Asthma

Sometimes I take a step back from my life and remember where I’ve been. Yesterday a couple of classmates and I were discussing a case for clinical pathology where a dog had a PCV of 15 (normal is ~45). The thought crossed our minds as to why the dog was released from the clinic given that he was severely anemic. While I was thinking about that I remembered working with a flamingo that at one point had a PCV of 14. I mentioned that to my classmates and one of them piped up with “and I bet you could convince me that was normal.” It isn’t normal. Later the discussion switched to pharmacology and Telazol. Telazol is an injectable medication used for anesthesia. Once again I piped up with a zoo animal related comment, and then I realized how unique my outlook on veterinary medicine is compared to my classmates. Having spent five years working full time with zoo animals and an equal time working in a small animal practice means the connections I make have a broad range. Some of my classmates can relate things to cows. I relate things to wallabies, flamingos, naked mole rats, and baboons.

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I thought this was some interesting information. According to the AARC’s “Guide to Aerosolized Medications,” the following are percentages of medications that actually reach a patients lungs:

1. MDI: 9%
2. MDI with spacer 15%
3. SVN: 12%
4. DPI: 13%

The rest of the medicine “is lost in the oropharynx, the device, the exhaled breath, and the environment,” according to the guidelines.

This is interesting. You can see clearly here that more medicine as a percentage that is taken reaches the lungs of a patient using an MDI with a spacer compared to that of an SVN and even a DPI.

However, we must also consider how much medicine is given. A typical SVN provides 2.5mg of a solution, which is usually twice the amount of medication as 2 puffs, or 200 micrograms (μg) of albuterol.

Still, even while there is more medicine delivered with an SVN, the 2 puffs generated similar results as the SVN. This is interesting. And I imagine this is the proof many hospitals have used in changing to using MDIs in the stead of SVNs.

Also, an MDI is much less expensive than an SVN.

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One of my first memories of learning about wildlife conservation was reading a news article on the endangered California condor. I think I was in fifth grade. That was the year I made a current event scrape book for fun. Yeah, I was a geek then too.

Anyway, while I was lurking on my wildlife news sites I found this:

http://laist.com/2010/03/09/first_condor_nest_appears_at_pinnac.php

Woohooo!

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One of my classmates was in the paper yesterday. I thought I’d share the link with everyone so you can get to know who I hang out with for the majority of my week. Lindsey is on my team for clinical pathology and we all know our team is the best one, right?

http://journalstar.com/news/local/article_152b8d72-2ac8-11df-909c-001cc4c002e0.html?mode=story

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Every respiratory therapist dreads having to draw cord blood gases, and all OB nurses dread the circumstances that require them to be drawn. So, that said, what are the indications for drawing cord blood gases, what is the significance of drawing them, and why do we draw them in the first place?

• pH: 7.28 (+/-.5)
• pCO2: 49 (+/-8)
• pO2: 18 (+/- 6.2)
• HCO3: 2.5-3.5
• BE: 10

Critical values that might show anoxic brain injury during birth (acidosis):

• pH less than 7.0
• CO2 greater than 50
• PO2 variable (remember this is the baby’s venous blood, so the PO2 is relatively low)
• BE is normal or low (10 or less)

Critical values that might show injury due to metabolic cause:

• pH less low (less than 7.25, critical is 7.10 as mentioned above)
• PO2 less than 20
• CO2 is normal or high
• BE greater than 10 (Best indicator of metabolic cause

The following are conditions that would warrant a CABG:

• Any abnormality during delivery process
• Low 5 minutes APGAR score (less than 3)
• Any abnormality in patient condition that occurs within 1st 5 minutes after birth
• Premature birth
• Post term birth
• Meconium in amniotic fluid
• Intubation
• Positive pressure ventilation (Neo-puff or bag mask ventilation)
• Suctioning
• Cesarean-section
• Severe growth retardation
• abnormal fetal heart rate tracing
• maternal thyroid disease
• intrapartum fever
• multifetal gestation

The following are sources used for this post:

• OBGYN.org: Cord Blood Gases to Determine Umbilical Artery Acid Base Balance
• Umbilical Cord Blood Gas Analysis
• Cord blood analysis
• FamilyPracticeNotebook.com
• Tips for how to draw CABGs
• Umbilical cord blood gases: routine measurement may exonerate ob.gyns

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I brought the subject up briefly yesterday at my appointment, but I’ve been giving a lot of thought lately to the long term impact illness is going to have on my life. I’ve been on this road for two years and it has been full of twists and turns. Some days I can do what I want, and other days I’m stuck dealing with things I would rather forget. What I learn from the twists are lessons I wouldn’t get elsewhere.

For example, this week has been a test of acceptance. I had to accept the fact I wasn’t going to do as well as I wanted to on my pharmacology exam. I just couldn’t study well enough for it and that was that. The impact it will have on my grade is yet to be seen, but I have resigned myself to just deal with it. This has left me wondering how often this piece of the puzzle is going to crop up, just how often I’m going to have to accept a less than perfect outcome. And if it happens frequently how do I learn to be happy with it? I’m starting to see areas in my life I’m accepting this fact, but there are many others that I’m not.

Take being physically active. I’m learning that I’m going to be less than perfect in this accept of my life for awhile. Running has been on the back burner for over a month. I’m realizing that I’m going to have to change my thinking on my training schedule and be more flexible. Some days I’ll be able to run, and other days I’m not going to be able too. In any case I went ahead and signed up for the State Farm 5k on March 27th. It might be another less than perfect outcome, but I want to keep doing what I love.

I need to adopt this attitude in other areas of my life.

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The past three weeks have been h*ll when it comes to studying and trying to pay attention in class, when I was in class. Last week we had two midterms that I manged to get a B+ and an A on. After that I had had to shift focus to studying for the exams I had this week. I almost asked to have my exam scheduled for this morning moved to tomorrow to give me one more day to study but I didn’t. I had my pharmacology exam yesterday afternoon and I was under prepared for because I spent half the time studying for systemic pathology exam that I had today. I was studying like a mad women yesterday every minute I got to make up for the lack of focus I’ve had recently. We all walked into class this morning ready to listen intently on the lecture given prior to the exam because we were told that something from it was going to be on the exam the next hour. It wasn’t hard for me to listen too it because it was on lead poisoning in birds something I’m interested in. Dr. D handed out the answer sheet to our exam at 8:55am and we all had a heart attack. Instead of the three page 18-20 question exam we were expecting there were two questions on one sheet of paper. Then we opened our PowerPoint file for the test to find two questions. They were jokes. This was our last exam in the class (which started last August), and Dr. D thought he had tortured us enough. We all got a 100% on the exam. All I can say is wow, it had to happen sometime.

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