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.