It's a plan!

I got called in yesterday--which worked out really well, in fact. Realistically, I would not have gotten around to studying anyway. As it was, the surgery was relatively quick (a back--over in three hours!), and fortunately there was no backlog of pans to sterilize in the CS for clean-up.

Also, one of the older surgeons was supervising. He was one of the ones who seems to have endless patience with students, always able to offer a bit of advice in such a way that you're glad to take it. He helped with the teching, which was good--I haven't been called in since fall, and I wasn't moving efficiently enough to have kept up with four surgeons (eh, two of them were students) and the anesthesiologists.

Today, though--I must study! But all my good intentions will run away if I don't set up a study plan, since I keep forgetting how many classes I have.

So!

1. Anesthesiology: set up a chart of the drugs we learned last week, review the calculations. Our first exam is Wednesday.

2. Parasitology: Chart out this week's life cycles. My goal is to hang them on the walls when I'm done, and I have a lot of wall space to cover!

3. Pathology: Review cardio, probably by looking at pictures and reading my notes aloud.

If I feel like it, I will tackle the most recent lecture, which had a lot of diagrams with horrible 60's era typeface. I have trouble keeping up with the professor, who rattles off the complicated proceedings of the endocrine system like an auctioneer at a cattle sale. But without repeating anything, ever. If you were a good student, you'd be paying attention and get it the first time, right? (To be fair, he's perfectly willing to stop and repeat something; it's just hard to recognize when you, the student, need to have it explained again. After all, the professor knows what he's talking about, so it sounds very reasonable when he says it.)

4. Clin path: Technically we have homework due tomorrow afternoon. Hm. In contrast to systemic pathology, the professor for this class has splendidly lucid lectures, so I can probably get away with reading through the notes.

5. And if there's any time left over, making flash cards for all of the above!

On 3 hours of sleep

This afternoon: Studying! I have to catch up on clin path and parasitology, not to mention pharmacy/anesthesia and toxicology. We had a great tox lecture today--emergency triage! Tox promises to be one of the stranger classes, because the nature of toxicology is that you mostly just treat the symptoms. Knowing the specific toxin is great, but it often remains a mystery. But at the same time, you need to know enough to not kill the patient with the wrong treatment. For example, if a dog swallows rat poison, you want to make the dog vomit, right? But if the dog swallowed drain cleaner, which is a nasty caustic material, you want to get it out quickly, all one way--because making it come back out the way it went in can kill the mucosa.

The three hours of sleep is working out pretty well. I was terrible about studying last night; I managed to read some parasitology while going through bellydance exercises (holding up the textbook during shimmies made good upper-arm work-out, AND I learned about pinworms). But then I got distracted by the State of the Union speech and by waiting for a phone call.

The phone call was much later than expected, so I was up really late. We (officially engaged! I hadn't expected to find it so exciting!) had a lot to discuss, including whether it's appropriate to fax letters to a study-abroad student at his school, if the letters are not in the target language. I mean, phone calls are great. But they have no physical presence, and no permanence. I like writing letters, I like having them arrive sooner than six weeks after I send them (or potentially as few as 2 weeks *gasp*), and I have a fax machine.

But...say, I've always wanted to learn Russian. I don't know that in the middle of vet school is quite the ideal time, but you have to start sometime.

Hours

I'm going for a thirty hour day. My boyfriend (actually, I've upgraded him to fiance), has a flight to his study-abroad orientation in two hours that I am helping him catch. Then I have to sit through five lectures. I haven't gotten sleep in the last twenty-three hours, because I was at the CDC Day for Vet Students, and subsequent flight problems meant I almost didn't get home today (tonight? This morning?) at all. As a result, I'm high-strung and mellow at the same time. I was terrified I wasn't going to get home in time, that my boyfriend was going to have to leave before I had a chance to see him, and that I was going to be stuck in a huge airport overnight on top of it all.

There weren't even really any problems at the airport where I was supposed to make my connecting flight--they just took so long to clear the gate of the previous plane that I missed the connection by five minutes. At that point it was eight hours until my boyfriend's flight, and there were absolutely no planes going to my home airport. Thank goodness for long-distance buses (definitely more comfortable, considering my current head-cold). And parents who are willing to stay up an extra four hours to pick me up from the bus stop. And the boyfriend, of course, who was very good about letting me decompress via cell phone.

All of this for the CDC. I have to admit, the margin of value has gotten really, really narrow. But I think, overall, it was still worth it. Oddly enough, I think I got as much out of the eight-hour delay on Sunday (planes and I really are not getting along this week). One of the professors from my school went to the same event, and we had the same (delayed) flight. Usher in long conversation about the school's curriculum and how useful it is to practice in a clinic before branching out into public health. Between that, applying for a USDA summer program, and the CDC event, I think I'm career-dayed out. Time for some straight-up clin path! And some really, really strong black tea.

The terror begins...

We have so many classes this semester: systemic pathology, clinical pathology, parasitology, toxicology, pharmacology, anesthesia (to switch over to surgery midway through the semester), and at some point, infectious disease recitation. Eek! I checked out half a dozen textbooks from the library, so I can figure out which ones I might actually need to buy and scribble all over. Pharm and pathology have returned to haunt me; I barely scraped through the first iteration of those classes. I considered checking out Goodman and Gilman, but the fact it's as large as a breadbox dissuaded me. Instead I found a "Quick Look Series" workbook on pharmacology, which actually is remarkably clear and relevant.

My schedule is doubly complicated by the trips I'm already committed to taking. Fortunately they're in these first weeks of school, so in theory I won't be able to fall too far behind. However...it turns out that the Western Veterinary Conference is the same week I have three exams in a row. And I'm taking a red-eye flight back, to arrive half an hour before the first exam is supposed to start. Um. Perhaps I can take that one a week early? How much can they really cover in the two intervening lectures anyway?

On the plus side, the boyfriend is going to be studying abroad all semester. This doesn't sound too great from the stand point of back rubs and needing someone to remind me not to panic; but, at least I get lots of evenings free to study.

Gearing up

I think I'm going to break my rule of no movies on school nights for the first week of school. My boyfriend and I are still working on the list of things he wants to see before heading off to the wonderful world of Russia (which conceivably has iffy cinema availability). However, I'm also going to try to work around that time constraint and stay on top of things. To that end, I will put fifty dollars on my print card and schedule an afternoon on the school's computer lab. I _really_ don't want to routinely miss the first five minutes of class trying to print out the lecture notes. There's always a mad rush, and I always end up losing a couple of print-outs by the time I start the review for exams.

I made it through my entire e-mail inbox too! I'm mostly caught up, but I get this knee-jerk reaction now when I come across the one or two items I've been putting off for months. They've been lying in wait for this day, I swear they have.

visiting cats

The best part about visiting the farm without the boyfriend is that I get to cuddle with the cats. I have Nanner, a petite tortie, on my lap right now and Beezle, the black and white pigeon-eating monster, is making bizarre whistling noises a few feet away. I generally have to watch my cat exposure carefully, lest I convey cat dander to any of my cat-allergic friends.

Since the boyfriend actually like cats, I can conceivably talk him into allergy shots and then we could have a cat. How well do allergy shots really work? We learned about them briefly in immunology: the repeated introduction of small amounts of allergen gradually switch the immune response from TH2 to TH1. The TH2 path involves immunoglobulin E, which triggers histamine release and the well-known effects of allergy, ex. constricted airways, runny nose, swelling, etc. The TH1 pathway, on the other hand, has less drastic effects on the body, since the production of immunoglobulin switches from IgE to IgG. IgG does not trigger histamine release. In addition, T-cells that react to the specific antigen eventually become anergic.

Now if only all autoimmune diseases were so easy to understand, we'd be set.

Self diagnosis

So the question is what exactly brought on persistent cramps today? My bet is on a combination of raw carrots and iron supplement, on top of my GI tract's general disgruntlement with the world ever since I forced metronidazole on it. However, the reuben sandwich (with extra sauerkraut) and coleslaw may have also acted as predisposing forces. Starting last night and continuing all of today, I've been doubling over every couple of minutes with a fresh round of abdominal pain. I'd been a bit tender in increasing increments after Wednesday's endoscopy, but this is actual pain.

And it's exhausting. It's a good thing our winter break goes for three weeks, because I can't imagine how I would handle classes on top of this. As it is, I don't see a way I can keep up the surgery tech job. Sometimes I feel fine (well, not this week so much, actually). But it's so unpredictable, I don't think there's any way I could ensure I'd be able to work any given night. I know that there's never a way to guarantee you won't come down with a stomach bug on a day you have to work, but I think you can usually count on not having that problem a routine basis.

My hope is that with meds and very careful eating, I won't have this set of problems during school. Even if I do, there's a trance-like quality to studying which can cover up minor discomfort.

I find it interesting that I am much less resistant to the idea of starting meds before seeing the doctor once I'm actually in pain. "Gimme anything that'll help!"

Hopefully the copious amounts of gatorade, pepto bismol, and avoidance of carrots will do the trick and I'll be back to normal tomorrow.

To med or not to med

Did I mention I don't like medicine that's happening to me? Iron was fine, that was a nice, straightforward solution. And it miraculously made all the other symptoms decrease so much that I was happy to consider them gone. Now that I'm paying more attention to it, I realize that they aren't really gone, just masked a bit. The abdominal pain is still there, but so damped down that I don't really consider it pain--just a constant slight unease, like I overate and just have to wait it out. It's easy to ignore moment to moment.

I should be glad that things with the doctors are moving along so fast. I'm sure if they were't I would be fretting my guts out (wait, didn't I already sort of do that?). However, I think I might not have minded having a day or two to pretend that things are normal. As my doctor sister pointed out, nothing has really changed.

The meds in question are asacol and prednisone. Prednisone is one of those scary names, which I prefer to apply to other people's (or dogs') treatment plans. I never heard anything about asacol until being told I was supposed to take nine tablets a day of it. The internet being what it is, it's way too easy to find all the bad effects people have suffered from these drugs.

Sedation, woo hoo!

Finishing off the PEG was only possible with the aid of much cinnamon chewing gum and a relatively mindless Heinlein book. It takes a lot of concentrated sipping to get down a gallon of PEG. It tastes like slightly salty water, but just a little off--almost as though it was slightly salty water that happens to be completely indigestible. Surprise!

Then it was off to the hospital. I wasn't very relaxed. The IV line going in hurt just like someone jabbed a small tube in through the back of my hand (funny, that).

Once they had me settled on the gurney, the soft spoken doctor came and told me about the procedure in a lot less detail than I already knew. The nurse started the fentanyl. I suppose it might have stung a bit going in, but the IV line was already making my hand sting pretty badly, so I wasn't sure. Then I guess the stuff hit my system, because suddenly my chest tightened and I sort of squeaked out, "I'm having trouble breathing!" The thought that flashed through my mind: I don't know that I'm not allergic to benadryl, and the lungs are the anaphylactic shock organ in people...

But then my breathing eased up just as suddenly. The nurse asked cheerfully, "Is the room spinning yet?"
"Yeah, actually," I said.

Then I was lying on my side, very groggy, and wondering if they were going to start the procedure yet. It took about a minute for me to wake up enough to realize that I was in a totally different room now--two hours later.

Once I was more or less awake, I got to see the pictures of my colon. Well, no wonder I've been having digestive problems for years! A number of ulcers, some that look fairly minor, a couple that are probably more concerning. I'm not in a position to make any diagnoses though. That's why I have another appointment next week, to find out what the gastroenterologists conclude.

And in the meantime, I get to eat food again!

Jello vs. truffles

In honor of my imminent 2-day eating ban, I had huge dinner last night: steak, mashed potatoes, and green pepper and mushroom saute. But before that--I made truffles! I've made them before, but only the solid ganache version where you roll them in cocoa powder under the supposition that this prevents them sticking to your hands on the trip to your mouth.

This time, I made a special trip to the local cake decorating store and got a truffle mold.* Ooo, ahh.* I almost got one while I was in Vegas, visiting the land of Sur la Table, but I couldn't think of a good way to pack it. And this way I was able to peruse the rack of concentrated flavorings, which has tempting flavors such as amaretto and blackberry.

Then to the kitchen! I improvised a double boiler with a bowl that I believe started life as a dog food dish, but has seen much use here and in the dorms. I had two types of chocolate: the Trader Joe's pound-o-dark, and the Scharffen Berger elitist bar. The elitist was a pale tan color, since it's been sitting in my cupboard for a year (or two? I don't recall...) and bloomed more than a bank of day lilies. But hey, all things chocolate are fixed by melting! I added in some 99%, too, for that special bitter flavor. I originally had three bars of Scharffen Berger in different grades of sweetness, but I ate the mildest long ago.

The elitist went for lining the mold. The pound-o-dark went for ganache. I had trouble with it--it decided to go all watery and clumpy on me. Adding more chocolate helped smooth it, at least enough so it didn't separate on the spot. I scooped out half to make pure dark chocolate truffles out of, then tried a touch of amaretto.
Meh.
Orange?
Hey...
I revised my plan for dark chocolate truffles to include dark chocolate + orange truffles.

Once they'd set and I'd figured out how to remove them from the mold (one truffle died bravely in my attempts to pry it out with a metal skewer) I tried one of the orange. It was like...like...like a real truffle! I forced one on my boyfriend, who made gratifyingly surprised sounds, and I wrapped up the remainder for my mom, the true chocolate connoisseur. *

Now today I keep looking over at them and then back at my little bowl of pineapple jello. I mean, I like jello. It's the closest thing to real food I'm allowed to eat for the next thirty hours. But the only thing it has in common with truffles is that they both come out of molds.

*EDIT: My mom was not enthusiastic. She felt the truffles were much too dark, with not enough mild flavor for contrast. *sigh*

It turns out...

I like medicine, but not when it's happening to me.

The main thing I remembered about metronidazole is that in our chart for bacteriology, it listed possible side effects: "GI upset" GI upset fails to describe the potential for stomach-knotting pain and uneasy nausea. Sadly, I didn't make it through the full 10 days, so the chances are I'll have to take something like it again. I spent most of my supposed vacation with family in Vegas huddled on a couch, while my GI microflora learned about living in a world with metronidazole. I was cheated out of three days of eating! In Las Vegas!

Now that I actually have doctors looking at my persistent anemia and vague GI symptoms, they want to do all sorts of things to me. The antibiotic was just the start. I spent the morning sitting in the gastro office, facing a very nice poster that details every thing that can go wrong with your digestive system from the esophagus down. I did not find it comforting.

If it were my dog (who, incidentally, ripped his scalp open yesterday and needed sutures) I would be all for finding a diagnosis. As it is, I have trouble. My constellation of symptoms indicate what I always suspected, that my GI tract is a lemon (more of an orange...I mean, it's worked okay so far). How do you fix that? It's not like you can replace it. I just spent a year and a half learning how irreplaceable the digestive system is. I also learned that imaging is often the biggest part of medicine. To illustrate this point, they have to look at my digestive system, which means endoscopes. Endoscopes mean sedation to the verge of unconsciousness, so I won't even be able to write it off as a learning experience. (someone, quick, invent an effective ultrasound scan!)

And I'm getting cheated out of two more days of eating. Hmph.