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The Small Animal Rotating Internship, Munich, 2014-2015 part 2





Our lovely team of 8 interns at the last day of internship

This has been an awesome year! I have a feeling that I learned so much and I became more self-confident as a vet. Working in Munich at the university clinic, the most challenging were night- and weekend-shifts while working on my own I learned to make decisions. Many times I faced a huge variety of conditions starting from simple gastro-intestinal problems, up to decompensated cardiac failures or animals in seizures. Many times I had to deal with many of those in the same time, learning the triage. Crazy hours including 24-hour shifts with no break, tones of seminars and trainings were absolutely rewarding and satisfying (but also tiring).During my time in internal medicine the most important thing I learned was the structured way of solving medical problems. It makes your life much easier! Starting from patients description, all the necessary data from signalment, through clinical exam, laboratory findings to the list of differential diagnoses. This oriented way of work saves a lot of time and money of your clients (before we fun more expensive investigations including endoskopy, biopsies etc).In anaesthesia and critical care I was able to anesthetize for many procedures but also take care of many critical patients (including sepsis, DIC, internal hemorrhages, tetanus and many others). I developed some interest in transfusion medicine as well.In neurology we mainly learned how to manage patients with seizures as an emergency but also long-term (including diagnostic imaging and drugs monitoring).My rotation in dermatology has been extremely usefull. I learned how frustrating these cases can be and how to avoid most common mistakes.In laboratory I went through hundreds of blood smears, urine sediments and other body fluids JIn cardiology we were trained to interpretate ECGs and basic echocardiography images.In surgery I was mainly interested in oncological surgeries, I have to admit that orthopedics is not my favourite topic...At the end I spent 6 weeks in my favourite oncology where I would do a complete work-up of the patient starting from imaging, FNA’s, biopsies and at the end treatment modalities including chemotherapy, surgery or radiation therapy. After a year full of work, I decided to further develop my interest in oncology and in October I moved to UK, where I have started working in Oncology Unit of the Animal Health trust. I hope to find some time in 2016 to update you about the new chapter of my life J

During the party celebrating our last day, we have spontaneously helped our colleague in CPR ;)





Bruno- my favourite and braviest patient, went through sepsis and DIC and thank to his great and dedicated family, he made it :) 























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The Small Animal Rotating Internship, Munich, 2014-2015























It has been a reeeeally long time since my last post, not without a reason. Let me update you a little bit with what I have been so busy in the last 6 months. During the last month of my stay at Vienna faculty I was informed that I got accepted for a Small Animal Rotating Internship at the faculty of Munich. It was just crazy! I have been to Munich just once before (when invited for a probe week of work) and would never think that it would become my new home for the next year. As they normally do not take candidates just after graduating, it was indicated in my case to go there month earlier to get some more training. That meant going directly from Vienna at the end of May. There was a little complication though :)
The intensity of work in the last year caused me an inguinal hernia which I did not want to operate at all (lack of time) but my mother insisted a lot that I fix it before going to Munich. So I had 3 days to get my surgery done and move everything from Vienna to Munich...so I did! With the help of God (and little support of Tramal) i made it safe to the Bavaria.
During my recovery next weeks I was getting familiar with the computer system of the clinic, with the standard procedures with clients when treating the patients etc. In order to obtain a license to be a Vet in Bavaria I had to submit tones of different documents (spending over 200 euro just to have them translated). I also had to do a special course about radiation protection in order to do the x-rays or radiation therapy (additional cost of 330 euro).  In the meantime I was learning intensively German or I just rather say Bavarian :)
July, 1 I became officially an Intern! This means a lot of hard work but on the other so much fun! Let me explain a bit how we work. 8 of us rotate through different services, including internal medicine, neurology, cardiology, oncology, emergency and critical care, anesthesia, surgery and dermatology. Each of us has to do certain amount of night shifts. That means being alone at the clinic, receiving all kinds of emergencies coming 24 hours a day. If the patient is stable enough to be sent home with the medications, we do a follow up in the next couple of days (or if they completely recover then never hear from them any more). If the patient requires being hospitalized he stays over night and in the morning the proper service takes care of him.
Apart from clinical work we have a lot of opportunities of training. I love attending journal clubs (chance to hear about some new treatment methods, studies outcomes) when also I can hear some personal experiences of our board-certified specialist in any field. Once a week one of them is discussing a different topic with us or we do cases. We also have cytologies rounds and some hands on practice like endoscopy workshops. I am absolutely amazed of the speed of learning that way which makes me really happy and satisfied about my job :) As a university clinic  I have chance to treat more complicated cases which makes it even more challenging.
If any of you is interested to follow up some papers we discuss or have some more complicated cases to work-up I am more than happy to hear from you,
Take care
Katarzyna Purzycka, DVM






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Graduation!


In May 2014 I officially became a DVM! Now a real fun begun :)








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Last months at the Veterinary Faculty in Vienna and ESVONC Congress

After finishing in anesthesia and critical care I moved to diagnostic imaging. A whole month of learning how to perform ultrasonographic examinations, interpreting xrays and a bit of MRI and CT. Great time, lovely people and a lot of practical experience, that is what I enjoy the most :) 

Po anestezjologii i intensywnej terapii przeszłam do diagnostyki obrazowej. Calutki miesiąc nauki przeprowadzania badania ultrasonograficznego, interpretowania zdjęć RTG i odrobina MRI i CT. Super czas, świetni ludzie, znakomici fachowcy i duuużo nabytej praktyki, to jest to co sprawia mi największą frajdę :)



Here performing a FNAB of a dog under sedation. It is important to suplement the animals with oxygen when giving propofol
Tutaj wykonujemy biopsje cienkoigłową pod kontrolą USG u psa w sedacji. Pamiętajcie o suplementowaniu pacjentów tlenem, gdy podajecie propofol







Every morning every case was discussed. Here a nice image of a TCC (Transicional cell carcinoma) in an urinary bladder.
Każdego ranka wszystkie przypadki były omawiane. Tu na przykład rak z komórek przejściowych pęcherza moczowego.



Another month was spent at the internal medicine and two following months at my favorite oncology :)
I learnt how to manage cancer patients, how to dose and apply chemotherapeutics, how to choose the best therapy between surgery, chemo or radiation.

Kolejny miesiąc spędziłam na internie, a dwa następne na ukochanej onkologii :) Nauczyłam się jak prowadzić pacjentów onkologicznych, jak dawkować i aplikować chemioterapeutyki, a co najważniejsze jak odpowiednio dobrać leczenie mając do dyspozycji najlepszych chirurgów, wszystkie możliwe leki oraz radioterapię.  


Here preparing doxorubicin: note special designed gloves for chemo, a special chamber protecting from drugs inhalation and special closed system for preparing and applying of the drugs.
Tutaj przygotowuje doksorubicynę, zwróćcie uwagę na specjalnie zaprojektowane rękawiczki do podawania chemii, wyciąg zapobiegający wdychaniu szkodliwych substancji oraz specjalny system zamknięty do nabierania i podawania chemii.




Here one of the coolest exotic patients, a 40-year-old parrot with squamous cell carcinoma. She underwent radiotherapy and showed much improvement.
Tutaj jeden z najfajniejszych egzotycznych pacjentów, 40 letnia papuga z rakiem płaskonabłonkowym. Poddana została radioterapii, co czasowo wstrzymało wzrost nowotworu


What a lovely final of my time in Vienna! The head of oncology department Professor Kleiter offered me to join the ESVONC Congress in Vienna and help to organize it. 3 days of lectures and great time with oncologist from around the world! 

Mój pobyt w Wiedniu miał cudowny finał! Szefowa Onkologii Profesor Kleiter zaoferowała mi udział w konferencji i pomoc w organizacji. I tak oto 3 ostatnie dni pobytu w Wiedniu spędziłam na wykładach wśród onkologów weterynaryjnych z całego świata!






After

Here is where we the lectures took place...
Tutaj odbywały się wykłady...



Good bye Vienna! I wanna thank Prof. Dupre for giving me opportunities of development, great anesthesia team, wonderful time with oncology team and to my beloved friends making this time even more special, see you soon!

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Two months at Anaesthesiology and Perioperative Intensive Care at Univeristy of Veterinary Medicine in Vienna








My Dears!
I have some awesome news- in one week I am travelling to Warsaw where I am going to officially become a Doctor of Veterinary Medicine! But that is not all, before I even officially finished my career one of my biggest dreams ever came true, I have been accepted for an internship at one of the best veterinary clinics in Europe- at the veterinary faculty of Munich!!! As we know internship is an essential step in a veterinary career to obtain a residency which so far is not available in Poland. Dreams really come true and I want to say to everyone not to ever lose the hope and work hard because impossible is nothing!
I wanted to tell you a bit about my time spent at the faculty of veterinary medicine in Vienna after I left surgery. I spent two truly awesome months at the division of anesthesiology and critical care. So far this has been the most intensive and productive time I ever spent at any place in the world! After just two days of some introduction and training I started to perform anesthesia by myself. My duties started with giving preanestethical examination, induction of anesthesia and I took care of my patients through the whole surgical procedures till they completely recovered.

Moi Drodzy!
Mam wspaniałe wieści- za tydzień wybieram się do Warszawy, aby oficjalnie odebrać dyplom z tytułem Lekarza Weterynarii! To jednak nie wszystko, zanim oficjalnie ukończyłam studia spełniło się jedno z największych moich marzeń i zostałam przyjęta na internship do jednej z najlepszych klinik w Europie- na wydziale weterynarii w Monachium!!! Internship jest to  specjalny program, który jest pierwszym obowiązkowym krokiem w karierze zawodowej w kierunku rezydentury, czyli specjalizacji z wybranej dziedziny weterynarii. Programy te póki co niedostępne są w Polsce (i zapewne długo nie będą), w całym kraju mamy jedynie jednego dyplomowanego specjalistę z neurologii… Jak widzicie marzenia się spełniają, nie wolno tracić wiary w siebie tylko bardzo ciężko pracować i na pewno zostanie się dostrzeżonym.
Chciałam Wam trochę przybliżyć jak wyglądały moje praktyki na wydziale weterynarii w Wiedniu po tym jak opuściłam chirurgię. Spędziłam dwa cudowne miesiące na anestezjologii oraz intensywnej terapii. To jak dotąd najbardziej intensywny i produktywny czas jaki było mi dane spędzić w jakimkolwiek miejscu na świecie! Po dwóch dniach intensywnego treningu i wprowadzenia, zaczęłam samodzielnie znieczulać pacjentów. Moja rola zaczynała się od badania wstępnego pacjenta, potem znieczulałam i prowadziłam pacjenta przez cały zabieg, aż do momentu jego wybudzenia. 



This has been the first patient I anesthetized and he successfully recovered

Oto pierwszy pacjent, którego samodzielnie znieczuliłam, po wybudzeniu


In a prep room working in team is very important, especially with big patients you always need some extra hands to help

W pomieszczeniu do przygotowywania pacjentów do zabiegów bardzo ważna jest praca zespołowa, szczególnie przy większych pacjentach 


While I am setting up all the monitors, my friend is already writting a protocol

Podczas gdy ja ustawiam cały monitoring pacjenta, koleżanka zaczyna już pisać protokół znieczulenia


This patient was going to receive TPLO, so we had to provide a really strong analgesia

Ten pacjent poddany zostanie zabiegowi TPLO, zatem moją rolą było zapewnienie bardzo silnej analgezji      



Heating lamp is a great solution to prevent any drop of temperature in anesthetized patient

Lampa grzewcza to świetne rozwiązanie zapobiegające hipotermii u znieczulanych pacjentów



My patient is already on the table

Tutaj mój pacjent znieczulony już na stole operacyjnym



In dental procedures (expecially in dental extractions) we used local blocks (mental and maxillar)

Przy zabiegach dentystycznych (szczególnie extrakcji zębów) stosowaliśmy miejscowe bloki (bródkowy oraz szczękowy)










Sometimes we had to anesthetized some exotic patients like this one

Czasami znieczulaliśmy bardziej nietypowych pacjentów


At the perioperative intensive care unit I also took part in some training at the special center designed for a practical education of veterinary students. With dr Alice Bennett (Diplomate in critical care) we practiced some basics of CPR.

Na oddziale intensywnej terapii poza opieką nad pacjentami brałam udział w róznych szkoleniach w specjalnie zaprojektowanym centrum naukowym przeznaczonym dla studentów, gdzie mogą oni rzeczy praktycznych, niezbędnych w przyszłym zawodzie. Z Alice Bennett (Dyplomowanym specjalistą w dziedzinie intensywnej terapii) ćwiczymy resuscytację krążeniowo-oddechową. 


















at ICU


One of the many brachycephalic patients with BAS after receiving a corrective surgery



Even though that is the last of the 20 Rules of Kirby TLC (tender loving care) is not less important than any other :)


Mimo, że jest ostatnią z 20tu Reguł Kirby TLC (ang. tender loving care) jest równie ważna jak pozostałe :) 




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