1 down, 3 to go...And a Cushing's update

Before I start blabbering about vet school, here's an update on Mika: 

The tests came back, and Mika tested positive for Cushing's disease. Her uncontrolled Cushing's is what most likely caused her to have a stroke, which she is still recovering from. She is, however, eating, drinking, and going to the bathroom on her own; she just is a bit wobbly and a bit confused. However, she's made a lot of improvement since last week, and we're hoping that that continues! With regard to the Cushing's, we are going to start her on a chemotherapeutic drug called Lysodren (Mitotane) to treat the tumor that causes Cushing's.  Things are looking up for Mika, and she's doing well! We couldn't be happier at her progress.

On another note, now Josh (our 6 yr old yellow Lab) has what the vet thinks is the flu! He has been having diarrhea and some vomiting. So that's a joy. He goes back to the vet next week for a re-check/suture removal on his aural hematoma, too. 

At this moment in time (no absolute guarantees), there is nothing wrong with Lucky, the 11 yr old Mini Poodle. Hopefully he doesn't catch this flu or wind up with some other mysterious malady. At this point, there will be no Christmas due to exorbitant vet bills. Oh, the joys of pet ownership.

Now, on to first year vet school, where the dogs are always dead and morale is always low....

We had our first final today in Small Animal Gross Anatomy. It covered the arteries and nerves of the hind limb, the cranial nerves and their branches, cranial arteries, the eye, bones of the skull, teeth, and various miscellany from old exams. Needless to say, I'm glad that's over! 

Here's the final exam schedule for next week:

Monday: Microanatomy (which I should be studying for now, but am instead snapping pics of my bunny and blogging)

Tuesday: Cell Phys (let's hope I pass...)

Wednesday: Principles of Surgery 

Here's the deal with Principles of Surgery. First they lock us in a room and make us identify surgical instruments, along with functions, and answer practical questions. Then we demonstrate proper surgical scrubbing (my arms are already killing me!), gowning, gloving, and draping, all while maintaining sterility. For a break from this stress-fest before demonstrating suture patterns, our instructor provides a room full of puppies. Well, not FULL, exactly. But there is a room, and there are puppies in there. After we do some yoga breathing and swallow back some nervous vomit, we enter the area where we demonstrate suture patterns and hand ties in front of veterinary surgeons. And then, guess what? If we screw up at any point, we have to re-do it the next day! HOORAY! I can't wait for that moment when my hand accidentally hits the water faucet, or when my Lembert turns out looking like a Cushing/Connell instead. 

But after Micro, Cell Phys, and Surgery, I'm DONE. Done with the first semester of veterinary school, and 1/8th of the way through with my veterinary training. So even if my damn gown does touch the table and break sterility, or I forget what Descemet's membrane looks like, I'll live. I'll live, I'll pass, and I'll be back next semester.

Putting it into Perspective

Yes, veterinary school is difficult. We have class, lab, electives, clubs, wet labs, quizzes, case studies, and exams. It's easy to get lost in the monotony that is school and forget about why we're here, and why we're training to be vets. But everything we're learning was put into perspective for me when my 12 year old Labrador Retriever, Mika, suffered what appeared to be a seizure less than a week ago. 


After the initial seizure episode, characterized by thrashing movement, disorientation, ataxia, and nystagmus (vocab word of the day: rapid eye movement up and down or side to side), Mika suffered a less severe episode. In this episode, only the top of her head convulsed, although nystagmus was still present. Mika was taken to the veterinarian at home (a WSU grad, in fact!), where they performed a physical exam and did blood work. Canine geriatric vestibular disease was ruled out, and, due to her high liver enzymes, Cushing's disease was suggested. The vet then performed a liver function test to determine how the liver is functioning and possible causes - we're still waiting on results, damn the lab to hell. 


In the meantime, Mika has been losing function in her limbs; she is now consistently ataxic, falls when she tries to shake herself, and can't roll on her back to itch as she normally does. She has diarrhea, although that could be from the food they feed during the liver function test, and has lost some interest in food. Mika is also demonstrating confused and dazed mentation, and a complete deviation from her normal behavior and personality. Due to these symptoms (excluding the diarrhea), as well as the fact that after her seizure episodes the right side of her face was drooping, the veterinarian has also postulated that Mika may have suffered a stroke.


So far the conditions considered are: problem with liver function, Cushing's disease, brain tumor, stroke.


We'll know more once the lab results are back; we have to wait to see the outcome of the liver function test before moving forward with testing for Cushing's. My parents may also bring Mika down to WSU for testing by a Neurologist, which I think is a great idea. The vet told us to keep her comfortable, and said that motion sickness medication (Meclizine) may help with her incoordination and ataxia for the time being. 


Although this case really hits home because it's my own dog, it also made a lot of what we're learning in our 1st year clinically relevant. For example: 

• Cushing's Disease (Hyperadrenocorticism) is caused by an overproduction of cortisol resulting from increased ACTH synthesis (CELL PHYS, ANYONE?!). There are 3 types of Cushing's - Pituitary Dependent, Adrenal-based, or Iatrogenic
• Pituitary Dependent Hyperadrenocorticism: Results from a tumor on the pituitary (adenoma or adenocarcinoma) that results in increased ACTH production, which sends a signal to the adrenal glands to produce high levels of cortisol. Non-surgical due to the location of the tumor, but responsive to radiation and chemotherapy; tumors usually benign.
• 10-20% of pituitary tumors are macroadenomas, which are large enough to cause not only Cushing's, but also induce neurological effects.
• Pituitary tumors are usually located on the adenohypophysis, with the pars distalis or pars intermedia capable of producing ACTH (HELLO, MICROANATOMY!)
• Adrenal-based Hyperadrenocorticism: A tumor is located on the adrenal glands (HEY THERE, ANATOMY!), causing them to produce high amounts of cortisol directly. Surgery (ALL THOSE SUTURE PATTERNS WILL COME IN HANDY!)is sometimes an option, as these tumors can be cancerous.
• Iatrogenic Hyperadrenocorticism: Results from long-term use of steroid drugs (ex. Prednisone). Can usually be resolved by eliminating steroid drugs.

So yes, what we're learning in the 1st year IS important. Incredibly important. And Mika's current struggle is a slap back to reality. So yes, I WILL be paying attention in class for these last few weeks. It's time to put away the crosswords, people. We have better things to practice. Like veterinary medicine.