Y3S2 Week 5: Cal Poly Zoom, Another Surgery, and Addison's Disease!

Week 5 is now in the books, and we are roughly halfway done with this block!

Monday started off with a quick run around the block with Churro followed by a treadmill interval session and recovery swim. We then had a two-hour discussion on anaphylaxis for our comparative species course and worked through a case so that we could apply our understanding. The rest of the afternoon was used to get a few things done around the house and meal prep for the upcoming week.

Tuesday morning began with a quick whirl around the park with Churro followed by a hot yoga session. I then had the opportunity to do a quick Zoom presentation for a Cal Poly Undergraduate Seminar class. This class is now being taught by one of my undergraduate classmates, so it was super fun to reconnect and lecture for his class. I discussed the vet school application process and then did a question-and-answer session. Any time I get the chance to talk to undergraduates, I am reminded of how fortunate I am to be where I am today. It feels like I was sitting in their seats yesterday, and my goal is to reflect what I would have wanted to hear when I was in their stage of education.

Cal Poly Zoom!

We then started the renal aspect of the sub-block and began the morning with three lectures on chronic kidney disease. This was a nice way to quickly review the physiology of kidneys in health and then apply that knowledge to what happens during disease. During lunch I was able to take a nice walk around the arboretum before heading back to learn about the nutritional management of chronic kidney disease. The day ended with a session on polyuria and polydipsia, which means excessive urination and water consumption. The rest of the afternoon was spent on the field with Churro and a little lecture review.

Wednesday morning was another surgery day, so it started bright and early with a quick run with Churro followed by our morning surgical check. I was the anesthetist, so my role involved collecting blood for pre-surgical laboratory tests and calculating drug doses for the procedure. Our patient was a sweet little mix named Penelope. We then had two lectures on acute kidney injury. This was a nice way to complement the prior day’s lecture material while also layering on some new topics.

After the morning lectures finished, we transitioned into our pre-surgical rounds discussion. Our patient had pristine bloodwork, so she was a great candidate for surgery, and we were able to proceed with her spay. Penelope was a rockstar under anesthesia and was super stable throughout the procedure. Gaby nailed the surgery! Penelope woke up smoothly and did not seem to be in pain. This was my group’s eighth surgery, and it is so fun to reflect on how far we have come and how efficient we have gotten. Every time we work together, I am reminded of how fortunate I am to have such great teammates.

That evening, I was able to spend some time with Churro on the field before the sun set and get a little studying before heading back to school for the evening surgery check. At the night check, Penelope looked wonderful and was given a little pain medication to prevent her from feeling any pain during the night. She was also given a nice dinner.

Thursday morning started with a quick whirl around the park with Churro followed by a hot yoga session and swim. It is always nice to have a little extra time in the morning to get in a solid workout before starting the school day. The morning lectures were a mix of glomerular disease and endocrinology. The glomerulus is a part of the nephron (functional unit of the kidney) that forms filtrate from the blood and when things go wrong, it can negatively impact the overall renal health of the patient. The endocrinology lecture was focused on hypoadrenocorticism, also known as Addison’s disease. This disease involves an immune-mediated attack of the two outer two layers of the adrenal gland (zona glomerulosa and zona fasiculata). These zones produce aldosterone and cortisol so when they are being destroyed, the body becomes deficient in these substances, and the physiologic consequences can be catastrophic.

This disease can be ruled out by performing a resting cortisol test. This test measures the body’s cortisol and if it is above 2.0 ug/dL, then the patient does not have Addison’s disease. If the cortisol level is below 2.0 ug/dL, then an ACTH Stimulation test is performed. This test involves a blood draw and then an IV injection of a synthetic form of ACTH followed by a blood draw an hour later. If the patient does not have Addison’s disease, their adrenal glands will be able to respond to the exogenous ACTH and their cortisol levels post-administration will rise above 6 ug/dL. If the patient does have Addison’s disease, their cortisol levels post-administration of exogenous ACTH will be minimally impacted and may not be impacted at all. This shows that the adrenal gland is unable to react to the stimulus, and treatment is necessary. There is a gray area regarding these levels and further diagnostics /future testing may be needed if the patient does not pass the 6 ug/dL threshold and Addison's is still suspected.

Fortunately, Addison’s disease is accompanied by a fairly good prognosis if it is treated and managed appropriately. Treatment involves replacing mineralocorticoids and glucocorticoids, and this is done with an injectable drug called Desoxycorticosterone Pivalate (DOCP) and oral prednisone, which is a glucocorticoid.

That afternoon I had the chance to catch up with a friend over the phone while walking at the arboretum before heading back to class for a lecture on anesthesia for patients with renal disease. The last session of the day included an imaging lecture for kidney disease which was a nice way to end the day. The rest of the evening involved some time on the field with Churro followed by the monthly Sacramento Valley Veterinary Medical Association board meeting. These meetings are always a fun way to hear from local vets and learn more about what is happening in the world of veterinary medicine on a regional level.

Friday morning began with a 7 miler with Churro followed by a renal review session with Dr. Palm. We were assigned a list of questions to review prior to the session and had an hour and a half to discuss our answers and clarify any misunderstanding. This was a great way to review the week’s material, and I am grateful she took the time to put this session together. We then transitioned into our comparative course, and this week’s topic was genetics. After the iRAT and tRAT assessments, we were assigned a case with a mixed breed dog and walked through the process of identifying genetic disease predispositions and working through the testing procedure.

During lunch I had a chance to walk around the arboretum before heading back for the final session of the day. This session was on disaster response and preparedness. Each group was teamed up with another team and assigned a topic to present. My group was assigned animal welfare and biosecurity, so we presented how to appropriately put on PPE before heading into a potential outbreak scenario. This was a nice way to learn about disaster medicine and understand our role as veterinarians. The rest of the afternoon included a nice walk with Churro followed by some studying.

Saturday morning began with a nice 7 miler with Churro followed by a hot yoga session. I then went grocery shopping before heading home to study. Most of the morning was spent reviewing the previous week’s lectures, and I was also able to go on a  25-mile bike ride in the afternoon. The rest of the evening included some playtime on the field with Churro and Naiomi stopped by for a visit. It was fun to catch up, and Churro also loved seeing her. The rest of the night included more studying and an early bedtime. Sunday began with a quick whirl around the block with Churro followed by a sweaty hot Pilates session. I then went to church and ran some errands before heading home to meal prep for the week. The afternoon included some time on the field with Churro and a walk around the neighborhood followed by some studying.

Morning Sunrise!

Quote of the week: “Then it’s game over, you either survived your anaphylaxis, or you didn’t” – Dr. Hopper