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