Mad Cooking Skillz: It looks like parasites!

I has 'em.

Granted, the last three things I made didn't really turn out, as such. But this one is awesome, I promise! And healthy, which is a huge step out of the ordinary for me. It's just wrong, though, that Whole Foods has cheaper orzo and kalamata olives than the local generic grocery store. On one level it makes sense: Orzo = specialty item, Whole Foods = specialty store, therefore Whole Foods = better orzo selection. But the idea of anything being cheaper there is an alien concept.

I needed the orzo to make salad for the celebratory end-o-finals potluck my class is holding. We have a competition for pathology/parasitology themed foods, and orzo...I mean, have you seen it? It looks almost exactly like little lucilia bots, without the hint of ridges.

I wanted kalamata olives to simulate cuterebra, although really I just wanted kalamata olives because they are tasty. And then I added so much spinach and tomato that it doesn't really look frighteningly parasitic at all. But my main goal is to bring something that people will eat, which never seems to happen when I bring cookies. Even the cross-section-of-the-pons cookies I brought last year completely failed to disappear, and they were delicious in addition to being neuroanatomically correct. Well, correct-ish. It's hard to prevent refrigerator cookies from getting a little lopsided. Those would have been neat to do this year--I could have added red hots and called it nigropallidal encephalomalacia.

Poisonous plants

Continuing my toxicology studying...(this is going to be a long one)

Most poisonous plants do not taste good. If you don't force the animals to eat them, they probably won't. (For a given definition of "force"...leaving a cat in the room with a lily may qualify as forcing the poor feline to chew on the plant).
Other definitions of "force":
-overgrazing
-underfeeding
-lack of forage (i.e. drought) or accumulation of toxins (ex. corn accumulates nitrates)
-misidentification

If the hay contains toxic weeds, stop feeding it. This may fix all the problems.

Berries are bad.

Common names are, well, common. Totally different plants may share the name.

Now, by system:

Cardiovascular
Cyanide and cardiac glycosides are the major toxins here. Oleander, Japanese Yew, and foxglove are potent, as are seemingly innocuous fruit trees like apple, apricot, and choke-cherry (which sounds totally innocuous, doesn't it?).
Kalanchoe has cardiac glycoside-ish substances, and it's sold as houseplant where it doesn't grow wild. But then, everything toxic seems to be sold as a houseplant. Like lily of the valley. And monkshood. And water hemlock.

Choke cherry (prunus virginiana)
delphinium/larkspur
foxglove (digitalis)
Japanese yew (taxus) has red berries with poisonous seeds. On the other hand, they've made a nice chemo drug with it now.
Kalanchoe causes vomiting, diarrhea, in addition to the CV signs. No struggling before death, cyanotic membranes, and petechial hemorrhages in the GI tract.
Lily of the valley (convallaria majalis) works through cardiac glycosides.
Monkshood (aconitum) grows in meadows and mountains.
Oleander (Nerium oleander) is very common in California. Do NOT toast marshmallows on sticks from oleander bushes.
Summer pheasant's eye (Adonis aestivalis) is similar to oleander and foxglove, horses and sheep are the usual victims.
Water hemlock (Cicuta maculata) is even more poisonous than poison hemlock, although it becomes deceptively palatable (to herbivores, presumably) after being sprayed with herbicide.

Blood
Bracken fern takes weeks to start causing bone marrow depression in cattle. Horses are done for by thiaminase and get neurologic signs.
Onions have n-propyl disulfides, which oxidize hemoglobin and cause weakness, depression, pale or icteric mucous membranes. Also GI distrubances, rapid pulse and respiration, and, of course, Heinz-body hemolytic anemia.
Red maple contains gallic acid in the wilted leaves, which kills horses by hemolytic anemia.
Sweet clover (melilotus), a question I got wrong on the neuropath exam, are only poisonous when dried improperly and make dicoumarol. Sheep are more resistant than cattle.

GI
Solanaceae: everyone's favorite little known fact is that tomatoes are related to nightshade! (a guy once tried to impress me with his knowledge of this fact, which would probably have gone over better had he not so obviously been clueless about anything and everything else botanical)
Other fun clinical signs: CNS depression, cardiovascular collapse, hallucinations (a specialty of Jimsonweed, aka datura).
Mountain laurel is related to azalea and rhododendrons, and its toxins can get into meat and honey.
Mayapple (sometimes called mandrake, though it's not the same plant as that mandrake). Vomiting, lethargy are the big clinical signs, but it can be treated with copious fluid therapy. Mayapple doesn't make much of a house plant, but it's sold as a lovely native plant for people doing shade gardening.
Sneezeweed is a direct GI irritant, seen in sheep in the west (where it's probably always overgrazed and droughty).
Tobacco.
Brunfelsia, known as Yesterday Today and Tomorrow, can cause seizures and resemble strychnine. Takes a long time for recovery.

Liver and skin
It turns out plant-filled diets contain phylloerythrin, which is a photosensitive compound that does really nasty things when it deposits in the skin and get exposed to sunlight. Cracking and sloughing sorts of things. Plants like St. Johnswort and tansy ragwort cause liver disease, and then photosensitization (pyrrolizidine alkaloids). Plants like alsike clover just cause photosensitization (mainly horses). Then there's cycad palm, which is just incredibly toxic. On the other hand, in more northern states where it never flowers, you don't have to worry about its seeds, which are the most toxic part.

Nervous system
Hemp grows wild and is occasionally eaten in complete innocence by pigs that are bedded on it. More often it is the basis of entertaining stories about teasing out the truth from people who bring their dogs in after the dog ate someone's stash...Expect nervousness, irritation, CNS depression, and coma. In the dog.
Horsetail shows up in forage. It's related to bracken fern, has the same thiaminase enzyme. Cows that eat it become hyperexciteable, stagger, tremble, lose weight and drop milk production.
White snakeroot also likes wetland areas. Its toxin is tremetol, which causes choke, from partial throat paralysis, and trembling in horses.
Yellow star thistle causes what is sometimes called "chewing disease". Horses develop a very focal lesion at the nigropallidal...um...spot.

Musculoskeletal
Black walnut shavings are used for bedding, and then cause laminitis, severe edema, and ultimately severe GI signs in horses.
Hoary alyssum creates similar problems when it shows up being fed in hay.

Well, that was a brief section.

Renal
Oxalates!
Also alkaloids.
Autumn crocus, honestly, affects the GI more, but colchicine alkaloids in the bulb still do irreversible kidney damage.
Death camas show up most in the western states--they're occasionally mistaken for onions, it seems.
Philodendron, peace lily, dieffenbachia (dumbcane) are all oxalate containing houseplants. Dumbcane is especially interesting--its cells eject calcium oxalate when it is chewed, which makes the throat swell up (rendering the chewer dumb).
Easter lily is the culprit of the cat-in-a-locked-room mystery (at least back before anyone realized that lilies were quite that toxic to cats--or that cats would eat something that was so completely deadly).
Greasewood and halogeton (Jack-in-the-pulpit, another native shade plant) contain oxalates that really screw up rumens and cause other problems for grazing animals.

Reproduction
Goats that eat avocado plants get mastitis.
Locoweed interferes with estrus cycle.
Lupine--which is actually grown as forage for cattle-- causes crooked calf syndrome if the cow eats it between days 40-70 of gestation. The calf may be born with cleft palate or more severe signs.
False hellebore, also known as corn lily, causes "cyclops lambs".
Poison hemlock, which is related to carrots of all things, is most famous for being used to kill Socrates (or was it actually water hemlock?)
Ponderosa pine can cause abortions.
White snakeroot is secreted in milk--that's the one that killed Lincoln's mother.
Then there's castor bean, a lovely toxic looking ornamental that contains ricin, one of the most toxic substances known to man.

Surgery: Anatomy, Art

Today for surgery class (i.e. sit in lecture hearing the basics once, so that next year we cannot say things like, "I've never heard of ___, how do you expect me to know about it?") we're covering anatomy.

So far: anatomy is important.

Anatomy has important implications for suture. Last week we went over suture, so in theory this all makes perfect sense, at any rate makes more sense than enzymology in clin path. In all fairness, the clin path professors do a terrific job, and I'm sure by the time we have an exam, enzymology will make more sense than whatever the next topic is going to be.

Anatomy has been occupying me outside of lecture recently. An artist friend of mine discovered anatomy last year by way of a life drawing class. All of a sudden her sketches of people included such innovative things as triceps. (This year I'm going to be taking the same class, actually, although for different reasons--my drawing skills need help. I know where the muscles are, I'm just lousy at delineating them.) She would like to now spread the joy of knowledge, so we're working on an anatomy workshop for fantasy artists. It will have skulls. If I could, I would bring in a horse leg with intact suspensory apparatus, but that's probably a bit beyond the scope of a one-hour talk that is starting out with "This is a skeleton..."

Pharm studying...

I. need. a. nap. I woke up at 5 am this morning, just like I did back in February on the untapered dose of prednisone. Alas, it was not accompanied by the irrepressible urge to study. It could have been; I caught an early bus to school, but I got sidetracked by the lake and took mostly blurry photos of geese for a while. If I'm going to make a habit of this, I really ought to start carrying my nice camera. It's not pocket sized, and it has the drawbacks of middle-range digital (grainy ISO, anyone?). But I can force it to do things like take photos in poor light that are not irretrievably blurry (or grainy), sometimes within seconds of pressing the button.

At any rate, I still have studying for the exam tomorrow to do, but my eyes are so tired it's distracting. So...perhaps a little nap...

path studying

I think the reason systemic pathology is so hard is because it completely fails to be cumulative. I'm not talking about the exams. The exams are the worst sort of cumulative, because they're two to three hundred different things to know. The class itself, though has no underlying direction. With clinical pathology, you have to know lecture 1 before lecture 2 will make sense, and the same goes for labs. It's easier to keep track of what you know and don't know. With systemic path, however, they really do just keep throwing names of diseases at us. With reproductive and dermatology it's especially bad, because although the diseases are different, all the symptoms seem to be pretty much the same. There's swelling. There's erosions. There may be keratin! And then you differentiate based on...well, based on whether the notes match up word for word with the picture's caption.

Studying after the first ten hours is just frustrating, when you're STILL just scrolling through disease (it's not even that they're diseases, they're specific symptoms which may or may not have a known disease attached).

But for a bit of a change, my kitchen sink clogged up! I used up the last of the drain-o, it's still not draining right, and my entire apartment now smells like rotting eggs. I think it may be time to take my notes to the gym and enjoy the ellipticals for a while.

Hymenolepsis

I have seen the Midgard Serpent and it is a tapeworm.

No, really.

In lab today, we had really beautiful examples of rat tapeworms (hymenolepsis diminuta). The professor put about an inch length on a slide for us to look at, and the first impression on looking through the slide is "Holy heck, it's MOVING!" Which I may have mentioned in the past as a special feature of parasitology lab. It was all the more impressive because through the eyepieces, what was a thin white thread has become a vast field of undulating, scale-like segments. Marvelous to behold, and squirm-inducing.

The odd thing about tapeworms, though, is that as far as parasites go they're pretty innocuous. They are mightily impressive, but they like to just hang out in the lumen of the gut and grow. Granted, they grow pretty impressively. And a couple of really big ones could potentially cause some obstruction. But it's nothing like the damage liver flukes or roundworms do.

Prions

The wet lab today was excellent, not least because I successfully removed a cow's spinal cord on the first go. With a grapefruit spoon. The sheep's spinal cord was trickier, and I'm afraid I shaved off half the section I was supposed to be retrieving, but hey, I found the tonsils! And the retropharyngeal lymph nodes too. An entire year of anatomy and it took a fresh sheep head to make me realize where the darn things are located. It becomes much more relevant when you are trying to obtain samples for very specific histologic testing. In anatomy, it was just, "tell the difference between fifteen different pinkish squishy bits of tissue."

I don't think any of the heads we were working with were scrapie-positive (though with sheep, you never know), but the demo head did come from a deer with CWD symptoms. I have been in the same room with prions...

If only prions weren't so potentially super-super-scary, they would be an awesome thing to study. However, as it is, they seem a little too subtle for working with. In some ways, they are in the same category with tuberculosis and smallpox; the deadly diseases that are so subtle that they've already escaped control again (granted, smallpox has been declared eliminated. But the book Demon in the Freezer makes a pretty convincing case that it would be too easy for it to make a reappearance).

I think this is what makes parasitology so appealing on one level: all you have to do is look, and if the worms are there you'll see them. And you can even remove them by hand if all else fails (sometimes). They make us squirm, but it is productive squirming! Prions, on the other hand, are virtually undetectable and insidious. They can't be killed, they can't be stopped, all you can do is avoid them and try to make sure they don't spread. Which is why CWD is a scary thing, for all that its impact hasn't really been seen yet. Deer across the country are seeding the ground with prions, and no one knows what's going to happen. But the impact, if any, is so glacially slow in becoming apparent that very little action is being taken.

Brr. Yeah, it was an excellent wet lab, but not the sort of stuff that makes you sleep soundly at night.