Radiology Exposure

What I have learned this week that I will remember:
X-rays are like toast:
-When they are underexposed, they are white
-When they are overexposed, they are too dark.

MIND BLOWN.

Tags: radiology, school

Why Wouldn’t He Have Chronic Bronchitis?

Rosenblatt has chronic bronchitis…of course, he does.

After a week of doxycyline, I took Rosie back to the hospital for yet another follow-up BAL. This time his neutrophil count was up to 30%. We decided to have the lab culture the fluid that was pulled from his lungs; there was a chance that he had a bacterial infection that was resistant to the doxy. However, his culture result was negative — so no bacterial infection. With that information, the docs diagnosed him with chronic bronchitis.

There isn’t a known cause or cure for chronic bronchitis. You actually treat it the same way you treat feline asthma: corticosteroids. Environmental modulation also helps lessen the signs of both disease; I bought a cover for my futon to decrease his exposure to dust mites (also keeps him from destroying the futon with his kneading) and am considering buying  a humidifier.

For right now, Rosenblatt is staying on the same dose of prednisolone to see if it will control both issues. I have noticed a random little cough for him, but nothing like the hacking attacks he had before taking the prednisolone. He goes back to the hospital in a couple of weeks for, you guessed it, a follow-up BAL.

Tags: BAL, chronic bronchitis, feline asthma, Rosenblatt

Rosenblatt is Kicking Asthma’s Butt: Updated

Rosenblatt had his follow-up bronchialveolar lavage (BAL) today. This allows the doctors to determine the amount of eosinophils in his lungs. He is down from eighty percent to TWENTY percent! Whoo!! That means the prednisolone is working. Normal ranges for cats are around sixteen percent, so we are going to continue the medications to see if we can bring down the eosinophil count even more. He is scheduled for yet another BAL in a month to recheck the cell count in his lungs. He has only had one attack since his last doctor’s visit, a great improvement from one every couple days.

He was really happy to get back home, though I can’t imagine the hospital experience is too incredibly traumatic for him. Every time I pick him up the vets and students tell me how everyone gets distracted by how cute he is. This time I heard, “He is just SO soft.” Yes, yes he is.

 

 

 

 

 

 

 

 

 

UPDATE: Rosenblatt finally had his follow-up to his follow-up BAL. His eosinophils are down to six percent!! Unfortunately, his neutrophils are up to seventeen percent, when they should be under five percent. The doctors think that he has an opportunistic infection that developed due to his immunosuppressive dose of steroids. So, his dosage of steroids is going down, and he is taking some doxycycline to see if we can clear up the infection. He has to go back in another three weeks for…you guessed it…another follow-up BAL!

Tags: asthma, BAL, cat, feline asthma, Rosenblatt

My Failed Asthma Research Cat Totally Has Asthma

It’s official: Rosenblatt is a full fledged asthmatic.

I took him for a re-check on Wednesday; we took the next diagnostic step and took radiographs of his thorax. They showed a bronchiolar pattern consistent with asthma. He also has a slightly enlarged heart, which would correlate to his right-sided heart murmur. This combination of signs are also consistent with heart worms. However, considering Rosenblatt was raised indoors at a research colony and lives inside my apartment, it would be highly unlikely that he had come into contact with a mosquito that could infect him. Still, we decided that on my next visit we should perform a heartworm test just to rule it out; also, if it was heartworms, then he would only have to take steroids for six months, rather than for life.

Okay, I realize you can’t really see much on here, but this is a radiograph of a cat (not Rosenblatt) with asthma. If you can see the “doughnuts” those are thickened bronchioles.        (Picture Source)

We met with one of the internal medicine doctors who told me that we needed to run a bronchiolar lavage (BAL) to really test for asthma. Basically, the animal is anesthetized, and saline is forced into the lungs and then suctioned back out. This saline then goes through its own barrage of tests to see what kind of cells or potential bacteria are in the lungs. The doctor also requested an echocardiogram be done, since Rosenblatt’s heart was slightly enlarged – this makes him a greater anesthetic risk. I agreed with everything that needed to be done; it’s not exactly cheap, but you have to know what you’re treating if you really want to help your animals.

On Friday, I rushed home after an exam to pick Rosenblatt up and deliver him to the hospital. (I also stopped by the local grocery store to buy doughnut holes for the receptionists and the different departments that had been so great treating my cat.) After spending most of his day at the hospital undergoing his tests, with an included complete blood count (CBC) to see what was happening throughout his body and not just in his lungs, Rosenblatt was declared asthmatic.

The normal eosinophil count in the lungs of a cat is around sixteen percent; Rosenblatt’s is eighty percent , which the doctor said is the highest she has ever seen ( I guess Rosenblatt has a go big or go home mentality). He also had a high eosinophil count on his CBC.

This is a feline eosinophil in the blood. (Picture source)

In addition to his asthma, during his echocardiogram, the doctors discovered he has an enlarged right atrium with some tricuspid regurgitation. The tricuspid valve is also known as the right atrial valve; it is what the blood flows through when it passes from the right atrium into right  ventricle. It is called a valve, because the leaflets are supposed to close during the contraction of the ventricle so that blood does not flow back into the atrium; when blood does flow back into the atrium, it is called regurgitation. Basically, Rosenblatt’s valve isn’t closing fully, so the blood is backing up into the atrium causing it to have to work harder, which in turn is causing it to hypertophy (the cells that make up the heart, called myocardyocytes, are getting bigger). It’s a lot like getting bigger muscles when you exercise, except that some of that growth is also due to hyperplasia, an addition in the number of cells.

So, what are we doing with this information? Rosenblatt is going on an immunosuppressive dose of corticosteroids. Asthma is a disease associated with allergies, basically the body overly responding to something it mistakes as a dangerous pathogen. If we can decrease the body’s response, then we can decrease the asthmatic signs. Rosenblatt will be on corticosteroids for the rest of his life, but the actual dosage will differ depending on how he responds to treatment. One of the side effects of this treatment is weight gain due to increase in appetite; I’ll have to monitor his food intake and make sure too keep him at a healthy weight. (The doctors told me he is at the perfect weight right now and is a “striking” cat; yeah, I had a moment of pet parent pride.) Two more worrisome side effects are the development of diabetes mellitus and congestive heart failure; obviously the heart failure is a bit more worrisome, since he does already have some heart problems.

We scheduled him for a follow up BAL in four weeks to see if the medications are working efficiently. He will also have a follow up echocardiogram in six months  to see how his heart is functioning. There is a possibility that the tricuspid regurgitation is due to tricuspid dysplasia, basically an underdeveloped valve. They hope to get a better visual during their next exam to decide if this is a correct diagnosis.

Oh, during the echocardiogram, they also noticed a linear object in one of Rosenblatt’s ventricles. It is probably just artifact, but it could be an adult heartworm. His heartworm test was negative, but the female heartworm is the only one that produces antigens in the body. Therefore, he could just have single male heartworm, but this is highly unlikely.

Tags: BAL, cat, clinics, echocardiogram, feline asthma, hospital, pharmacology, radiograph, Rosenblatt

My Failed Asthma Research Cat Might Have Asthma

Here’ s a little something dealing with veterinary medicine and my general life: my cat, Rosenblatt.

I adopted him at the beginning of September from the feline asthma research lab on campus. I fell in love with his chubby cheeks, incessant biscuit-making, and aloof yet loveable demeanor. He settled in pretty easily, and, despite his numerous attempts to take out Kingsmore, my guinea pig, we’ve gotten on fantabulously. Basically, he follows me around the apartment and yells at me if I move and wake him up during one of his numerous naps.

Anyway, not too long after Rosenblatt moved in with me, I noticed that he appeared to be having respiratory attacks. He would crouch low to the ground, hunch his shoulders, extend his neck, and kind of hack. At the end of the attack, he would lick and smack his lips and act like nothing had happened. His attacks varied from every few days to every day.

I decided to make him an appointment to visit the teaching hospital so we could try to figure out what exactly was happening. The way the teaching hospital works for community care (that’s pretty much your normal dog/cat visits) is that a student is assigned to the case; they greet you in the waiting room and  escort you to an examination room where they take a thorough history and do a physical exam. They then present their findings to the doctor and discuss various etiologies and treatments. The doctor then enters the room with the student, and, together, they discuss various treatments and options with the client.

My visit was a bit different, because I am a student at the school. I went in the back with the clinical students and waited with Rosenblatt for a doctor to become available. Rosenblatt loved watching all the people and having all of them tell him how adorable he was. Once we met with the doctor, he told me what I expected to hear: there were several reasons why Rosenblatt might be coughing. It could be due to a bacterial infection, parasites, allergy, or he could have asthma. We decided the best course of action was to start off with some pharmaceuticals that would treat a bacterial infection and lung worms. It’s the cheapest option, and it allows us to rule some things out from the start. If this doesn’t work we will probably move onto taking radiographs to get a look at his lungs. This would also allow us to view his heart; during his examination, the doctor heard a very slight heart murmur. It could have just been due to excitement or fear caused from the visit, but we’ll continue to monitor it.

Right now the big issue is trying to get a capsule and liquids down my cat. So far I have met with a fair amount of resistance, growling, little bit of biting, and copious vomiting on one occasion. My best tactic thus far is waking him up a little from a nap and then sneaking the drugs in him real quick. He doesn’t get or stay as upset as when I try to do it when he’s fully conscious. It doesn’t hurt that he gets a reward of canned food after successfully downing his meds.

That’s a little bit of what’s going on in my life right now. I’ll update you on how the situation progresses. Hope you found that at least sort of interesting.

Tags: cat, clinics, feline asthma, hospital, Rosenblatt

Koala in Africa

As a sort of teaser to my upcoming posts on Africa, here is a video that Columbia College, where I received my undergraduate degree, made about my trip.

Go Koalas!

Tags: alumnae, Columbia College, South Africa, travel

Second Year was so Nice, I’m Doing it Twice (that’s sort of true)

So, I kind of dropped off the face of the blog planet. Sorry about that to anyone that actually reads this. While attempting to make it through my second year of vet school, Life happened, as it is want to do. The end result of frustration, hard work, and tears was that due to not performing as well as I needed, I’m repeating my second year of vet school.

Yeah…turns out if you say in passing “I’d really rather have a 5 year program: 3 years in the classroom and 2 years in clinics. I think that’s what would work best for me” the universe will go, “I can make that happen, lady”.

I was devastated when I got my dismissal letter, but I have discovered a great many things through this process. I found fantastic friends who supported me in various ways, be it through studying with me, distracting me with fun and phone calls, or surprising me with flowers and balloons for my appeal letter. I found great professors and administrators who encouraged me and showed their support through emails and letters to the appeal staff. I also found out that failing out of vet school does not mean the world is ending. Life keeps going, and for that I am grateful.

So, what have I been up to since then? Well, I moved into my own place at the end of August and immediately filled it with animals. My new roommates are a guinea pig named Kingsmore and a failed asthma research cat named Rosenblatt. They live in harmony thus far, probably because Rosenblatt doesn’t like going in the living room where Kingsmore lives. I spend my time prepping for upcoming classes and getting used to living on my own.

BUT, that’s what I’ve been doing since August. Let’s backup a little shall we? I spent most of the month of July in…wait for it…AFRICA! South Africa to be specific. It. Was. Awesome. Amazing. Fantastic!
We traveled across the country working with two veterinarians who practice wildlife veterinary medicine. After our scheduled work was done, a smaller group of us traveled around for a week doing the tourist thing. If you want to know more about it and to see some cool pictures, I’m planning a post that details some of the things we did.

I plan to keep updating the blog, but for the longest time it seemed like I didn’t have anything to share, or I wasn’t really sure how to share what I was going through. So, I’m leaving the negative in the past and bringing to the future only those positive lessons and relationships that will help me live a better tomorrow (okay, that sounds super corny, but it’s also super true, so deal with it).

Thanks for all of the support and encouragement. Hope you’re still interested enough to stick around and see what other surprises life decides to throw my way.

(For anyone who is curious, the pets are named after college baseball stadiums. Kingsmore is the Clemon Tigers stadium; Rosenblatt was the original College World Series stadium. I realize they’re kind of ridiculous names, but still cute, right?)

Keeping Family Traditions Alive is Going to Kill Me

It’s Easter time again, and I am again in Missouri and away from my family thanks to school. I actually have no recollection of Easter last year, which means I probably celebrated it in no way. (Cue me feeling like a terrible person.) This year I decided I would at least celebrate the holiday in the manner my family celebrates pretty much anything: Food.

Don’t get me wrong, on Easter we usually got up super early and went to sun-rise service out our small family church. After service, my grandparents, parents, and the rest of the grandchildren and I would serve sausage breakfast casserole to the whole church with crock pots full of grits, pans full of biscuits, and pots full of coffee.

Later in the day we would all head over to my Granny and Granddaddy’s (aka walk across the yard) and enjoy dinner over there. Anyone who hadn’t already dug through their Easter basket would do so at this time. I can’t actually remember if there was any one dish that summed up Easter dinner; all I can remember is the deviled eggs that Granny would make out of the eggs we had dyed previously in the week.

Side note: Dyeing eggs with my Granny is one of my fondest memories. I can immediately smell the almost painful burning scent of the vinegar and hear her talking about the beautiful eggs the chickens had laid. We always had one or two green or brown eggs that nature had done too good a job on for us to dye. I still never think that eggs that started out perfectly white are anywhere as pretty as the brown eggs that we would dye as kids.

Well, I don’t have a church that I go to here in Missouri, so I decided that I would celebrate by making the traditional sausage breakfast casserole. For lunch I decided I would make the Coke Ham my mom makes for Thanksgiving along with Watergate Salad, because it’s fluffy and light and always makes me think of Spring.

Immediately upon starting to prepare the casserole the night before I became homesick. Family traditions generally involve a family, and it was just me at home by myself. Depressing. But then it happened, I was starting to make the dish and could immediately imagine my family around me, mainly due to my incompetence at trying to perform the simplest tasks.

Step 1: Crumble and brown sausage.
Realization: I have no idea how to crumble sausage. It just became these giant mushy-pork balls (appetizing?) that I had to quickly chop into pieces with a spatula before they cooked that way. I immediately heard my mother’s voice in my head: “Jessica….it’s sausage. I don’t…just….just CRUMBLE the sausage. How did you get to be 24 and NOT know how to crumble sausage?!”

Step 2: Drain the sausage.
Sigh. Yeah, I can’t drain things out of a pan without losing a good 1/3 of it. And the amount of sausage already looked a little small (probably due to my issues with step one). My solution: I drained it in the colander. Yeah, that happened. I quickly imagined my dad unsuccessfully hiding his laughter at my “solution”. AND, I just realized I drained fat down our kitchen sink, AGAIN.

Step 2: Butter both sides of 6 pieces of bread.
I cannot butter untoasted bread. Last year, slices of bread were snatched from my hands by my mother and aunt with accompanying expressions of, Seriously? It’s buttering bread? What the heck is wrong with you? I don’t understand it, but you give me untoasted bread and butter knife and it’s like a gorilla attacked tissue paper with a machete. Not pretty.
It’s about this time that my lack of basic kitchen skills is mentioned in the one single act I cannot master: whisking. Every year it comes up and every year my grandmother acts likes it’s one of the craziest things she’s ever heard. “What do you mean you can’t whisk? Of course you can whisk. Come here, I’ll show you; it’s all in the wrist….What are you doing? That’s…that’s not it. Well, okay. You can’t whisk.” And repeat the next time the family gets together to prepare a meal.

Step 3: Spread sausage over bread evenly.
The issue here being the word “evenly” and my slight OCD habits. I spent a solid five minutes spreading sausage. Some pieces of bread had big chunks of sausage, some just had little chunks, some pieces had the chunks all in the middle, others didn’t. I had to make sure the sausage was spread EVENLY: it said so in the directions. Again, my mother’s voice: “I don’t understand; you graduated with a degree in Biology. How do you function in normal society?”

Step 4: Sprinkle 1 cup of shredded cheese over sausage
My fault: I bought a 2 cup bag and didn’t measure out 1 cup. I tried to guesstimate. This involved me looking at the bag from various angles trying to decide if I had in fact used 1 cup or 1 1/2 cups. “Jessica, it says to use 1 cup or more of cheese. Did you do that?” Yes. “Then. Move. On.” At which point my mother shoots my dad the “I know I dropped her in the lake as an infant, but, seriously, what’s wrong with this kid?” (By the by, true story. My mother does not find it funny. My grandmother Really does not find it funny.)

Step 5: Beat eggs.
Like…whisk them with a fork? Great…..

Step 6: Add milk, dry mustard, and salt.
I broke the spice container. It was new, I couldn’t pop it open, used a knife, shattered the top, broke a piece off. Whatever, I got the mustard out and, really, isn’t that the most important part?

Step 7: Pour evenly over cheese.
Evenly. Right. After doing so, I wondered what those chunks on top were. Stupid mustard chunks that refuse to unclump and dissolve. I’m sure I didn’t find all of them, so at least a couple of pieces of casserole will have a nice mustard surprise for someone.

Step 8: Cover with tinfoil and refrigerate.
Yeah, that burner you just put the roll of tinfoil on is still hot. MOVE IT! We’re fine; I actually noticed this one pretty quickly.

I am done preparing for the night. I’ll let you know how things work out on the actual day. Happy Easter Eve!

UPDATE: The sausage casserole was yummy, but not quite as fluffy as it should be. Dinner actually turned out really nice. I made Coke Ham, Watergate Salad, Ham Rice, and rolls. Female Roommate made cheesy potatoes, her beau brought brownies, and another one of our friends/classmates brought a veggie tray so we could be pseudo-healthy. Hope y’all had a great Easter!

Tags: cooking, Easter, family

Oh, It’s the Most Stressful Time of the Year

It’s finally that time: Time to Pick Clinic Schedules. Duh Duh DUHHHHH!

At this point as VM-2s we now have to go through the 112 possible clinic schedules and decide which one we want. Which doesn’t sound so bad….except it’s torture. In less than a week you have to decide your schedule/life for the next two years. When do you want off? Do you want to take path before boards? Do you want equine in the winter, so you aren’t busy? Do you want time off to study during the boards? Do you want to take path in the winter so you don’t have to deal with decomposing and bloated cows in the summer? Do you want to avoid taking surgery first so that you are not sacrificed to the scalpel gods in hopes for good wound healing in the future (or something along those lines; I might be a little dramatic right now…..but only a little)?

Seriously, this is one of the craziest times I’ve dealt with. Along with this schedule monkey hanging on my back, I have started another block. Yeah, I made it through pharmacology (*cough* barely *cough*)! This block I am taking Small Animal Surgery (hard), Toxicology (not so bad so far), Anesthesiology (pretty hard), and Companion Animal (what in the world did I sign up for = hard). Right now I am freaking out.

Oh, and just so you know, when you decide which schedule you want, you don’t necessarily get it. No, you’re assigned a number and have to hope no one chooses your schedule before they call your number. They say if you choose 6 schedules you’re pretty much guaranteed to get one of them. With that in mind, I have 3 categories of color-coded schedules which totals around twenty schedules…..I’m not taking chances here. I’m 49 on the list, which is actually a pretty good spot Since, they go in backwards order to pick electives, I don’t get seriously shafted in any direction.

Oh, did I mention electives? Along with schedule choice is deciding which electives you want, which of course have to be offered during your elective block chosen with your schedule. Meaning:  choose the wrong schedule and you don’t get to take the electives you want.

……I want to be a groundhog. Decided that’s my calling. I want to hide in the ground until this Thursday is over and someone taps me on the head and tells me which schedule they assigned me. I’ve seen my shadow; I’m going back in the hole, back to the previous block where my biggest issue was trying not to laugh in class at one of my teacher’s incredible over pronunciation of words.

Okay, no. I am not a groundhog. I’m a koala and a tiger, which is a pretty bad ass combination, you have to admit. I will suck it up and handle this. Besides, schedule craziness will all be over on Thursday, and then I can totally focus on my classes this block. I can handle this. And I get to go home in a couple of weeks and not worry about any this. It’s okay. I’m okay. Okay? Okay.

Last words for the day are a quote shared by my surgery professor:
“Learning veterinary medicine is like throwing manure at the barn door… Some of it sticks, and the rest – you’ll know where to find” –SF Swaim, DVM, MS

Update: I got my first choice of schedules!! That means I get to be home in SC for Christmas both years!

And Now for Something Completely Different

Warning: There will be graphic pictures at the end of the post!

Saturday I was able to do something a little different: Alligator Dissection!!

Members of the Zoo, Exotics, and Wildlife (ZEW) Club were invited by Dr. Casey Holliday, one of the professors from main campus, to participate in a program he was hosting. The program was the Howard Hughes Medical Institute Maps in Medicine workshop. “The HHMI MAPS program is designed to expose underrepresented high school students to fields of medicine” (direct quote from the email Dr. Holliday sent the group). This workshop focused on evolution and anatomy. It started out with Dr. Holliday giving  a lecture on the evolution of alligators and crocodiles. The second part of the workshop involved several set-ups of hands-on activities for the students to work with. For example, there was an area where students learned how to appropriately measure skulls and then calculate the length of the alligator.

The section we were involved with was by far the most popular. The five vet students were given two alligators to dissect and to use to teach the high school students. We arrived a little early so that we would have some cool stuff to show them, instead of just watching us skin the animals. We invited students and their teachers to join us dissect if they wanted. I helped one student cut through the sternum, remove the heart, remove the pericardium, and dissect the heart more thoroughly. It was a lot of fun to work with my fellow classmates and other people of various ages. Also, I got to dissect an alligator, so how is that not awesome?

Once the students were dragged away, and I mean that literally for a few of them, we were allowed to continue our dissection if we wished. We decided to open the skulls to see the interior structures (pictured below).  Jeremy, a VM1, and I operated the saws to open the skull. (Actual story, I worked through 3 battery operated saws. When Jeremy told me if I “needed help” he would do so, I became a generous person and stepped aside so he could play, too. But he got to use the plug-in saw, so his never died out due to a low battery.)

I had a ton of fun with this workshop. It was really fun to teach other people about some of the things we learned, like how to determine the sex of the alligators and how to properly handle a scalpel. We also got written up in The Columbia Daily Tribune: http://www.columbiatribune.com/news/2011/feb/13/mu-brings-science-to-students/. I am the person whose face you can’t see with the blue scrub top and purple gloves.

Graphic Pictures as promised:

Look at those cute little webbed toes!

Sawing through the head so we can see the internal structures

Internal Structures of the Alligator Head

Beautiful alligator heart dissected out by one of the high school students. Alligators have four-chambered hearts like humans.

Alligators don't have diaphragms, so they don't have a separated thorax and abdomen.