More time, please

Vet school really has done a number on my conception of myself as a good student. Now that we have one month left of lectures before we start clinics, it seems a little late to make any significant changes, but I still get very regretful on the nights before exams that I don't have a couple more days to show that I can study, I can be a good student, I just ran out of time. Unfortunately this trend has been going on for two years now, so the best I can do is pass the exams. Even if I study my butt off, at this point there's so much background information I'm trying to make up for that I realistically can't ace an exam. (I did try--I started studying three weeks ahead and attended all the lectures in a state of awakeness and so forth. I got 52 percent. On the other hand, the class average was 68 percent, and I had company down on my end of the curve, so I figure that particular exam was designed solely to crush our spirits.)

Being in a class full of overachievers doesn't help. ALL of them complain that they have not studied enough for the next exam. They then quiz each other on things that I am lucky if I remember from lecture, and which I haven't gotten around to reviewing yet. Really annoying when this happens five minutes before the exam.

Then there's meds. They screw with my concentration and my sleep schedule in maddeningly unpredictable ways. One day I'm fine with five hours of sleep, and the next day--although I may stay awake--I won't be able to recall a single thing from lecture aside from a vague sense that horses' joints came into it somewhere.

But part of it is really that I just don't spend enough time studying (unpredictable sleep schedule doesn't help, I will concede that much). Studying is like writing, I find--it won't get done if you don't sit down, and it's surprisingly hard sometimes. So It's especially frustrating when technology sabotages an hour of writing up notes by crashing the moment you try to save them. >.< Aargh. I already had one panic attack today, I refuse to have another one, plus my boyfriend told me he'll force me to e-mail the professor about not taking the exam tomorrow if I do. And even with a medical excuse, I don't see that going over well. Radiology exams involve lots of actual radiographs, which I suspect they don't want to put up and take down more than once.

At least I have the comfort that the act of creating questions was the point of the write-up. It would have been nice to go back and read through them (again, aargh), but realistically I would have run out of time anyway. So it's on to the next batch of write-ups, and this time remembering to save--if only as proof that yes, I studied!

The eyes would have it

Except I was wiped out by the food animal exam and then grocery shopping turned into less of an outing and more of an endurance test than I had expected. Instead of going to the Great Big Grocery Store of Limitless Choices, I ended up at the local pricey-elitist food store instead. I put up with it because 1) they have some of the obscure food items I am now looking for, and 2) it's all of a quarter mile away. Which when the snow arrives is pretty handy. But it's still pricey. And I had been looking forward to seeing what Limitless Choices might have had. They might have had kefir! They might have had sugar-free-but-not-plain kefir! I really truly needed to go grocery shopping, though, because I have begun to run out food I can eat.

Background: my last little run-in with Crohn's made me realize I haven't been exploring all the options for treatment. If the medicine was working, I would be getting better, not going to the hospital the night before finals week. I rather foolishly assumed that my doctors knew what they were talking about when they said diet doesn't affect it. I now realize that this is a bit of a blind spot for Medicine. For some unfathomable reason, Medicine doesn't like the idea of diet having anything to do with health, except in a general "eat your vegetables" sort of way. I was told to go onto a low residue diet like a good little patient, whereupon I said, "but that's like what my boyfriend eats."

(My boyfriend, by choice, eats white bread, pasta with no sauce, and blueberry yogurt. Fortunately he does like quality beef, lamb, and zucchini brownies, so we still get along.)

The desperate search for dietary advice (is oatmeal okay? Blueberries? Ice cream?) led me over into the realm of macrobiotic diets (thank you, Google Books!). And while a little more research reveals a certain delusional quality that attends alternative diets (if you're supposed to eat seasonally and locally, and you happen to live in the middle of a continental landmass, explain to me again how Japanese seaweed is local?), there was also a hint of reason. Goodness knows refined sugar isn't natural in the quantities I enjoy it. It took me all of two days on liquid diet to get over the initial brooding about a life without cookies, and all of half a day on solid foods for me to discover a way to make cookies entirely with honey (it's not refined sucrose! Close enough!).

I got into a huff at my GI because she thought I was going to go holistic and quit my medications on her, just because I asked if she knew any nutritionists.
So, goals:
1. Find a dietitian who can tell me whether I'm allowed to eat oatmeal.
2. Find studies showing the effect of diet on Crohn's disease.
3. If there are no studies...well, I may have to reconsider my stance on not wanting to do research. I'm a vet student, not a med student, which decreases my ability to say "Time for a human study!" But there's so many people about my age with Crohn's, I can't believe there's NOT a way to gather some scientifically useful information about how diet affects it. New facebook group, anyone?
4. Cut refined sugar from my own diet, to start with.

Other possible foods to get the axe: dairy, wheat, possibly specific carbohydrates (but that's starting to get pretty extreme, when you cut rice--and chocolate!). I get the sense there's a true correlation between Crohn's and sugar, though. Funnily enough, it's one of the macrobiotic books claims that sugar acidifies the intestines that tipped the balance for me. I don't buy the pseudoscience, but there's sometimes deeper truths that Medicine hasn't gotten around to looking at because it *ahem* has its head up its bum.

The funny thing is that I had a professor last year whose ongoing research is the connection between Johne's and Crohn's. I'm trying to figure out a good way to ask him about his research. It just seems awkward to send him a random e-mail, though, saying, "So, after you gave that lecture about mycobacterium last year, it occurred to me I ought to check out my disturbingly recognizable symptoms, and heeey, guess what disease I am now becoming an expert in?"

Oh, but hey, I'm supposed to be taking a massive scary exam in ophthalmology tomorrow. My perspective is so skewed these days...even as I'm finding more and more compelling reasons to learn medicine really well, the relative value of grades becomes very distant and abstract. I shall study a bit, though, and hopefully I'll finish out the semester with passing grades even with all the road bumps along the way.

4th year what?

We had a 4th year planning meeting today to learn about all the wonderful intimidating aspects of setting up our 4th years rotations and externships. I think for most of us--definitely for me--there was an element of: "Wait, what? Shoot, I have to get on this! I'm not ready!" On the one hand, I want to excel! I want to be enthusiastic and personable and competent on every rotation I do (and I want to do them all). On the other hand, I know I'm going to be tired and frazzled and will want to just go home as soon as I can, so I worry that I'm going to completely FAIL to be enthusiastic and competent (and as for being personable, well, one can only do so much while trying to remember the medicine, the science, the animal-handling, and how that one person is a pain to work with but DON'T let them know that).

Oh, and I have an exam tomorrow. I did not realize this until this morning. Upon reflection, I probably would have spent a lot less time driving around doing errands this weekend had I known. And more time studying the prevention of mastitis in dairy cows.

Too Hot

I need to get up a lot earlier if it's going to stay in the high 80's + humidity. Nine AM was obviously not early enough to be outside doing things. Granted, I think the mosquitos would have been happy to eat me at whatever hour I went outside, but at least I wouldn't have felt like I was wading through liquid warmth to boot. I have achieved one main thing today, and that was moving the roosters. They have been eating the tomatoes as the tomatoes got ripe, and when they chowed down on a golden jubilee I had had my eye on for three days, that was it. (They took a few bites out of every single other tomato that was within a day of ripening for good measure.)

Roosters are easy to catch if it is at night and you have a flashlight to shine in their eyes. They stare at the flashlight and, though suspicious that you might be doing something out of their sight, they don't panic until you have already caught them. Then they shriek bloody murder. We collected all 7 from their various roosts in the barn and sheds. They had to hang out in a dog crate all night, and of course the dogs had a splendid time running over to look in at the birdies, running away when we yelled "No chickens!" and back again as soon as the echo of our voices had died down and, to a dog's brain, had no more authority.

I drove the crate out to the other farm, and released the roosters onto the lawn. Only one of them bothered to check out the corn and water I'd put out for them. All the other roosters were interested only in getting as far away from each other as possible. Hopefully they'll make a couple of circuits and either find the water I put out or, ideally, figure out where the cows' waterers are and drink out of those.

Dog adoptions

This has been a summer remarkably free of veterinary medicine. I believe I had planned to be more enthused about inflicting my presence on local veterinarians, but between driving home every other day, gardening, and the trying to write on a daily basis, I've been remarkably busy. It takes about three hours of procrastination for me to get around to one hour of writing. This is an improvement over it taking three days to achieve the same level of frantic "must-write-NOW". At some point, I may achieve two hours of writing at a time. And that will be about the time school starts, at which point busyness truly descends with a vengeance.

In the meantime--I inadvertently talked my fiance into getting a greyhound. Not YET, but presumably we'll be picking a dog-friendly apartment for next year. I think it's Pye's fault. Pye is one of my dogs, very old but only recently starting to act like it (something about megaesophagus and retching all the time...). We adopted him when I was in middle school. He wasn't a mellow dog then, but the intervening years really reduced the running off/playbiting/barking all night. He now has just about enough energy to wander up and gaze imploringly at you. My fiance, who has never had dogs or cats, is a complete sucker for this sort of canine manipulation. And I may have mentioned, one time when I was trying to explain greyhound dispositions (from what I've seen--I admit I don't have a ton of experience with them), that they do this same sort of imploring gaze.

I'm hoping that adopting a greyhound goes smoother than adopting Pye went. I remember the local Humane Society, which I previously had considered a Good and Intelligent institution, really didn't want to let us adopt a dog from them. The problem? We live on a farm. The dog would be on a farm. The dog would be outside on the farm. Apparently, it is anathema to the humane society's mission to let any dog spend nights outside the warmth and protection of a house. If the dog came from a farm? Well, then it would be okay--unless the dog had become an indoor dog since its days on a farm. All dogs at the humane society are housed indoors. Ergo, all dogs from the humane society are indoor dogs. I think they finally let us have Pye because he had already come through the humane society twice (both times because he had way too much energy for living in a house), and they were getting desperate.

Talking with other people from farms (often vet students), this is pretty common. It doesn't matter how qualified the potential owner might be, the humane society would rather euthanize dogs than adopt them out to farms. Do they think the dogs are going to be unhappy on the farm? Do they envision horrible accidents involving combines? Do they think all outdoor dogs are abused dogs?

That said, greyhounds would not make good farm dogs. From what I know, they are capable of a little too much speed with not enough discretion for wire fences.

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.