And Step 2.



Step 2 is this Friday! Helloooooo M4 year. Amongst my bulletin board full of notes on the differential diagnosis of hyponatremia and renal cell metabolism, you will see a tiny glimmer of horse.. Cindy Ishoy is coming back to our barn this weekend and I somewhat rashly decided to ride in the clinic (9 hours of Step 2 test on Friday.. clinic Saturday and Sunday.. start sub-internship in the NICU on Monday.. what could go wrong?)

 

 

That's really all the news I've got. Study x all day x repeat every day. Good stuff!

 



The field on the way to the barn has baby cows. I luff them.

 All the boys are doing well.

Scheduling anxiety

I decided to sign up for a twice weekly exercise class, which will start tomorrow evening.

I think a good chunk of my anxiety is due to my now well ingrained tendency to obsessively guard any free time for studying. (MUST STUDY ALL THE THINGS)  But another good chunk of this worry is due to the slow but steadily progressive atrophy of any muscle and good exercise habits over the last several years of medical school (again with the study all the things..).

I have been riding fairly regularly in lessons this spring and am getting ready for a clinic this May. Fear really is excellent motivation...

As we start to work on more fun (and difficult) things I really need to have my end together to expect Teddy to be able to work effectively. If I'm asking him to carry himself well around a 10m circle in the canter I can't be flopping down or collapsing my hip. I am struggling to keep my core engaged and stay stretched up tall, especially when Teddy is struggling too and tries to throw all of his considerably proportioned neck into my arms. Trainer tells me I need to kick on and send him up and out of my hands-- I get this in theory, but right now I honestly just am not strong enough to do this well (I get pulled down from my arms then can't keep my core engaged then can't have a long light leg... it's not pretty!)

 

 

Poor little fattie.

  

Out on one of our conditioning hacks

 

 

Ol says Happy Easter!

Power differentials

A sarcastic "fun" nurse I met recently calls me Maggie. That's not anywhere close to my real name, she says she gives nicknames to all the students. I spent a lot of time trying to decide if asking her to call my by my actual name demonstrates respect for myself, or if asking her to do this means I can't work easily with people / am not a team player.

Solution: I sing this song to myself and walk away.

Dear future self:

I need to remember what it's like to be a medical student when I finally finish my training, the attendings really must not remember. It is so exhausting, physically, mentally, and emotionally, to constantly be the member of your team that is lowest in social standing, intelligence, and ability. I'm rotating through specialty clinics, and man is it humbling.

Notes to future me, Part 1:

1. Your medical students Do. Not. Care. about your fancy personal hobbies or your adorable shnuckum offspring. However, because you are responsible for our grades we will agonizingly pretend to, despite having 3 notes left to finish from this morning's clinic (knowing it means we'll be staying till 7 or 8 that evening, while you trot off at 5pm to co-sign our notes at your leisure)... AHHH stop it already! Also stop. Also I'm not sad that you are having difficulty finding good storage facilities for your boat.

2. Stop interrupting my presentations every other sentence. I have trouble keeping track of the 50 things a patient has just thrown at me in a completely disorganized fashion and have worked hard to present in a logical and clear way.

3. Remember all the completely dumb dumb dumb stuff you said when you were a 3rd year. Then remember how awful you felt for the rest of the day agonizing over it.

4. Your med student is not impressed by standoff-ish arrogant attitudes. We don't think you are smart because you intimidate people. News: I've worked with a bunch of really brilliant physician teachers by this point in my training, and I have worked with doctors I respect and want to be like who are super nice to me. You being a jerk just makes me hate you.

Doing work.



Long list of things to do today:

So far, one has been checked off, to the displeasure of Oliver (he hates the rain).

 

 

So close, and yet so far..

Bright light

 

In an otherwise rather dreary existence. Currently on the renal consult service.

Here is the lovely Teddy (referred to as 'Hank' in previous posts) in a Cindy Ishoy clinic held at our barn last week.  As you can see we're working a lot on basics, trying to maintain a steady contact, transitions, accuracy of figures, etc.  All good things.

Our canter work leaves much to be desired, some of this is fitness (as evidenced by his belly). I ride once a week (more if at all possible, but rarely possible), and his rides w other lessoner's are mostly WT and if canter not any kind of collected 'non-nose sticking way out' kind.

 

 

Things to work on (there are lots, here are 3):

1. Shoulders back!  I feel like they're rolled back, but in seeing the video they really look slouchy.

2. Hands down. I tend to carry them a little too high above the withers.

3. Accuracy of figures, all the time.  Cindy's quote "make the figures do the work"

 



Week 2 of my surgical rotation down, I feel like an idiot I'd say 95% of the time - it's super. I actually am enjoying my time in the OR, I like the procedures and when I'm standing in there I really don't feel the hours ticking by, but as soon as you stop holding a retractor or step away from the table you realize WOW that was really cramping my hand or yep my legs are exhausted or hungry hungry hungry please let me eat (or sleep, sleep would be good too)..

I'm also on edge all the time; attendings ask questions at any moment. I'm at the hospital from 4:30am- 6-8 pm (which apparently isn't that bad for surgery rotations) so study time is limited, I'll try to read up on whatever procedure I'm going in for and scan as much as the patients' charts as I can before going in, but inevitably whatever I've managed to read is Not what they decide to ask. 

As always, Sucks to suck.

So crescent rolls might taste good...

"But if you have them in your kidneys, you're gonna die!  - insert maniacal laugh - "  ~ Dr. Edward Goljan
(his voice haunts my dreams)
(he has a board review audio series)

Studying for boards this semester has been .. draining.  My last final is Monday morning, after which I'll have roughly 4 weeks of dedicated study time before the biggest exam of my life.  Naturally, I have Excel and Calendar plotted this time out, with each day accounted for including a Daily Schedule dictating my hours 7am-10:30pm.  Step 1 scores are one of the largest determining factors in our residency applications.  I'm not handling the stress excellently, I would say.

Yes, I included motivational quotes for myself on my study schedule.  Don't judge.

I really hope I have the fortitude to stick this schedule out for 4 weeks.  I'd like to believe I can do this, and part of this blog is me posting my goals and plans hoping I'll live up to them.  So, future Rachael you better stick to this schedule and rock your boards.  No excuses.  Quitting is for pansies.

Out of shape

Riding shape, that is (lets not talk about any other kind of shape, ok??).  Last weekend I was able to ride Fri, Sat, and Sun - it was heaven.  However, my muscles were decidedly not so blissful, particularly my right peroneus longus.  On Saturday I was riding the friend's trainer's retired grand prix horse and our lesson was quite long and tough.  My right ankle started giving me some serious pains and it really felt like it was just going to shatter.  I finally had to ask to take a break by taking my feet out of the stirrups (I was quite embarrassed, I'm not the type to give in to pain, but it was at the point where it was a real stability issue and I was worried about damaging a joint).  Feet out of the stirrups helped relieve that pain, but it made me more aware of my burning muscles everywhere Else that were being worked by this horses' awesomely big trot, now without stirrups!  Needless to say, I had some recovery in order over the week.

I pulled out my trusty Netters and between that and some avid UpToDate reading determined I must have strained my peroneus longus.  I think the excessive time in dorsiflexion and using too much leg not core to try to control my posting must have caused it; I was tender to palpation all the way up my lateral calf over the muscle belly and sharply painful on eversion and plantarflexion (surprising to me why dorsiflexion caused plantarflexion pain, learn something new every day).

 

(not a lovely Netter image, but you get the idea)

 

And thus almost two years of medical school is almost, slightly useful, but I still needed textbooks and le internetz to diagnose myself. 

 

I leave you with some photos of my fuzzy little munchkin:

 

 

I started to do some clipping to get ready for spring, but unfortunately misjudged the ears, they're a little lopsided!

 





Luckily I left the rest of the fuzzy quite Fuzzy- it's been super cold this week.

He loves this rope, he'll entertain himself for a good 20min at a time (impressive for him) lying on his back and snuffling and chewing at it.





Always behind

That's how I'm feeling right now, anyway.  The 'To Do' list seems to be never-ending, I can never seem to reach the end of any given list before a new one is started.

Two things checked off and it's 2:30 in the morning.. lovely. (to be fair, the Path cases were a Huge task, and my boards questions are almost finished.. so yeah..)

 

 

I haven't ridden in the past several weeks, there just hasn't been time, and it's miserable.  I'm hoping this weekend to break that cycle!  Over winter break we had really terrible weather, I tried to ride every day it was above 15 degrees, but sadly that was really not that often when you factor in wind chill!  One Really cool opportunity I had was to ride at a friends' barn, her trainer let me take a lesson on a retired grand prix horse!  That, my friends, was a much needed reminder of why I'm muddling through lower level dressage - it was such a lovely glimpse of what I one day want to be able to achieve / train.  (the canter really made me laugh out loud, the smoothness but huge jump - so cool!!)

 

I leave you with Valentine's Day French Toast.  Happy February!  Hug and kiss your horses and pets if you have them, significant others should do if you don't! 

 

 

 



 



Grumpy and Grouchy

That's what being in the middle of week 3 of finals will do to you.  Ugh, how do they expect us to possibly fit all these little tiny facts into our overstuffed/overstressed/overtired brains?  Not feeling very zen right now.
Poor husband, he'll cheerfully say "Oh don't worry you're going to do so well!" - to a normal human being this is probably a comforting and nice thing to hear.  To freaked out med student it feels somehow both insulting and patronizing. 

Tricky Situation

At the therapeutic riding center where I teach and volunteer we receive a good number of horse donation offers each year.  We've had a number of just super horses come to us this way, many of them a little older but not ready to retire, perhaps not able to do the level of riding the owner wishes, or the owner may have too many horses to keep in work.. There are lots of reasons.  Our horses have amazing lives, have free turnout 24/7 on our acreage, cared for by an on-site property manager who treats them all as her own, and are doted on by volunteers and students. 
Our clients range from four - sixty-four year olds (and everywhere in between) all of whom have some type of mental and/or physical disability.  Understandably, our vetting process for new horses is pretty strict, and unfortunately we're only able to accept maybe 1/3 of the offers we receive for trial, and of these maybe only another half make it to being a full member of our herd.   A lot of the reasons we have to say no have to do with health, many people are in search of retirement homes for their loved older horses, and while we Love gentle older horses they simply need to be sound and able to be in light work (and by light, I mean at most 5 days/week, up to 4 hours (2 max consecutive) at mostly walk with a little trot).  It isn't a retirement-type situation. We have to turn away horses that have any propensity to stumbling, who need corrective shoeing or expensive health maintenance.. We also only accept geldings over the age of 10. 
After email or phone communication and a visit to the horses home (we expose them to a few of our toys and props and see their reaction, watch the owner ride, and ultimately ride ourselves if everything looks to be going OK) we ask for a trial period to bring the horse to our center and see if they'll work out.

So, the situation at hand - we've had a horse 'on trial' at the farm and needed to make a decision re stay or go.  I worked with him once a week in Oct/Nov, along with another instructor on other days, and when the equine manager asked if I thought he should stay I had to give my vote of No.  He is physically in OK shape for the work he would need to do here, but mentally I just don't think he has what it's gong to take.  Therapy horses are super special guys and it's just not a job for everyone.  They need to be able to deal with working with different volunteers every night, and have to be a little forgiving of a rider who is learning, and is going to make some loud noises or abrupt motions, and frankly some 'mistakes' too.  We always set up our horses to succeed, they wear halters and have leaders with the most involved riders, and many riders have sidewalkers walking next to them for support, but we count on our horse as integral team members to the students' success too. 

Horse in question is just not there mentally (some concrete examples include two separate occasions on the lunge line where he rushed me and has turned to kick out to the center.. 'laziness'/wanting to get of work I'm ok with but dangerous behaviors like rushing aren't good signs).  In hand he is manageable to an experienced horseperson but many of our volunteers have basic knowledge and while they work excellently will well trained superstar horses, may not be prepared to work with a horse who has 'NO' in him.  So, basically for a variety of reasons including those above, he is not going to be accepted into the program as a therapeutic riding horse. 

The problem - the owner is upset  that we don't want him, and will not agree to take him back.  This hasn't actually happened before, and we're not sure what to do about it.  Unfortunately the contract we have in our lease doesn't have language that can force her to - I'm not sure how all that is written or what the deal is but that's what I'm told.  (I assume that wasn't an anticipated problem..)   I keep thinking about it and I can't help feeling guilty and worried about what's going to happen to this horse.  He's older, doesn't have nice manners, and not very nice conformationally.  It's a difficult situation, and I'm not sure how it's going to play out.  We've been looking for people who might want a 'buddy' pasture horse, but frankly there aren't many of those homes out there especially in the middle of winter.  In any case, our contract is being re-worded. 

Hank

Lesson Friday!  This week I was on a new horse, I get out to the barn and trainer is in the back with the farrier and sends me out with a halter to catch Hank, an 11 yo draft-paint (??) that he has in the barn to sell for his owner.  Overall, I do think it's good for me to get to ride lots of different horses and experience different ways of going but Man do I wish I had my own horse. 
Hank was fairly good on the ground but needed lots of reminders to No stay out of my space and Hey stop flipping the cross ties around.  This was my fault for just getting up on a horse I'd never met before, but after mounting and trying to warm up he jigged all over then started bumping around up and down and breaking to canter and trot (not dangerous just excited and fresh).  Trainer was there at this point so he had me dismount and we free lunged him for a little while to let him express himself and Wow I was glad we did so - lots of 'expression' / exuberance/ bucking and kicking!  Up I went again and we began our lesson.
Theo and I have been getting along well together (and I rode Luke in my last lesson, So great to be back on him as well!) - what both of these horses have in common that I love is that they are very sensitive off my seat and leg.  Hank- not so much.  Especially with Luke, I just need to Think about turning and it happens.  Hank was not tuned in this way.  I was using a Lot of inside leg and I felt like an inordinate amount of rein support to stay on the rail, and bending was very difficult for him.  We did lots of circles to try to loosen up..   It was just a little frustrating because it honestly just made me feel like a bad rider to have a horse not listening (or not able to?) do what I've been working hard to achieve with Theo and Luke.  It was good for me to experience working with a horse like this I suppose, and yes by the end of the lesson things he had gotten better.  We worked a lot on driving him forward when he leaned on my hands and staying centered and tall in the saddle and supporting from my core.  (Good lessons to take to my work with Theo)  Finally towards the end of the lesson he started to carry himself a little more and things were going a little better, but he's just not physically as supple or capable right now as I would like/enjoy to ride. 
I have a feeling though I may be riding him in more lessons. Trainer was very kind - he said Hank hadn't had much professional riding experience and he liked seeing him go with me / someone working to make him go correctly.  Don't worry I didn't let it go to my head, but it was just such a nice thing to say and hear.  Maybe there is a nicer horse in there, the end of our lesson definitely showed promise.  We'll see what happens next week. 

In med school news, dreaded finals are underway and I'm dying.  Insert tiny whining violin. 

One step forward

And two steps back.

My last two lessons ended on decidedly different notes. 

After the first I was thinking Hey maybe I know something (anything?) and maybe we're getting somewhere on this whole dressage journey.   We were working on a 20m circle and really Theo had a nice powerful trot cooking along, I was sitting and felt connected for once..  Trainer had us throw in 10m circles to the center off the 20m and alternate between motoring off in trot and picking up the canter as we got back to our 20m circle.  And.we.could.do.it.  It was neat.  Accuracy with canter transitions is not my forte, I'm happy to get one in a few strides.  All this circle-y stuff really helped us as we had to both stay super focused the whole time. 

(MS paint version of exercise)

Canter at the star.  This version = success!

And then, I rode this weekend.  We tried some new exercises, again with our friend the 20m circle, but it got trickier.  We were in sitting trot again, having our nice little motor rhythm, then spiraled in to a pretty small circle, I'd guess 8m, around trainer, then leg yield back out to big circle (all in trot).  This was going OK, we had some nice moments.  Then things went to hell.  The new task was spiral in, leg yield out to 15m circle around trainer and pick up canter and STAY on 15m circle.  Mind was blown, people.  Both mine and poor Theo's.  He's doesn't have a super balanced canter and trying to get him to stay on that smaller circle was not so doable.  It was like 15m for maybe half a circle then skitter skitter skitter Right past my outside leg - like blow right past it you're not stopping me lady kind of thing.  It was disheartening.  THEN we added in a ground pole, this did not help.  Theo loves to jump and I think he was getting pretty sick of my trying to thrust my amateur dressage on him. Instead of ground pole helping us get him to rock back on those hindquarters and balance it was more of Ohhh whee let's grab the bit in our mouth and vault, then take off excitedly in rushy rushy canter till rider can organize herself enough to get even a modicum of connection.  Not my finest moment, and frankly I Still am at a loss on what to do.  He gets very strong and I KNOW dressage riders are Not supposed to have sore arms so I feel pretty that's a pretty obvious failure.  It feels like he's pulling and leaning on me to help him balance, but I'm just not quite sure what to do about it.  Trainer says to just keep sitting still and resisting and no pulling back whatsoever, sit tall and use my core buttt.... nothing seems to be happening (or at least, it wasn't in that lesson). 

Exercise 2: Not successful

Black arrows at trot, spiral all the way in around disgruntled looking trainer, grey arrows leg yield out to 15 m circle and pick up canter at Star, attempt to canter 15m circle but instead careen out to orange line matching despairing trainers face.

 



 

 

Oliver says to stop whining and get back to studying. 



Wake me up when it's all over

When I'm wiser and I'm older..
(Aloe Blacc)

It's a rainy night and I'm muddling through a seemingly never-ending stack of notes, test tomorrow.  Current lecture I'm working on is over recognizing and differentiating causes of chest pain (hint to my fellow med students out there, after MI, think P P D and four little E's).  Time to learn. 

Giddy up.



(myocardial ischemia, pericarditis, pulmonary embolism (central or small), aortic Dissection, mediastinal emphysema, esophageal rupture, esophageal spasm, esophageal reflux)

Lesson musings

Luke threw a shoe before my lesson two weeks ago so I rode one of trainer's more experienced horses, Theo.  This weekend I came in to the barn and Theo was waiting for me again.  I had mixed feelings frankly, Luke and I are finally developing a good working relationship and things have been coming along in lessons.  And, I have to admit it's a little secretly cool to get to ride the more 'difficult' horse of the bunch, who isn't used in other lessons. (don't get me wrong, Luke isn't actually Difficult in the real sense of the world, he's really a sweetheart but comparatively a horse that has an opinion and isn't afraid to share it with you.)
Theo is older and already knows his job - all the cues are nicely installed and he is more capable and comfortable in collection and 'dressage-y' things.  I feel like I'm learning a lot from him, just different things than I was with Luke.  Luke taught me to sit up and ride forward in tricky spots, and was patiently teaching me confidence.  Theo is teaching me what a floaty sitting trot feels like (awesome). 

In my lesson this weekend with Theo I was having trouble getting a nice bend to the left, he felt stiff through the neck and I felt like I couldn't get through to him.  After multiple attempts to communicate what to do and my dismal failure, Trainer (who is super tall) came up and walked next to us and actually reached over and took the reins on each side (reaching up over this 16something hh horse), and had us walk along with him controlling the reins  --- yep immediately Theo arched that pretty neck of his and had lovely bend to the left.  It was so cool!  Helpful, too - we started to get it sorted out at walk and trot (canter not so much, there our focus right now is just my posture, pony can do more or less what he likes as long as we're traveling the right direction as I try to sort myself out).

School marches on.  It does not take time off for riding in beautiful fall weather.

0.2mm

Not a fan of the 0.5mm pencil lead.  Lead breaks constantly, and it doesn't show up cleanly/dark on page.  And as someone who writes a crap-ton of notes, this is legitimate issue.  (you know, relatively speaking)

 Bought to save $, of which I have little.  Utter crap.

 

 

 

Much better.  0.7m Matic grip BiC pencil.  I take exams with the green ones.  not weird.

Hour 15..

Of studying today, that is.  Pharmacology is going to be the end of me.

I've been having fun with my Anki flashcards though.  I take pictures of mechanisms with my iphone and email them to myself to then add to a flashcard.  So cool, right?

 

 

 

 

There are 142 drugs on this exam (one of my classmates counted and posted this encouraging tidbit on our facebook page), not so bad I suppose compared to what it will be come final exam time.. But really right now poor brain is at maximum capacitance.  Exam in T-8.5 hours!  Ahhhhh!



Ride on

Kicked the test on Thursday's butt.  That was neat.  But, my favorite part of last week was my lesson on Saturday!  I just had so much fun - Luke was really forward and was Right there when I asked with the leg (this lead to me letting him run away a bit though and reminders from trainer to keep things rhythmic).  Canter work was pretty good for us, that is we had the correct lead each time and generally got into it within a few strides (low standards here, people).  A few minor frolics occurred, as is generally the norm for our cantering as we get warmed up (again with the low standards) one of which resulted in a lost stirrup for me and the requisite shouts from the center to SIT UP SIT BACK in response to my reflex hunched shoulders and grasping of mane.  Did manage to sit up and back despite instincts pressing me the other direction, and Luke was saintly and didn't take advantage of my poor equitation.  In typical advanced rider fashion, trainer is rather blasé about these moments and simply sends us back off to the rail to try again.  This, I think, is part of what makes trainer such a good fit for me. 

Should I be worried about that shadow??

 

I feel like I'm a fairly neurotic and high-strung person (a la most med students), so having someone on the ground who's so relaxed about these moments when I struggle helps Me to be more relaxed.  Actually, I feel like he treats me exactly as one might treat a high-strung and spooky horse - lots of new instructions to make me concentrate if I start to look nervous and a super relaxed chilly manner to encourage me.  I constantly overthink things, he tells me to just Sit Up and RIDE FORWARD.  He doesn't baby me, which I think would just make me realize oh yes maybe that does sound scary or hmm maybe that Is something to consider/worry about.

Well, that escalated quickly.

M2 year has begun, just starting week 3 now and holy batman they aren't kidding around this semester.  We have four courses, two of which are absolutely giant and soul crushing (pathology and pharmacology - but don't worry the slightly more manageable clinical practices and infectious disease courses are still beasties in their own right). 

I'm trying out a new system for the big courses, using a 'smart' flashcard program called Anki.  You make cards like any old flashcard system but it sets up quizzes and reviews of the cards based on how you rate the ease of answer (easy, had to think, forgot) as you flip through them.  The web version is free but there's a fee to download onto smartphones.  I think it's helping, I've never been a flashcard person before but I'm hearing they are imperative for the big gun classes.  I guess we'll see come exam time (first one this Thursday, then non-stop once per week till the end of the semester... yayyyy)

I was able to lease a very kind older gentleman horse over the summer from a friend at trainer's barn, it was very reaffirming and just good for my confidence.  He is a schoolie and as long as you do the right things up top (ie don't pinch him with my knees!) he just opens up and powers along.  When I took lessons I was still able to ride our friend Luke, which of course kept me plenty humble.

Kinda the worst picture ever, but shows the sweetest most darling gentleman horse.

Oh yes - and I got married this summer!   Yayyy!

 

 

Since med school started back up I've ridden twice.  Sad face.  I was supposed to have a lesson this past weekend but when I showed up trainer had forgotten and was 2 hours away picking up a horse from the vet clinic!  After a super stressful first two weeks of school frankly I was unreasonably sad about this, #whitewhine.

However, I will be more sad, and reasonably so, if I don't finish getting through all these notes for the exam on Thursday.  Byeeeeeeee