectfulness of values are so important to them. And although trust takes quite some time to establish, once it has been, the ISFP will be a solid and dependable friend. Yes it will take some time to really get to know the inner values of an ISFP but the reward will be a friend for life, a friend who will proactively anticipate problems and support others. Quiet supporters, rarely will an ISFP be the leader, preferring to remain behind the scenes, observing, understanding, but saying very little. There is a stubborn side to the ISFP, but this is more of a passive stubbornness, meaning the person may say ‘yes,’ but mean 'no.’ Their gentleness and thoughtfulness means that the ISFP can be an excellent mediator in the team, seeking good things and building harmony.

ENFP [The Champion]

The ENFP is the heady individual, creative, quick, impulsive who will get up in the morning thinking of how many possibilities the day may bring. They are excellent at devising new ways of doing things, and bring a totally unique and fresh perspective to people, projects and situations. People-centred, caring and spontaneous, the ENFP will be excellent at getting things started and they’ll do so with energy, enthusiasm and zeal. The ENFP cannot help but see possibilities. Future oriented they will look far beyond the obvious often seeing things that others fail to. They are driven by the new, the complex, the novel and have an insatiable curiosity making them mercurial, fresh and enthusiastic. Friendly with endless energy the ENFP will be at the heart of where the people are, loving fun and a good drama. Unconstrained by rules, regulations or strictures the ENFP will be expedient in their search for what pushes their buttons and every day is a big adventure.

ENFJ [The Teacher]

The ENFJ has high drive, bundles of energy and a commitment to ‘the cause,’ (whatever that cause is) which borders on the evangelical. Their energy levels increase the more functions they have to attend, the more people they have to meet and the more activities they have to organise. They can juggle masses of activities and tasks at any one time, rarely dropping the ball and making sure each activity is given the right amount of attention and loving care. This desire to ‘get it done’ can at times mean that the ENFJ becomes inflexible and a ‘controlling parent’ in their desire to ‘finish what we’ve started.’ Under such pressure they can lose their sense of balance and perspective but will ultimately bounce back because that is just what the ENFJ is built for. They have an innate sense of what is required and can genuinely make others feel really special. They can generally be found at the emotional heart of a group or body and will be the one making sure things get done.

ENTP [The Originator]

Engaging, plausible and entertaining the ENTP is very closely attuned to their surroundings and constantly on the lookout for opportunities and possibilities, which will feed their strong desire for something new. An ENTP will be like a breath of fresh air, infusing people and projects with a whole array of new ideas and creative ways of doing things. However, they can become bored and withdraw their energies as they go off in search of the next 'fix.’ They are of the moment and are great at creating momentum for anything new. However they may become bored after the initial fascination has passed. ENTPs love telling conceptual stories. They will often go off at tangents, weaving apparently contrary pieces of information into a conceptual whole, bringing others in and teaching them in the process.

ISFJ [The Defender]

The ISFJ is the quiet, shy, gentle individual yet a behind-the-scenes mover and shaker who will not seek the glory, indeed would prefer to remain understated, needing only stroking from those they trust and value. Loyal, shy, devoted to the cause, the ISFJ has an intense need to belong and will work tirelessly for the cause and will channel their considerable energies into their work, or indeed anything which has been asked of them. Although generally shy and reserved the ISFJ takes work, indeed anything they do, seriously and much prefer it when others do the same. They are caring, sympathetic and want to help, but do not need the kudos, indeed they may be suspicious of those who try to confer compliments on them especially in the early stages of a relationship.

ESTJ [The Guardian]

Formal and structured the ESTJ works best when everyone is clear as to the ground-rules, (the ESTJ will happily create them if they are lacking!), and they tend to be better at maintaining the status quo squeezing more out of the existing processes rather than radically recreating new ones. Factual, accurate, detailed and process driven the ESTJ will bring order, structure and focus to their environment. This can mean the ESTJ will be traditional and often quite conservative in their approach, preferring the known to experimenting or trying a more novel, creative approach. Thus the ESTJ may not always adapt well to change (unless they are doing the changing!), and indeed if pushed hard can make formidable opponents to any new order. For the ESTJ change must make logical sense and ‘if it ain’t broke then why fix it?’ Emotional arguments or pleading won’t work as only hard facts and logical reasoning ‘compute’ with the ESTJ.

ISTJ [The Duty-Fulfiller]

Logical, detached and detailed, ISTJs pride themselves on their store of data and knowledge, all arrived at with clinical procedure and experience. They take great care not to get it wrong and like everyone to take responsibility for their actions - and their mistakes. Serious-minded, individualistic and thorough, the ISTJ may focus so much on the task that they forget the needs of others - including themselves. ISTJs like to plan, schedule and drive through to completion, in a logical linear sequence. Any deviation from the plan would be questioned and may take some convincing of its merits. An ISTJ can be trusted to complete, to work hard and play by the rules. However they may not always articulate how they are feeling or even how things are progressing. The ISTJ plans the work and works the plan, so why should there be any need for up-dates!

Descriptions from Prelude Character Analysis.


Filling That Hole in Your Heart

Repairing defects and ruptures deep inside the body may have just gotten a whole lot less invasive. Up until now, fixing damaged cardiac tissue, ulcers, hernias and holes in other places within patients has meant serious surgery and sutures to bring tissue together so it can repair itself.

But researchers have unveiled a new, much less invasive procedure that harnesses a catheter equipped with inflatable balloons and ultraviolet-light-activated, biodegradable adhesive patches.

A team from Boston Children’s Hospital, Harvard and Brigham and Women’s Hospital catheter has successfully used the device in animals to repair holes in organs without needing to resort to risky major surgery and stitches that can erode tissue over time. Learn more and see the device deployed on actual ruptured heart tissue below.

Keep reading


30th November 2017

Today I went back to work after 6 weeks off, I was put on light stuff but even that was hurting my chest. I made sure I didn’t push myself and only did what I could.

Yesterday I went for my first CBT appointment and I was surprised with how nice the woman was, we talked about my self esteem and anxiety, my thoughts and feelings and my past. Overall it went good and I hope this helps me become less negative and calm my emotions down a little.

On the 27th November I went to the gender clinic and spoke about my surgery and how I feel now and any life updates and CBT. Then we spoke about Futher surgeries and what I would like and the different procedures and clinics that do them surgeries. I hope to get referred to get a hysterectomy next year sometime once my chest has healed more and I’m ready to get cut open again.

My chest is bothering me very slightly lately just because I feel like my left side is more bigger than the other side and I am hoping in the end they both look the same shape. The puckering is slightly annoying also but again I’m sure it will just take time. I am happy with my chest don’t get me wrong, I guess I’m just over analysing it. What I have to keep in mind is that everyone’s chest is different and healing takes time.

That’s all I have for now :)


« Rose and I had some spooning practice in the second season, with that scene on the top of the cliff. And you obviously talk it through beforehand. But it’s also a very clinical procedure, you know? It’s very strange. I’ve never done a love scene before, and especially a nude scene, so it’s very strange being naked in front of a hundred or so people. So we obviously rehearsed it a few times — fully clothed, mind you! But this wasn’t sex for manipulation. There are very few love scenes [on Game of Thrones], so we wanted to do it justice. It was important that we didn’t screw it up. Hopefully it worked. » 

Things I’ve Learned and Said During my First Week in my Vet Med Externship

Things I’ve learned: 

- Being a fast surgeon doesn’t mean anything if you have sloppy knots and your patient bleeds to death. Focus on being meticulous and accurate before you even begin to worry about speed. It will come with time.

- Your first time doing anything has the potential to be awkward, slow, or a disaster. Keep your head up and focus on what you can do to improve. 

- Sometimes, the best gift you can give a suffering animal really is euthanasia. 

- Half of the battle of being good at something is showing up with a good attitude. The logistics of whatever you are trying to do (whether it be surgery, a clinical procedure, knowing the in and outs of the pharmacodynamics of a particular drug, etc), will happen in time. 

Things I’ve said:

-“Oh my gosh look how adorable these little ovaries are!”

- “Did I just step in…?… you know what, I don’t want to know.”

- “Heart rate: 30 purrs per minute." 

- "I’m sorry I stole your manhood this morning. Can you ever forgive me?” *gets licked in the face* “I’m going to take that as a yes.”


“Trust God” aka potentially die. No wonder the clinic wouldn’t do the procedure. I hope she gets help from an actual doctor and not these people.

If she dies because of this pregnancy, make no mistake, these people who have harassed her and annoyed her through text message played a part.

These screenshots were taken from a public Facebook.

Re: First Mission trips

For ermedicine.
My phone keeps eating the reblog, so I’m giving it a try this way.

Yay medical missions! I’ve never been to Haiti which is surprising because it’s like THE place people go for medical trips (or Guatemala. Don’t get me started on how there are like 150 other countries in the world who need help…anyway YAY helping people!)
Ok, let me go back in my brain to my
first trip…

First off, is this gonna be a mobile clinic situation or a hospital situation? I’m going to assume mobile clinic since they’re more common, especially in Haiti.

With your current super-secret work experience you should be a lot more prepared than I was for my first. You already have a good understanding of triage and patient care that I didn’t have.

You can be of use in a ton of ways:
- counting/sorting drugs to be given out
- taking vitals and triaging, which would include mingling among the masses of people waiting to be seen and moving the sickest looking ones to the front.
- learning, if you haven’t already, injections, phlebotomy, and lab techniques if you have a lab component to your clinic
- Assisting in minor procedures or even doing them if you catch on quickly (as a high school student, I was the earwax guru on my first trip- you’d be amazed how many bugs I’ve pulled out of ears)
- monitoring patients who may be in the clinic for a long time getting IV fluids or antibiotics or such
- assisting in fitting eyeglasses if this will be a component of your trip
- teaching the patients who are waiting to be seen about various health topics. Find out what problems are common in the area you will be visiting and prepare a few short 10 minute talks or skits on an elementary level. You will need the cooperation of a translator for this. You can use the translator as a narrator to tell a story that you (and others) will act out to help educate the people there on treatment and prevention of common problems. Have hilarious props and visual aids.
- keeping kids occupied. Every trip I’ve been on with mobile clinics had designated childcare folks to help keep kids from wreaking havoc on the clinic. You can educate them too with skits or puppets (who doesn’t love puppets) or simple crafts. We actually gave out kids toothbrushes on one trip and taught kids a tooth brushing song to help them learn oral hygiene.
- shadowing docs and taking patient histories
- if you don’t have anything to do, ask everyone if they need assistance. Always ask if you can assist on procedures too.

Things you should expect:
- total chaos and lack of organization
- heat, sweat, smells, and exhaustion
- you will see lots of problems your clinic is not equipped to handle
- large masses of people, some of whom you may have to turn away
- the necessity of changing plans frequently. Be fluid and go with the flow.
- at least 1 flat tire
- a mix of emotions ranging from culture shock, sadness about the state of poverty some of your patients will be in, joy from getting to help people, frustration with the language barrier, exhaustion, and excitement.

Things you should remember:
- your patients overseas deserve to be treated with the same respect as your patients back home
- cultural differences may get in the way of your perfect plan for fixing the nation. This is totally okay.
- local people are not Instagram selfie props
- eat the unidentifiable food. It is delicious.
- this is not a vacation. Work hard, but enjoy yourself too.

A note of clarificarion

If someone comes into the clinic and they even suspect that they want to keep the pregnancy? They won’t do the procedure. Clinic counselors will have the client come back the next day to make sure. Also if the counselor thinks they are being coerced? They won’t do the procedure. I know, because I’ve seen it. I’ve also been a client. They are very serious about making sure this is what you want.