Goodbye 2009, Goodbye California

Above: Sunset in San Martin on my last day in California 2009.

It's the end of a long year. I'm going to take a break from blogging for awhile. I'll update in a few weeks, until then I'll be hard at work in my second semester of vet school.
Hermit Thrush

Updated-- I'll do my best to keep writing. It's a nice way to keep in touch with people and I love that some complete strangers read me and offer support. Thanks all. But it is tough when faced with the onslaught of my second semester.

San Martin-- Arabians, Bucks And Cowboys

Above: View of San Martin from SelfSustainableNurse's kitchen. It's not easy to piece together a panoramic view like that from multiple photos-- I'm sure there has to be an easier way to do it than how I did it.

I plan to spend my last hours in the Bay in San Martin. I've roamed the Bay, from San Martin to San Anselmo (given a few more days I would have extended my range South to Monterey, possibly even to Big Sur, and to Point Reyes in the North). The two ends of the Bay are my favorite-- the coast of Monterey bay and Point Reyes National Seashore. Two of my favorite places on this planet. (My other two being the forest in central North Carolina where I grew up and Maayan Tsvi in Northern Israel, overlooking the Mediterranean ocean). And of course I love San Jose, the perfect mid-point, in particular the trails and hills of Almaden Quicksilver.

I made SelfSustainableNurse and her husband laugh a good deal on my visit. I wasn't even trying to be funny. I was just studying. Part of what I have to learn for my 'Veterinarians and Society' course, which specializes in ethics this block/semester, are the different breeds of horses, cows, sheep, goats and pigs (do not ask what this has to do with ethics-- I've long since stopped trying to make sense of my courses and accepted that they are beyond ecclectic in the mix of material covered). I've always found horse breeds especially difficult to distinguish, even way back in tech school. While looking over Arabians, I asked SelfSustainableNurse if she'd ever owned an Arabian. She and her husband just about fell off their chairs in the kitchen laughing. When she regained her breath she explained that both her horse, Percy, and her husband's horse, Phoenix, are Arabians. So yes, two of the horses that I looked at all winter and spring are Arabians. Oops. SelfSustainableNurse loves Arabians because she says they have such distinct individual personalities. But she admits that they are easily spooked/very reactive, which is why I am wary of them.

Next, I was looking out the back kitchen window and saw the new, registered Nigerian Dwarf goat that SelfSustainableNurse recently purchased. I commented, "There's your new ram!" To which she replied, laughing, "You mean buck!" Right. I do remember memorizing that, as well as other livestock terms. Obviously it didn't stick.

One thing I love about San Martin-- the cowboys. There are lots of people out on horseback. SelfSustainableNurse distinguishes between the real cowboys and the macho Mexicans on stallions foolishly showing off just to be cool. She assured me that the photo below was of a real cowboy.

Working Emergency Over The Holidays

Above: That's how I felt at the end of three shifts in a row at the emergency clinic!

I worked Wednesday, Christmas Eve and Christmas. Although everyone has been complaining that business has been slow this year, it was pretty busy. I had a hard time keeping up with the pace-- it's been a year since I've worked as a technician and to top that off everything had moved (those of you who have worked emergency know that there is nothing more frustrating than not being able to find what you need quickly-- I couldn't even find the muzzles as they were in a completely different place than last time I had worked there!)

We saw a lot of chocolate toxicities, which is typical of this time of year. Giving charcoal or UAA gel to animals is one of my least favorite things to do as a technician. Not because it is messy but because I am terrified of my patients aspirating. I've seen a few charcoal aspiration pneumonias that have been referred to us for overnight care and none of them have lived. I especially dislike giving charcoal when my patient is still heavily sedated from the drugs used to induce emesis or is struggling with me fiercely. In fact, I had one very stubborn (but otherwise totally sweet) chihuahua fight me so much that I told the veterinarian I could not get the full dose into her patient. She then came over to help me and found the same thing to be true with both of us working on getting the charcoal into this dog. She commented that one way to get veterinarians to realize that what they are asking is impossible is to make them help. I know that I am just working relief and so I don't really have the doctors' trust the way a regular employee would... but still I hope that if/when someday I am a veterinarian that I trust my technicians' judgment and don't push them to do things that might jeopardize my patients' health.

I also saw one marijuana toxicity. Classic signs-- ataxic, acting as if it is reacting to something when there is no stimuli, low heart rate, peeing all over the floor. The receptionist asked me to triage the dog and after doing a quick once over (pink mm, normal capillary refill time, low heart rate, acted like it had neurological disease and/or was hallucinating) I asked the owners point blank, "Do you have any marijuana in your house?" I think my bluntness caught one of the teenagers off guard and she nodded. Mom was ready to kill. I felt badly and explained we had no interest in the legality of the matter but that it would be much easier to treat her dog if we knew what it had eaten.

What I enjoyed the most on my shifts was the two things I've always liked best as a technician-- lab work and anesthesia. It was rewarding to find that after not working for so long I still knew what I was seeing under a microscope. I found tons of giardia on a direct fecal smear from a puppy that had projectile, watery diarrhea and had just been treated (suprise, surprise) for giardia. It's been a long time since I've seen that alien face-like trophozoite staring back at me through the microscope, flagella undulating wildly. I also found schistocytes on a blood smear from another patient when doing a differential-- I called out from lab to the vet, "Hey, has this dog had a splenectomy?" To which she replied from her desk, "No, why?" Well, it turns out the dog had splenomegaly. Hmm...

I had a cat with rouleaux on the blood smear, differential was a classic stress leukogram. Nothing too remarkable in my book as far as blood work goes in an emergency clinic. The vet later told me she suspected FIP based on a constellation of signs-- uveitis, high globulins, not responding to treatment. When I showed her the lab work she noted that rouleaux is often found in cats with FIP, has something to do with the elevated globulins. I thought that was interesting.

I also got to be the anesthetist for two difficult anesthesias. The first was a geriatric dog, which made me nervous as after not doing any anesthesia for a full year the last thing I wanted was for my first patient to be old and sick! And it was not a smooth anesthesia-- the dog was too light once the vet started doing something painful, and when I deepened the anesthesia the dog got too deep and so we partially reversed its premed dose of hydromorphone. The vet joked, "This dog either wants to walk off the table or die." No fun. But the veterinarian got her job done in a hurry and I turned off the anesthetic gas expecting a fast recovery. Twenty-five minutes later I was still monitoring an intubated patient on oxygen. Realizing that the patient was not going to wake up on its own, I asked the veterinarian if we could reverse the rest of the hydromorphone. She agreed. About one minute after I gave the naloxone to the dog intraveneously, it woke up. Amazing. In all the years I've worked emergency this is the _only_ case where I've ever had to reverse a premedication.

My other anesthesia was a c-section. I had trouble intubating (super elongated soft palate!) and was nervous because there were no premedications on board and a masked induction, which can make for a rocky anesthesia. Plus, I wanted to keep my patient as light as possible so that the puppies would not be too anesthetized themselves when delivered. My patient's blood pressure tanked and wouldn't come back up no matter what I did-- lighten the anesthesia, bolus fluids, give hetastach... you name it. So finally, once all the puppies were out, the veterinarian had me give a dose of hydromorphone to see if that would help. As soon as I had injected the hydro IV, the dog began to tremor violently. I don't know what was going on. I've never seen anything quite like it (although I did once have a dog seize on a propofol induction). My first panicked thought was that my patient was going agonal, but the continuous, steady heart rate and regular, spontaneous respirations did not support that. Eventually she stopped shaking. (Of course then I was shaking from the adrenaline rush that came from thinking my patient was dying). She had a smooth recovery and went home with her pups the next morning.

I went home at 4:30 am Christmas morning after being on since 5:30 pm Christmas eve. That's emergency. And I came back the same day at noon. Now you know why I konked out like the puppy in the picture after I was done working!

Random Useless Information, Results Pending On Post-Mortem

I was extremely lucky to make it back to California last night after an extended stay in the Syracuse airport thanks to the blizzard that wreaked havoc on air travel. I think it is just plain luck that accounts for me getting the last seat on a flight to San Francisco after missing my connection to San Jose.

I'm back, but none the wiser. I find that I know a lot of useless information:

• When I saw a logo with a woodchuck, I thought of what lesions from hepatitis and lymphoma look like on necropsy of a woodchuck. How's that? Cornell has a breeding colony of captive woodchucks that they use for research (apparently a good animal model of hepatitis?)

• When merle coat color in dogs came up, I knew that it arises from a SINE_Cf insertion.

• When a melanoma in a grey horse was mentioned I thought of the connection between grey coat color and the eventuality of developing melanomas and knew that both grey coat color and melanomas also result from a specific insertion (read more here).

• When my dad mentioned an epidemiological study on statins to me on, I immediately thought of how statins are contraindicated during pregnancy based on the discovery (by Cornell veterinarians) that Veratrum californicum is the cause of cyclopia in ewes that ingested it around the second week of gestation. The biological mechanism underlying the teratogenicity of Veratrum has to do with hedgehog and patched signaling and cholesterol hence the concern that statins would also be teratogenic.

• Perhaps most disturbing of all, while watching a TV documentary on Jack the Ripper (article here), I understood why the coroner estimated that it took at least fifteen minutes for Jack the Ripper to severely mutilate his victims' bodies. It's not that easy to cut up a dead body. It takes skill. Which is perhaps why profilers also suggest that Jack the Ripper knew some basic anatomy and perhaps worked in a mortuary. Kind of disturbing that I followed all the profilers' thought processes. If you've never cut up a large dead body (I'm thinking alpaca, horse or cow) then you don't know what hard work you're in for. You have to repeatedly sharpen your knife with that kind of sustained effort (which is another reason the profilers suspect Jack worked in a mortuary-- he'd have access to the kind of instruments needed to quickly and effectively disfigure a body).

And speaking of post-mortems... Back when I was a first year in college I got placed in a special advanced chemistry intro class that was mostly quantum mechanics. It was legendary for being incredibly difficult and for being next to impossible to get an A in (though I did achieve that much to my surprise). The first exam was so tough I still remember questions off of it-- like this one "Prove that orbitals are symmetrical." Uh-huh. I was convinced that I had flunked and I remember telling that to my professor as he prepared to leave the exam room with our stack of papers. He said coolly, "Wait and see what the post-mortem shows." Which, like most exams in my life, yielded a grade much better than my wildest expectations.

So now I always associate grading exams with the word "post-mortem." The problem with Cornell is the time it takes them to do a post-mortem is maddeningly long. I took a midterm at the beginning of December. I will not get it back until I return to school in January. Given that this waiting game makes me extremely anxious, I decided to institute some ground rules for myself to help manage this anxiety. Rule one: do not look up answers after leaving the exam. I can often recall almost every question on an exam just after finishing and would look up ones I was unsure of. This only heightened my anxiety when looking up something made me realize I got that question wrong, especially if I realized I had gotten several questions wrong. Rule two: do not, DO NOT, think about the exam. At all (if possible). Forcing myself to stop thinking about the exam when I find myself worrying about my grade also helps.

Winter Rebirth

alone in the library late at night
snug in my jacket, legs curled under me
a heavy book
(pathologic basis of disease)
half-balanced against the chair's armrest
there is the low background hum
of computers, printers, fluorescent lights
and outside snow falling under a street light

stepping into the parking lot
everything is coated anew
with fine powder

the white layer covering the ground
unblemished
like the smooth skin of a
newborn

there is no ice, no treachery
the fresh snow is crunchy underfoot
like styrofoam packing peanuts

and i think
what better reminder that every moment
i start anew, afresh

i'm starting over, tonight
is the first moment
of my new life
there is no trace of the old
scars and worn ruts of bad habits
i couldn't break

soon this new snow will be marred too
with footprints (already I see dog pawprints by the back door)
soot from car exhaust
and mud from the sludge of soaked soil underneath

but for now i am reborn
silent, in awe
like a puppy taking its first breath

8 Nights Of Hanukah, 12 Days Of Christmas And 13 Ways Of Looking At A Blackbird

It's the first night of Hanukah. I took my block 2 midterm this morning. In just over a week I fly back to California.

I want to celebrate with Wallace Stevens' poem "Thirteen Ways Of Looking At A Blackbird." I hadn't thought of this poem in awhile, but yesterday while composing my own (yes, I wrote "Frozen"), I remembered how much I had loved this poem and realized how well suited it is for December in Ithaca.

Thirteen Ways Of Looking At A Blackbird

I.
Among twenty snowy mountains,
The only thing moving
Was the eye of the blackbird

II.
I was of three minds,
Like a tree
In which there are three blackbirds.

III.
The blackbird whirled in the autumn winds
It was a small part of the pantomime.

IV.
A man and a woman
Are one.
A man and a woman and a blackbird
Are one.

V.
I do not know which to prefer,
The beauty of inflections,
Or the beauty of innuendos,
The blackbird whistling
Or just after.

VI.
Icicles filled the long window
With barbaric glass.
The shadow of the blackbird
Crossed it, to and fro.
The mood
Traced in the shadow
An indecipherable cause.

VII.
O thin men of Haddam,
Why do you imagine golden birds?
Do you not see how the blackbird
Walks around the feet
Of the women about you?

VIII.
I know noble accents
And lucid, inescapable rhythms;
But I know, too,
That the blackbird is involved
In what I know.

IX.
When the blackbird flew out of sight,
It marked the edge
Of one of many circles.

X.
At the sight of blackbirds
Flying in a green light,
Even the bawds of euphony
Would cry out sharply.

XI.
He rode over Connecticut
In a glass coach.
Once, a fear pierced him,
In that he mistook
The shadow of his equipage
For blackbirds.

XII.
The river is moving.
The blackbird must be flying.

XIII.
It was evening all afternoon
It was snowing
And it was going to snow.
The blackbird sat
In the cedar-limbs.

Frozen

frozen inside myself
all day long i have not spoken
one word
out
loud

i have not seen another
soul

birds, yes
(aren't they souls?)

house finch, chickadee
tufted titmouse chattering wildly
and the striking yet furtive white-breasted nuthatch

they keep me company

i feed them in this barren landscape
buried under snow

in return they unknowingly
keep me alive

i practice in my head
words i might say
hello?
how are you?
hi!

longing to connect
locked inside myself

I'm Going To Nevada With Rural Area Veterinary Services

On a day when it feels like my world is ending, it's grey, snowing, and I've spent almost the entire day sitting at home studying minutiae that isn't falling into place for me...

I get an email with a ray of sunshine. I got accepted to go on a RAVS trip to Nevada in March. I'll be working with a team of veterinarians, veterinary students and veterinary technicians to provide free veterinary care to pets on Native American reservations.

I can't believe I got picked.

I have one week to respond. I will think it over, but I think this is a go. Gets me out of Ithaca in the snowy spring and gets me going someplace I've never been before and working with people I've never met. Exciting.

Please G-d, just let enough of this cell-signaling, apoptosis and necrosis pathway stuff sink into my head for me to not be a total failure on my exam on Friday.

If I can only hang onto the feeling of hope for the future.

Getting this email makes me so happy I want to sing, so I put on one of my favorite songs to sing along to (only it makes me homesick for California and my friend LaMexicana who also loves Juanes and was surprised to hear me listening to him, white girl that I am)

A Dios Le Pido
I ask of G-d

Que mis ojos se despiertan con la luz de tu mirada yo
That my eyes wake up to the light of your gaze I
a Dios le pido
ask of G-d
Que mi madre no se muera y que mi padre me
That my mother doesn't die and that my father
recuerde a Dios le pido
remembers me I ask of G-d
Que tu quedes a mi lado y que mas nunca te me vayas
That you stay by my side and never again leave me
mi vida a Dios le pido
my life I ask of G-d
Que mi alma no descanse cuando de amarte se trate
That my soul never rests when it comes to loving you
mi cielo a Dios le pido
my sky I ask of G-d
Por los dias que me quedan y las noches que aun no
For those days that I have left and the nights yet to
llegan yo a Dios le pido
arrive I ask of G-d
Por los hijos de mis hijos y los hijos de tus hijos a
For the children of my children and the children of your children
Dios le pido
I ask of G-d
Que mi pueblo no derrame tante sangre y se levante
that my village doesn't shed so much blood and that will rise again
mi gente a Dios le pido
my people I ask of G-d
Que mi alma no descanse cuando de amarte se trate
that my soul never rests when it comes to loving you
mi cielo a Dios le pido
my sky I ask of G-d

Un segundo mas de vida para darte y a tu lado para
One more second of life to give to you and by your side
siempre yo quedarme
to stay forever
Un segundo mas de vida para darte y mi corazon
One second more of life to give to you my heart
entero entregarte
delivered whole
Un segundo mas de vida yo a Dios le pido
One second more of life I ask of G-d

Y que si me muero sea de amor
And if I die let if be because of love
y si me enamoro se de vos
and if I fall in love may it be with you
y que de tu voz se este corazon
and that of your voice this heart can be
todos los dias a Dios le pido
every day I ask of G-d

Out For A Walk In The Snow

It was sunny (SUNNY!) today and so I went out for a hike where I used to run before it snowed. I'm with Coral, my landlord's dog. (Over the years I have been blessed with sundry canine companions, none actually my own dogs so I never have any real canine responsibilities, just companionship for those long solo hikes and runs that I love to take. I look forward to the day eight or nine years down the road when I finish my schooling and will actually have a schedule that will allow me to be a good dog owner).

You might recognize the photo below from a photo earlier this year on my blog-- back then there were still leaves on the trees but it is the same trailhead. I took the shot of Coral because I didn't know if I would run into any other hikers to take a picture of me (but I did, as you can tell).

Collagen Related Diseases And Odd Facts About Guinea Pigs

I'm studying for my block II exam. It's not a disease course, but we are expected to know the diseases that arise from different molecular etiologies.

There are quite a few diseases having to do with collagen defects.

• Osteogenesis imperfecta aka Brittle Bone Disease or Lobstein syndrome results from a mutation in collagen type I that substitutes another amino acid for glycine (which is the simplest, smallest amino acid), and as a result the triplet of alpha helices which make up collagen cannot pack as tightly.
• Ehlers-Danlos syndrome can manifest in many different forms. The host of possible problems include abnormally flexible joints, loose joints, abnormally stretchy skin, fragile skin and blood vessels and poor wound healing.
• Dystrophic epidermolysis bullosa involves a mutation in collagen type VII, the anchoring type of collagen, which links the basement membrane of the epidermis to the fibrillar collagens in the dermis. There is a recessive and dominant form. The disease causes severe blistering and skin wounds heal extremely slowly.

As far as I can tell OI, EDS and DEB all affect both dogs and humans. I'm not sure about other species.
Note: Epidermolysis bullosa simplex is a disease of cattle (and humans) that involves a mutation in keratin 5. Keratin is an intermediate filament, not a collagen.

Scurvy is a disease that is caused by a deficiency of vitamin C. Humans get this disease because they cannot synthesize their own vitamin C. Vitamin C is a co-factor required for the hydroxylation of prolines and lysines on the alpha helices of collagen. Without hydroxylation, the alpha helices don't form the triplet superstructure of which collagen is composed and so you can't make collagen. This results in problems any place in the body that needs new collagen formation-- hence the resulting clinical signs of fragile skin and blood vessels, bleeding, loose teeth and impaired wound healing.

Guinea pigs and primates are the only animals that aren't able to synthesize their own vitamin C. (I can't find anything about guinea pigs' larger South American relative, the capybara-- which is the largest rodent in the world. I wonder if they can make vitamin C?)

So here are the ood facts I know about guinea pigs so far from vet school and the clinic:

• Guinea pigs are not able to make vitamin C and so must have it supplemented in their diet.
• Guinea pigs' bronchoesophageal artery often branches off the right subclavian artery whereas in dogs and other domestic species the bronchoesophageal artery branches off the right fifth intercostal artery (yes, that was in my block I notes on embryology)
• You should not use Clavamox or other cephalosporins in guinea pigs because it will affect their gut flora (I'll never forget an exotics vet that I did an internship with back in tech school ranting about a general practice vet prescribing Clavamox for one of her cavy patients)
  

From Sunny To Snow

This is me headed out on a walk this afternoon with my landlord's dog, Coral. I'm also testing out one of my new coats and found it works great (thanks!). It arrived just in time for today's snowfall.

Yesterday it was sunny and warm and snowless. I went for a hike after class with two of my classmates in an area that I discovered on my return from my Thanksgiving travel. Crossing the suspension bridge we had the view below:

I guess the weather changes pretty quickly here in Ithaca.

I composed the beginning of the following poem in my head after making a trip to the farmer's market this morning, heading home in the snow:

cocooned in confetti
white specks against a grey sky
falling silently

My post on blastomycosis generated more responses than I anticipated (not everyone posts comments, sometimes I get emails etc from those who know me). The lecture wasn't actually part of my cell biology course, it was open to the whole college. I don't know if we cover blastmycosis in our disease course, I won't take it until next year. The talk didn't go much into treatment so I had no idea it took so long to treat, thanks for the info, Ceres.

This was the first case of blastomycosis that has presented to the Cornell hospital in recent years. It wasn't treated as blastomycosis because no one realized that was the organism causing the dog's illness until the dog had died and was sent to necropsy (by the time this dog was referred to Cornell it was too late in the course of the disease to have any real shot at a successful treatment judging by the pathology report-- there were blasto yeast buds in the brain, not to mention everywhere else, and the dog was only hospitalized a brief time before death so those lesions were likely there on presentation). The reason that it was not diagnosed as blastomycosis was because the presentation was anything but classic. I wonder how many cases of blastomycosis are atypical and don't present with a cough? I was also impressed by how difficult it is to accurately diagnose blastomycosis-- I remember the resident saying that to get a sample one must typically do a lymph node or lung aspirate, that tracheal washes aren't usually sufficient. Yuck. It seems like a pretty nasty disease all around.

For those of you looking for some interesting reading, check out _The Medical Detectives_ by Berton and Boueche. It is a compilation of puzzling human medical cases and includes one that involved a systemic fungal infection. I won't tell you which one that is, I don't want to spoil it. I did get to show off though during my orientation week when the dean of learning picked this case to use as a model to teach us how to tackle problem based learning and I knew the answer. I kept quiet until the end of her presentation, after my classmates had taken their best stab at it, and then I raised my hand and gave the answer. It was quite satisfying, although she would point out that problem based learning is not about the answer at all but rather about the process. Bah humbug.

The Word Of The Day Is Gynandromorph And The Disease Of The Day Is Blastomycosis

In a conservation genetics lecture this morning (wrapping up our week of medical genetics-- never say vet school isn't fast paced) I learned of the existence of gynandromorphs-- animals that exhibit have both male and female sexual traits because they have cells with both male and female sex chromosomes. In the case of birds, gynandromorphs may have bilateral symmetry-- with one side of the animal having male coloring/features and the other half being female. This presents a problem in chickens because the male half of the head is much larger so the skull ends up being deviated to one side. I have pictures in my notes of a gynadromorph eclectus parrot and zebra finch ("Neural, not gonadal, origin of brain sex differences in gynandromorphic finch" Agate et al. PNAS 2003). Gynandromorphs arise from a non-disjunction event post-fertilization and are not viable in mammals but in addition to birds also occur among butterflies, insects and crustaceans. (Just for kicks, avian gynandromorphs have cells with the sex chromosomes Z and ZWW; a typical female bird has sex chromosomes ZW and a male ZZ. In insects and butterflies gynandromorphs possess sex chromosomes X and XYY whereas a typical male has sex chromosomes XX and a female is XY. Bilateral gynandromorphs arise from a non-disjuction in the first division after fertilization because unlike mammals, in insects the cells are determinate even at this earliest stage and each cell will go on to form the left and right half of the body respectively).

At lunch I went to a lecture titled, "Atypical presentation of a fungal infection in an upstate NY dog." It was a great medical mystery-- a thriller on par with the best whodunit. Of course, it is a bit of a spoiler when the senior pathology resident is one of the three speakers presenting on the case-- you kind of know from the get-go that the patient died and that the mystery was only solved post-mortem. I learned that systemic fungal infections are distinguished not just based on morphological or other features but that they are localized to specific geographic regions. Blastomycosis is a reportable disease in Minnesota and is also endemic to Wisconsin and parts of Canada. Needless to say the dog's history involved travel and the infection was not acquired in the Ithaca area. I also learned that one should never-- I mean NEVER-- try to culture Blastomyces dermatitidis in one's hospital as it will potentially infect everyone if it grows because it will convert from the budding yeast form which is not contagious to people to the hyphae form which is spread by inhalation. You can also accidentally inoculate yourself if you puncture yourself with a contaminated sharp instrument.

The presentation can be quite confusing. Treatment of choice is itraconazole and the dog often gets sicker in the initial days of treatment.

And finally, I ended my Friday in the farrier's shop. My favorite quotation from our hour of instruction-- when asked how much physical strength is required to do the job (note-- asked by a classmate and not me), the farrier responded by saying: "Women don't have the testosterone so they think their way through situations that men just bully through." Although the profession seems like it would require a bit of bulk, apparently 50% of applicants to farrier schools are now women and so that profession is seeing the same shifting demographic that has occurred in veterinary schools. Pretty cool.

Random Tidbit: How Spider Silk Forms And Why That Has Anything To Do With Prions And Alzheimer's

According to my notes, the formation of spider silk involves a conversion from the globular, alpha helical conformation of the silk protein to an insoluble, beta pleated sheet conformation of the silk protein. This is somehow accomplished by the spider "spinning" the silk protein.

You might wonder how this is highly relevant to veterinary medicine. It was cited in my notes on transmissible spongiform encephalopathies as another example of proteins changing conformation. The more clinically relevant example is the conversion of the prion protein from an alpha helical conformation to a beta sheet conformation that induces other prion proteins to change conformation, which leads to the formation of incredibly stable fibrils that accumulate in plaques visible on stained sections of diseased brain.

The formation of amyloid (insoluble plaques of the beta sheet conformation of a protein) is also a hallmark of other neurodegenerative diseases, such as Alzheimer's disease and Huntington's disease. Although not my area of expertise, I worked in a lab that studied Alzheimer's disease and so am familiar with both it and prions circa 2000 or so. (In fact, geek that I am, I used to have a depiction of the prion protein from a biochemistry article hanging in my bedroom in college-- at least I put up artwork then. Now my walls are bare).

I'm surprised to learn that there haven't been any significant breakthroughs in either field since my college days. The closest we've come to a treatment for prion diseases is curing yeast of a prion-like protein, the extrachromosomal element PSI+. The experiment identified a chaperone involved in thermotolerance in yeast that was able to cause the PSI+ protein to convert back to its normal conformation. It's a long way from yeast to mammals and this was all work done before 2000.

Among many unanswered questions in the field, the one I most expected to be answered by now was what is the role of the normally folded prion protein in the body? Genetic knockouts didn't show any abnormalities so this remains a mystery. But prions are conserved in all vertebrates so they must have played an important evolutionary role at some point in time.

On a simpler note, one thing that I've never understood-- prion stands for proteinaceous infectious particle. How does one get prion out of three words that have the acronym PIP?

Perhaps tomorrow I will write what little I know about Alzheimer's disease.

Oh yeah, in case you are wondering what falls under the category of transmissible spongiform encephalopathies:

Creutzfeldt-Jacob disease (familial and the sporadically occuring variant), which is the same as Kuru
Bovine Spongiform Encephalopathy aka "Mad Cow Disease"
Chronic Wasting Disease (found in cervids-- deer)
Transmissible Mink Encephalopathy
Feline Spongiform Encephalopathy
Gerstmann-Straussler-Schneinker Syndrome
Scrapie
and my all-time personal favorite--
Fatal Familial Insomnia

Lucky White Rabbit Numero Dos

Last time I posted a picture of a white rabbit on my blog I had to go looking for one. This one just fell into my lap. Well, kind of. I'd explain but I can't. Let's just say I got to spend the evening doing physical exams on animals that were not patients at Cornell's hospital or part of the low-income clinic and leave it at that.

If that sounds scintillating, then you'll probably drool over my plans for tomorrow evening-- practicing suturing! As anyone who has had to learn to suture knows, it's not nearly as easy as it looks. I've actually sutured live animals before-- it's allowed for licensed technicians to suture skin under the practice act in California. I'm hoping that if I get in a good review tomorrow night then the veterinarians will let me suture on the shifts I picked up over winter break.

Did you notice my hair cut? I can't decide if I like it-- short is easy and my motto is no muss, no fuss, but my identity is all wrapped up in having long hair... A lot of my classmates have complimented me on the new look, which is nice. Although several people think it makes me look younger!&($%@

One more funny thing-- the car I parked next to in the vet school parking lot this morning had a bumper sticker that said, "Ithaca, 10 square miles surrounded by reality." That made me laugh. EB and D always used to say that Northampton was La-La land. I think Ithaca is even more out there. At least someone else had a similar thought-- enough so to make a bumper sticker.

Fun For The Whole Family

That's me with EB, D and a very squirmy Ianite over Thanksgiving vacation. And a photo of Ian and his dad in which you can actually see Ian:


Here Ian is walking around with a block, showing off one of many pieces of canine-themed clothing I purchased for him back in California.


I wish I could have another two weeks of vacation. It was great to see my parents, EB, D, Ian (he's a real little person now, no more baby) and their finally renovated new old house.

It was also great to get out of Ithaca even if just for a few days. The sun is so much brighter in North Carolina! (Just before I left I began using a light box to try to make up for my sunlight deficit so hopefully that will help me continue to feel good now that I'm back).

Not to mention that I made out like a bandit-- I got my mom and dad each to buy me a piece of warm winter clothing as a holiday/early birthday present and my mom also gave me a book that I love even though I am only a few pages into it-- Something for the Pain: Compassion and Burnout in the ER by Paul Austin. It's tales from human emergency medicine-- hauntingly similar to veterinary medicine in some respects and completely different in other ways. I'm riveted.

Thanks everyone!

Round One: I Advance

I got back my final exam yesterday, but waited to open it until this morning. People were opening theirs in the hallway at school and there was a lot of talking about grades and how people did and how they felt about how they did. I don't think there is anything wrong with this sort of thing. But I was certain I did badly and didn't want to show my emotions at school. Then, last night, before going to bed, I was worried it would keep me from falling asleep if I looked.

Needless to say, my classmates and roommate were shocked by my self-restraint. Last night as I sat studying at my desk, my roommate asked inredulously, "You mean you don't know what grade you got yet?" And I said calmly, "No, I haven't looked."

This morning I woke up with butterflies in my stomach. I ate my cereal, fed my cats, and took out the thick manila envelope.

I was shocked. I got exactly the grade I was aiming for. Not an A, but a very respectable grade at Cornell. The class average was a C, and I wanted to be above that.

I have no idea how they graded as I am certain that my raw points should not add up to my grade, but I'm grateful.

I think I'm most proud of my laboratory section. There are many people who said they scored roughly 50% on their lab portion. It was incredibly difficult. People were crying during it. I started in the hardest section of all and was just trying not to panic for the first hour. Even now, people are talking about how they left that section almost entirely blank. Well, I struggled to put down an answer for everything, even when I had no idea what I was looking at, but I really felt like it threw me for the rest of the exam and like I was so shaken I could barely think. But I did perform well under pressure (my lab % was 75%, pretty amazing).

In other news, I've been feeling really sad lately. Depressed. It could have something to do with daylight savings and be related to seasonal affective disorder. There's other things going on in my life that have made me feel sad, but I don't want to go into them here.

I'm now solidly into block II, Cell Biology and Genetics. I like basic science a lot. We're currently studying cell signaling, which is super complex and kind of confusing but I am trying to focus on the major themes. When we started the section on cell-signaling this week our professor put up a slide of a painting by Hieronymous Bosch and said we might feel like we've entered one of his paintings and arrived in a very strange world filled with minutiae. He then put up another slide by Bosch, of Saint Anthony being tortured, and said that we might even feel like our professors are trying to torture us just like Saint Anthony was suffering in the painting. Kind of bizarre. I know the pathologist I worked for over the summer is famous for saying to students, "This isn't meant to be mental torture." Maybe this guy thinks the opposite. I certainly hope our final is not as brutal as the one I just got back, I don't want to take another exam that hard for a long time!

East Coast Medicine

There are certain diseases and problems that are more common in certain regions of the country. California is famous for foxtails. I've seen them in just about every place imaginable, including in the urethra of the penis of a 12 year old blocked cat (that was an unusual blocked cat case just to prove you never quite know what to expect even with something you see all the time).

In the Bay area I also saw a lot of snail bait toxicity, specifically metaldehyde toxicity. And quite a bit of hyperthermia (the only time we ever closed the doors to the emergency clinic was on a weekend where it stayed over 115F and we literally had no more room for bodies, dead or alive, pretty horrific).

Things on the East coast are a little different. For example, I'd never seen a dog with a face full of porcupine quills before I came here (the paws were covered too).

Today I went to an emergency medicine lunch lecture titled "The Perils Of Winter." The speaker covered hypothermia, ethylene glycol toxicity and house fire (for reasons I do not completely understand, house fires are more common in the winter).

I guess winter emergency medicine will be a whole new brand of medicine for me. I haven't seen an ethylene glycol toxicity in quite awhile, California had the good sense to mandate that manufacturers add a bittering agent to any product sold in the state. In fact, a similar proposal is currently on the table nationally, HR 615, but apparently only Republicans support it so far????? Here's another article I found on the subject, "With antifreeze, bitter is better." It seems crazy to me that such legislation has yet to be passed when ethylene glycol toxicity has killed children, not just pets, who ingested even tiny amounts of the sweet substance. When I have time maybe I'll write to my representative and voice my opinion on the matter. I encourage you to do the same if you are at all so inclined.

In other news, I've started block 2. Cell biology. Lots of my classmates are whining about this class but since I love basic science I am enjoying the material.

I'm still learning lots about cows, and other species, but not allowed to post any pictures.

And tonight I went to the low-income clinic again and saw some interesting cases but can't write about the details here. It is nerve-wracking seeing a patient with no one to follow you up. I feel like I must be missing something important every time I do a physical exam and can only hope that I'm not missing anything important.

And the rumor is that if the administration hasn't contacted you yet then you passed your exam and are not on academic probation. I don't totally believe it-- and I won't till I actually have my exam back, but every day that passes works in my favor and means it is more likely I was in the passing range.

Survive And Advance

One of the second year vet students likened vet school to an NCAA tournament. He said, "The goal is to survive and advance [to the next round]. How much you win by does not matter."

I've achieved step one-- I survived block I, and all five days of my final exams. Now I have to wait two weeks to see if I advance to the next round. At this point, I don't care if I get a D or an A as long as I pass. Of course, it is preferable _not_ to be on academic probation, but the end result is the same if I get a D or an A-- I advance.

I've posted the picture of me with a white rabbit because I don't want to be outdone by my sister. She thinks she can keep up with me by posting some photos of her and her daughter with a plastic cow. So I had to find a white rabbit (his name is Gideon) to prove I can keep up with her photos of my niece with a white rabbit!

Now, let's hope I can pull a passing grade in this class just like I pulled this white rabbit out of a hat!

One Down, Four To Go

I got one exam out of the way today in my five day marathon of finals. It was the written part for the clinical portion of my course, called Veterinarians and Society or something rather silly sounding. Basically, we begin to practice physical exams on a variety of species, gain experience working with dogs, cats, cows, horses, pigs, sheep, goats, chickens, rabbits-- you name it, and learn a little bit about various sundry other topics from practicing doing ultrasounds to practicing a cranial drawer.

It wasn't too bad, which is good, as I didn't expect it to be. It wasn't exactly easy either and I definitely need to work on some things before my oral exam/clinical skills test on Thursday morning.

I studied this evening with a classmate, working through last year's final that our professors gave us access to online. It was HARD! It made me a little nervous about passing, which is something I haven't worried about too much since my midterm.

I had to laugh about some things though. We reminisced about our fondest memories from the semester. Mine is definitely from gross anatomy lab when we were dissecting the inguinal canal (in the female the external pudendal artery and some fat passes through the inguinal canal, and there is a superficial inguinal lymph node externally that drains through the inguinal canal; in the male the testicular artery and vein, ductus deferens and lymphatics pass through the inguinal canal). I-- along with the rest of the class-- was very confused about the vaginal ring, basically an outpocketing of peritoneum that wraps around the structures in the inguinal canal. I was having an argument with my gross lab partner about whether anything goes through the vaginal ring. She adamantly insisted nothing passed through the vaginal ring. This did not appear to be the case to me on gross inspection (I have since learned what one thinks one sees can actually be very deceiving) and so I went to ask one of our professors circulating in the gross lab about this. The professor I addressed is a very famous, old school anatomist. In the words of another very famous professor, 'He is a big muckety-muck.' (I like that phrase). The following conversation took place:

Me: 'Dr., what stuff goes through the vaginal ring?'
Dr. Big Muckety-Muck, exploding, 'STUFF!!! There is NO "STUFF" in anatomy. NEVER say STUFF. AND NOTHING GOES THROUGH THE VAGINAL RING.' (spitting in my face with his vehemently delivered reply)

I think for the rest of my life that dramatic exchange will be a memory that stays with me. And I will never forget that nothing goes through the vaginal ring, it is the wrapping that forms the vaginal tunic for the testes (quite suitable as vagina means sheath).

A few days later classmates in my tutor group were discussing what structures passed through the vaginal ring. I told them nothing, but they didn't believe me. But I was right and for once I was dead certain of it.

I think I will pass on a few wise words of advice to next year's class. Among them, use Konig Liebich's veterinary anatomy text for the larynx and use Pasquini's anatomy text for the reproductive system, in particular, a careful study of Pasquini's image of the spermatic cord and vaginal tunic will head off the massive confusion experienced by my class. Or perhaps I shouldn't pass on these words of wisdom as they will not get to experience the fun I had laughing over these trials and tribulations.

And now, back to histology and then more reproductive anatomy.

After all, I have to know my 'stuff' :)

Addendum: It occurs to me that what I wrote might come off as seeming like I don't like Dr. Muckety-Muck. Rather to the contrary. He is very helpful, kind and totally dedicated to teaching. However, it took me some time to realize that he is also rather dramatic and to not be intimidated by his style. And, as my study partner commented, 'He would never say stuff because he has a Latin term for EVERYTHING!' So true. Only in vet school can one appreciate the usefulness of knowing every bump on every animals' body and that is why Dr. Muckety-Muck is so amazing.

You Know Finals Are Near When...

1. You sleep through your alarm and in your haste to get out the door on time, you put your shirt on backwards and don't realize it until after lunch. (That was last Friday).
2. You sleep through your alarm again on Monday, even after sleeping in all weekend (perhaps because you are so used to getting up at 6 am that you don't ever sleep past 8 am even on weekends).
3. You have no milk so you have your granola cereal with water (Monday and Tuesday).
4. You eat all the buffalo stew you made and start in on the frozen dinners (Wednesday).
5. You forget/mis-remember a good friend's birthday (sorry!)
6. You don't understand your own cryptic notes. I looked at something I had scribbled in the margins during a case presentation-- LR6SO4-- and could not figure out what it referred to. It had once made perfect sense to me, so much so that I wondered why our ophthalmology professor had said it was the last thing her resident said to her before walking out the door to take his boards. I remember thinking it was so obvious that no one would ever need a mnemonic to remember it. After much searching, it stands for the extraocular muscle innervation. Cranial nerve VI (abducens nerve) innervates the lateral rectus and retractor bulbi. Cranial nerve IV (trochlear nerve) innervates the dorsal oblique (superior oblique). Cranial nerve III (oculomotor nerve) does everything else. And so LR6 stands for lateral rectus muscle cranial nerve VI, SO4 for superior (dorsal) oblique muscle cranial nerve IV. All this to help me try to remember on tomorrow's test that abnormal deviation in the position of the globe of the eye can look like ventrolateral strabismus (lesion involving oculomotor CN III), medial strabismus (lesion involving abducens CN VI) or rotation of the globe (trochlear CN IV), which can be difficult to see if the pupil is round because the deviation in the position of an elongated, ellipsoid pupil is the easiest way to assess whether the glove of the eye is rotated (otherwise one is forced to look at the position of the retinal blood vessels on the back of the eye, the fundus). All that just for the eyes! And cranial nerves are just a small part of a neurological exam, there is so much more to the nervous system and so much more to just a basic physical exam (especially when one considers species ranging from chickens to alpacas to cows)!
   

Pre-Exam Drudgery

I've been studying since noon, it is now past 5 pm. I'm about to eat dinner and then head into school to meet up with a classmate to study for a few more hours.

I'm tired of studying. On the up side, I got to spend the afternoon at home curled up with my cats.

On the down side, I have a stack of flashcards a foot thick.

I'm busy re-learning all my large animal terminology that I once memorized for tech school and then forgot. Wether is a castrated adult male goat. Farrowing is when a pig gives birth. Etc.

I'm also reviewing all my histology. From Peyer's patches in the ileum to arcuate arteries in the kidney.

Last night I did get a bit of a break. Where was I last night? On the necropsy floor. I like necropsy. It's interesting. It's also a break from spending every evening studying.

Back to the grindstone.

My first exam is Friday. I then have exams the following Monday, Tuesday, Wednesday and Thursday.

There are moments when it is grey and rainy and I have been studying all day when I wonder why I didn't choose to go to a vet school in a warm, sunny location. Or a vet school that gives multiple choice exams (seems like they all do except for Cornell).

Instead I am about to experience one of the most grueling and infamous exam periods of any vet school in the country.

Addendum: My favorite word of the evening-- 'British term for a yearling sheep of either sex.' You guessed correctly if you guessed HOGGET. Uh huh.

Picture Perfect Weekend

We had lovely weather this weekend-- warm and sunny. I was studying most of the time but did get outside to go to the farmers' market and for a run. Above is me last weekend at the farmers' market with my friend FishVet, also from California, who is going to be a fish veterinarian (you guessed it).

Below is my house and another view from my window.


One week till finals. I'm trying to remember everything I learned. My favorite today-- when asked to name the specific area of the superficial leaf of the greater omentum where the short gastric arteries run from the spleen to stomach and I was able to say, gastrosplenic ligament. There is also apparently a duodenocolic fold or ligament. Who knew?

I've been enjoying cooking with my crock pot. It's perfect for my busy schedule. After doing a buffalo stew last week I am preparing to do a lamb with green tomatoes stew this week.

Fall In Ithaca

Above: The view behind me as I pulled out of my driveway at 6:30 am Friday morning to go to school.

Below: The view driving up my road to come home from school Friday afternoon.



Above: The view looking down from the road onto my favorite running trail's entrance taken this afternoon (Saturday) on a study break when I went for a run.

Below: The view running back towards the trailhead at the end of my run.


Below: Me at the trailhead with a German shepherd belonging to a hiker entering the trail-- for the entirety of my run I was the only person on the trail!




Above: The view out my bedroom window behind my desk of the fiery orange leaves of a tree in fall.

Below: Simon and Lindy curled up on my bed.

Week 9: First Patient, First Snow

I spent the afternoon practicing physical exams on horses. I was mostly listening to gut sounds, but here it appears I am ausculting the heart or lung sounds (or both!)

Last night I had the opportunity to be a student clinician at the low-income veterinary clinic run by Cornell for the first time.

Today it snowed for the first time.

I'm tired. I miss the sun and warmth of California.

I am busy learning all the muscles, nerves and vessels of the limbs.

12 more days till my first final!

Week 8: Back In The Saddle Again

Above: Me in my bovine abdomen lab today. One of my professors commented that I must enjoy the hands-on labs because I smile so much during them. It's true. Like he said, I like getting to actually touch the animals. I miss working. I miss putting my hands on a patient. I know I picked the right career because I am happier doing it than studying!

I'm in the middle of week 8 and it's back to the frenetic pace of the first semester of vet school after a luxurious long weekend.

So what have I been up to lately?

• New York State Veterinary Conference-- I went to a session geared towards students and learned some of the pluses of being in a small, rural practice and of owning one's own business, both of which I hadn't given serious thought before.

• I also attended a fabulous talk by Dr. Bonnie Campbell, DACVS who spoke on the "Amazing Omentum." The omentum facilitates hemostasis, releases angiogenic factors (new vessels invade omentalized tissues within six hours), releases neurotropic factors that promote re-innervation and help modulate pain (algolytic products), is involved in immune surveillance and can absorb fluid via peritoneal lymphatic drainage (thereby acting as a physiological drain). To take advantage of all these amazing properties, one can increase the size of the omentum by releasing the ventral leaf from where it attaches to the greater curvature of the stomach or one can reflect the omentum cranioventrally and release the dorsal leaf from the dorsal body wall. To further elongate the omentum one can make an L shaped incision in it. One then places the omentum over the desired site or you can even tack it in place. One can tunnel omentum through subcutaneous fat to non-healing axillary wounds. One can even omentalize the brain and spinal cord. Pretty darn cool.

• I helped paint part of the OTS house as my pledge promise. Friday is my initiation. All I know is that I am supposed to wear coveralls. Only in a veterinary fraternity does one have to wear coveralls to events.

• I went to the farmer's market and bought a ton of vegetables and made a vegetable stew kind of like the ones I enjoyed so much in San Jose last fall. I got to test my brand new crockpot, which is great because I don't have to pay any attention to the stew while it is cooking (I've been a bit of a space cadet in the kitchen lately and that has posed something of a fire hazard).

• I enjoyed the cat-dog interactions in my house, watched the cats and studied while the cats and dogs watched me and the whiteboard I draw on intently.

• I tried to get outside and enjoy some of the good weather that we had on Saturday.

• I got a flu nasal spray in an effort to try to avoid the seasonal flu this year (the H1N1 flu vaccine is not yet available).

• I caught up on sleep.

• I got in some nice runs on nearby trails.
  

Bovine Fundic Exam And End Of Week 7

You might get the idea from looking at these photos that examining the eye of a cow is not easy. Well, that's not true. I'm just a novice though. And direct ophthalmoscopy (which I am practicing here) is much harder at first than indirect ophthalmoscopy but apparently indirect ophthalmoscopy is not frequently used on cows.

I was able to see the blood vessels on my fundic exam but a little disappointed that despite several attempts I could not visualize the optic disc and white stringy thing coming up from it whose name I forget but which is an embryonic remnant of the vessel that fed the lens I think.

In other news, I finally got my midterm back and so have a feel for how I am doing in the course, which is just fine, and so am much relieved. Up until yesterday, professors kept asking me, 'So how do you feel you are doing?' and I would say, 'I honestly don't know. I'm lost in the abdomen' (which is what we are currently studying). What I really felt like saying was, 'Isn't it your job to tell me how I am doing?!' I mean, after all, for most of my academic career I got frequent evaluations. But Cornell does not believe in that. Exams are few and far between. There are lots of thought provoking questions in class and in the worksheets in the Modular Resource Center but never any answers. We are supposed to learn to decide for ourselves how we are doing and to evaluate for ourselves the level of detail to which we must delve in order to be good clinicians. Needless to say I find this quite challenging (euphemism for frustrating).

This afternoon I got my first chance at ultrasound, on a dog abdomen. I LOVED IT! After all these years of watching ultrasonography, I had a feel for what I was doing and was able to quickly find all the structures that the radiologist asked me to look for (quite rewarding) though I wanted to hunt for the pancreas, unfortunately others wanted a turn and I had to let that go.

Now it is back to the books. I have a short break this weekend and I will probably spend most of it studying as the weather has now really turned cold (New Yorkers of course laugh when they hear me say that as they consider this 'early fall' weather). I am going to look into finding a swimming pool I can use, that is my next project outside the classroom.

Week 6: In The Small Animal Hospital And Pig Handling!

Here I am today in the small animal hospital with a classmate from California! I have blacked out my patient's eyes to protect his identity (actually, this dog belongs to another classmate of mine so I do have permission to use the photo :)

Below: The sunrise and sunset have been pretty spectacular lately. It's hard to tell because it is blurry but on the way to school this morning there was an orange sky below the grey clouds, with the mountains below.


This evening was not quite as eery. It was a lavender and pink sky instead of the pumpkin orange of the morning (taken in the vet school parking lot on my way to a dinner break).


Yesterday I learned about handling pigs. I was lucky to get to go onto a pig farm as the large commercial operations have such strict biosecurity that they do not allow vet students to visit. The reason? Pigs are at a high risk of contracting the flu virus from people and such transmission can be devastatingly costly to a pig farm.


And here I am with my classmates getting ready to enter the farm:


Vet school week 6 is almost over. The pace continues at breakneck speed. Tidbits from some conversations today:

Classmate (owner of dog in photo above): "I try to stay on top of my workload and not get behind. But it's hard. It's like trying to keep your head above water when you keep getting hit with big waves."

Me: "I don't have a game strategy. I'm always behind. It's not like keeping my head above water. It's more like not breathing when you're underwater the majority of the time!"

She laughed good naturedly or maybe she actually thought I was funny.
*
Conversation in the library at 9 pm tonight--

Me admiring free hand drawing of collateral circulation to the stomach and commenting on my classmate's phenomenal ability to picture things three dimensionally.

My classmate: "Well, yes, just today I was picturing what it would be like to walk down the esophagus and all the structures I would encounter along the way."

Second classmate overhearing this: "I was imagining myself as a dorsal mesentery sliding down and becoming the bursa [of the omentum]."

Yes, people, there is a reason that I do not fit in. It is because I do not think like this. I need to learn to be more 3 dimensional and less square!

Update On My Angel Lindy

Lindy has a cyst on her left kidney. It is big enough to initially make it appear on as if her kidney is lying in her bladder on ultrasound. But nope, as she does not have two bladders then one is the cyst containing kidney.

Not sure what this means but it appears it is not compromising blood flow to her kidney and so can be left alone.

She had some fluid retroperitoneally so I may be giving her too much subcutaneous fluids??? and am going to cut back a little.

Her blood work was much better than I expected and she is not as anemic as I feared.

The echocardiogram will have to wait till a day when the hospital is not as busy. No big deal as her heart murmur is very low grade.

I'm happy to have her back at home after a long day (for her) in the hospital.

Below: One gets very sleepy when one is kidney failure! (Lindy sleeping on the screened in porch on a warm towel I had just taken out of the dryer to entice her to curl up in the warmth of the sun). But there is always Simon to get in the way (as in the photo at the top of the page where he is about to jump in from the background) and plenty of interesting things to watch out the window... see below

Rites Of Passage

Today I took my first midterm. I have no idea if I passed or not. All I can say is that it was very hard and I am exhausted from taking it.

It's now definitely fall and we had our first frost the other night.

I'm settling into life here but there is little to report. I study, I eat, I sleep. I hope to figure out a way to start running or swimming again soon.

It's a pretty solitary existence, but I don't mind it. The pace is relentless, but without the added stress of moving all the time I'm hoping the second half of the semester will feel slightly more manageable.

Tomorrow Lindy goes into the vet for a work up complete with abdominal ultrasound and echocardiogram. I'm not terribly optimistic and feel I am already doing everything possible for her but I'll get to find out in more detail how she's doing and if her treatment needs to be modified.

Bovine Handling And End Of Week 4

This is me trying to get a pulse rate on a cow by palpating the coccygeal artery, on the underside of the tail-- I'm counting and watching the second hand on my watch, which is why I look so intent on what I am doing. So far it's been a lot easier to find a coccygeal pulse on a cow or horse than on a dog (which I was sometimes forced, by unusual circumstances, to do in small animal emergency medicine).

This is me listening to the heart. I've been getting all kinds of practice lately at ausculting heart and lung sounds in different species. I also got some practice at 'pinging' the cow's side to ascertain the location of air in the abdomen. And finally, I got to strip some milk (I think that is the right way of saying it).

I really like working with cows so far. They are gentle and curious. It is amazing how much you can do from their back end-- in fact, they don't care to have their faces touched but you can practically do an entire physical exam without having to go near the head (well, not quite, but you can get a whole lot of information just from the rear end-- pulse and temperature as well as hydration and capillary refill time from the mucosa of the labia).

Week four of vet school is almost over. I've heard the fire hydrant analogy for medical/veterinary school (it's like trying to drink from a fire hydrant instead of a water fountain or something similar about the amount of information one has to ingest). My best description would be that it is like running on a treadmill that is constantly being turned up. (Those of you who know me well know that I love running, albeit not on a treadmill). This summer I watched horses running on a treadmill (for research) at 80%, 90% and 100% of their maximum effort (based on prior data gathered for their baseline heart rate etc). I've felt since about the end of the second week like I was running at maximum effort. Yet at the end of each week I feel like the speed is turned up a notch. I'm running harder than I've ever run before. Just when I think I've hit my stride and caught my breath and adjusted to the new pace, which feels like all I can handle, they throw a whole bunch more at us. This weekend is the beginning of our comparative anatomy labs, which they set up and we teach ourselves on our free time. I know where I'll be all weekend if anyone is looking for me...

Love At Every Sight (Not Just First Sight)

That's my angel, Lindy and my menace, Simon, curled up on my bed when I got home from school yesterday while it was still light. (Can you guess which is which? Hint: Simon, as usual, looks mad or at the very least suspicious). The house is usually empty, but seeing the two of them curled up together always melts my heart and cures any loneliness.

It was already getting to be dusky. Below is a blurry shot of my room. I will decorate at some point. I kind of like my spartan existence though.