Block 4: Off To A Rollicking Start

Monday morning started with me sleeping through my alarm. Really. On the first day of the semester. Off to a great start already. Luckily I naturally wake up early, around 7, so I wasn't late for class.

I had a dream Sunday night that I had a bad outbreak of a nasty virus that has turned out to be the subject of several lectures this week. A rather strange coincidence that my dream portended the subject of the virology lectures.

Just because I made it to class did not by any stretch of the imagination mean that I was awake. In the second lecture of the day one of my classmates asked the professor to slow down so he could copy his slide. I had no idea why since we had been given notes that were an exact copy of the lecture slides.

It was only last night that I realized this is what was written under innate immunity on the second slide:

h17ct klllng
hi nlkzti n
hn 1kc c kti n

And this on another slide:

k117lzktkv 7 c
k1h7t k 1c h 17c 71
1 h kl c 71

Needless to say I had to copy this section of the notes from a classmate! I guess that's what happens when I don't read the notes before class and am not awake for class. Not sure how the letters got all scrambled but that was quite confusing gobbledygook.

The amount of material in this block is, as promised by upperclass students, completely overwhelming. And very detailed. For example, in this same soluble protein lecture in the innate immune system series mentioned above, there is a sentence in the section on lactoferrin that says:

Contains a loop structure with a basic α-helical domain whose primary sequence is very similar to frog magainins.

Frog magainins??? Thank goodness for google! A frog magainin is an antimicrobial peptide. Who knew? And do I really need to know this level of detail to be a good practitioner? This is the problem with having researchers lecture to you-- they are so detail focused and not as clinical. Oh well, it's interesting at least.

I remember last year one second year describing her feeling of being overwhelmed in block 4 as feeling like she was lying at the bottom of a swimming pool staring up. This is not inaccurate. I've talked to several of my classmates who haven't even started studying yet because they don't know where to begin. So overwhelmed we're paralyzed. Vet school is fabulous!

On top of block 4, we also have a parasitology class. Both classes have weekly online quizzes. Our professor generously put up a mock practice quiz for parasitology. I got a 2/10. Yikes. I compared scores with my classmates and found several other people who made a 2, one with a 3 and one with a 4. I might have to crank up my studying. Sigh.

More Ithaca Sky

This top one is my favorite. It is a classic Ithaca sky. It is amazing the contrast of greys. You can say it is a grey day, but there are definitely many shades of grey in Ithaca!

And some taken leaving the vet school parking lot:

We've also had some amazing sunsets lately:

Aesthetics Of The Farmer's Market: Your Input Needed

I'm going to print some of my farmer's market photos and frame them and hang them in the kitchen. (Taking photos at the farmer's market has become a relaxing pastime and I even met another woman there taking photos too for the first time this weekend. It was a soothing afternoon diversion after euthanizing Lindy Saturday morning).

These are the three I am thinking of printing as 16x20-- the top two would go on one side and the honey one on the opposite wall which is not as prominent visually.

Of the others, I was thinking about printing five 8x10s-- I have put them in order of my preference from top to bottom but am curious which ones you like best.

Goodbye My Sweet Angel

I euthanized Lindy this morning. It was very peaceful. We tried to do it on my bed but we couldn't place a catheter because she had some weird bleeding diathesis and formed a huge hematoma whenever we poked her. So we took her to the ICU for catheter placement.

I euthanized her in the quiet room reserved for euthanasia. I stroked and kissed her head while her doctor injected propofol and her head slumped into my hand. Then we gave her a massive overdose of barbituates. I didn't expect to cry but I started to tear up and cried the whole way home.

My only regret is that I did not have the strength to let her go a day or two earlier. She definitely had a lot of pleural fluid again on Friday during her echo even though we had tapped her Wednesday night. I am sure it was not comfortable for her to breathe her last days and I regret that I kept hoping she would get better and just couldn't give up that hope until this morning.

She was only 9, but she'd been in renal failure her whole life and so had quite a long life for a renal failure patient. I had been giving her fluids for the past three years, every day. She just hadn't been right this fall, she was so weak and vomited frequently and was inappetant. I felt certain it was her time.

I never did find out what caused the pleural effusion and Lindy to fail as a result. The echo was showed a normal heart with mildly decreased contractility but normal cardiac output, wall thickness and atria size. The other differentials are some kind of cancer (lymphoma, mesothelioma), vasculitis secondary to the uremia or pressure from the pseudocyst on her kidney causing blood to regurgitate back into the aorta and leak that way.
*
Dear Lindy,

I will miss you so much. You were such a sweet cat. You never once tried to scratch or bite me even though I poked you with an 18 gauge needle multiple times a day for years and poked your neck and bladder frequently for blood and urine samples. The worst thing you ever did was wiggle a little when things really hurt, like when we tapped your chest the week you died.

I will miss your deep purrs, how you liked to crawl under the covers and curl up next to my chest at night. The way you curled one side of your lip up in a smile when you were happy to see me. The way you always wanted one part of you to be touching me, whether it was your paw on my leg, your side against my arm or your the tip of your tail just touching my hand.

It is so unfair that you had to suffer so much in life, sweet girl. You were very stoic right up until the end, eating, drinking, grooming, cuddling, going outside to lie in the sun and sitting in the window looking out.

You taught me so much about what it means to care for a sick pet and that will be invaluable to me when I become a doctor and will help me to be compassionate with clients in similar situations. Thank you for teaching me about how important it is to be an astute observer, how even an astute observer can miss the subtle signs of dyspnea and how difficult it can be to make a decision about euthanasia when what is going on is a mystery.

I will miss you and love you always.

HT

Gratuitous Cute Puppy Picture

Me at Felicia's Thursday night for the gay graduate student night with a very cute labrador x hound puppy, only 9 weeks old!

Tennis Star At Work

Today I went to see one of TennisStar's matches. She won. Of course :)
She is really an awesome player, especially for just starting high school.






















Above: Moose. Big and goofy.
Below: IntrepidHomeImprovmentMom and Moose.

Done With Block 3b!!!; Found Out My Angel Is Dying

Above: Me with a beautiful male Eclectus parrot at the house of a woman who sold me a bunch of iris and daffodil bulbs (another Craigslist find:)
Below: Beautiful apple tree on a crisp, clear day.





Above: More typical upstate New York scenery.
Below: View of Ithaca coming down route 79.




Above: Houses around Ithaca.
Below: Road near my house on a grey fall day.



Above: Ithaca scenery on a grey day.
Below: I've realized that even on the greyest of grey days, if you look hard enough you can almost always find a small patch of blue sky at some point during the day. I hold onto those glimpses of blue with my whole heart.




Above: Tumultuous sunset, with the sun peaking out beneath the grey.
Below: Barn next to my house on a sunny day.
Below: Cats cuddling on my bed, so sweet. I guess Simon makes a good head rest!


I found out last night that this is probably Lindy's last weekend of life. I had noticed that over the last week she had been intermittently dyspneic but the signs were so subtle that I wasn't sure that I wasn't imagining it or that it wasn't stress because it mostly happened when I was giving her fluids. And I'd look over at her again a few minutes later and she'd look totally eupneic.
Then Tuesday night when I was giving her fluids I noticed marked abdominal effort with her breathing. I knew this was bad but I chose to go to bed instead of taking her into the ER because I wanted to get some sleep and take my final. In the morning she looked fine to me again, and she also looked good in the afternoon. But I was supposed to go to North Carolina tomorrow morning and so I decided to run her into the hospital and get a weight and a quick once over from her wonderful resident doctor.
When I got there, her doctor palpated both a very cranial bladder and a caudal bladder. Obviously she does not suddenly have two bladders! She had had a small pseudocyst on her bladder last year and so she suspected hydronephritis.
We took her to the ICU for a quick ultrasound. Sure enough, she had a huge pseudocyst surrounding her right kidney.
We decided to scan her chest while we had the ultrasound out and she had a large amount of pleural effusion. We ended up tapping her chest and getting 340 ml off the left side!
I felt so guilty for not taking her in earlier. She must have been having trouble breathing for at least a week. How awful.
I always feel doubtful of owners who come in and say they just noticed their cat having trouble breathing last night when there is significant disease. But from now on I will be much less judgmental-- cats really can hide disease incredibly well.
We suspect that Lindy has heart failure and so I have not given her any fluids since yesterday. I expect to euthanize her on Saturday morning because she will dehydrate rather rapidly without fluids (she was getting 250-300 ml subq a day, but if that sounds like a lot she is a BIG cat).
Since I'm not certain that she has heart failure and I want closure before I euthanize, I am going to take her for an echo Friday with one of the cardiology residents. If she by some miracle doesn't have heart failure and does have lymphoma, I would treat her. But I'm not holding out much hope.
I'm going to spend most of the day lying in bed reading with her and sitting in the sun outside if she wants to go out.
So now that I know death is so close, Lindy can do whatever she wants. Which means standing on my computer whenever I sit down at my desk. This is one of her favorite things to do, and it usually drives me crazy because I am trying to type or study. I think she does it as a way of getting attention.
She can also finally eat tasty food instead of k/d. I'm about to run out and get her some Fancy Feast and tuna. I will add water to the food to make a slurry, but know that amount of extra fluid will barely make a dent in her massive losses.