Class of 2020... how you doin?

[supershorty]

Pure curiosity: Do they talk much about indirect/unconjugated bilirubin vs direct/conjugated in that class? Or do they just sorta stick with total bili?

We don't usually measure IBili/DBili (just TBili, because at the end of the day, having the split doesn't really practically change much), and I saw it on some rDVM bloodwork recently in a patient with TBili of 32 and it occurred to me that I didn't remember the last time I saw it broken out.

And then I had flashbacks to pathways of unconjugated non-water-soluble albumin-carried bilirubin being conjugated with glucuronic acid to become water soluble and ...

... my eyes glazed over and I went and got a beer and turned on Netflix.

We start covering chem stuff next semester, so I'll report back.

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[JaynaAli]

I personally don't think it matters much because let's face it - with a significant TBili elevation once I've ruled out some sort of hemolytic differential, which is simple 'nuff, it's liver+gallbladder and I'm sending it to ultrasound where I'm getting a better dx than I was going to get from bloodwork.
But in the world of ClinPath, I would guess they love their indirect/direct since they can in theory utilize it to narrow down the differential list.

Summon the pathology peeps..
@JaynaAli @WhtsThFrequency

I feel lazy today. Eclinpath on bilirubin breaks it down pretty well. Go down to the heading 'the bilirubin split'. Long story short, it can be helpful to see the split but to really interpret it you have to keep in mind all concurrent processes and a whole lot of the time there are multifactorial things going on with the liver/biliary system so it can get muddy. Some places (and subsequently their trainees) care a lot, and (most) others care only a little. I've seen it more often used clinically in horses, since the hyperbilirubinemia they get with fasting is usually unconjugated vs the other causes for an icteric horse.

 

[raf2769]

Not being done until the 21st sounds terrible. Our last final is the 15th and I'm already beyond ready to be done and enjoy Christmas stuff.

Oh, I've been enjoying my Christmas stuff since early November, don't worry. This isn't ideal, but I think if they tried to squeeze it all into less time I would've been a lot more stressed. Only thing I'm kind of not looking forward to is that I have an orchestra concert 8:00 this sunday night and my micro final monday morning. but eh what can ya do

 

[LetItSnow]

Summon the pathology peeps..

@JaynaAli @WhtsThFrequency

Dear god. That's the SDN equivalent of saying their name three times while standing in front of a mirror. Don't. Do. It.

 

[DVMDream]

Dear god. That's the SDN equivalent of saying their name three times while standing in front of a mirror. Don't. Do. It.

Too late.

 

[LetItSnow]

I feel lazy today. Eclinpath on bilirubin breaks it down pretty well. Go down to the heading 'the bilirubin split'.

(For vet students: eclinpath.com is an awesome website that I still use at work once in a while.)

(And I <think> @JaynaAli basically said I was right.)

 

[JaynaAli]

(For vet students: eclinpath.com is an awesome website that I still use at work once in a while.)

I agree it's great. I do wish it was a little better cited, but the information is excellent. Tracy Stokol and the other peeps at Cornell do a good job with it. I'm surprised they haven't made it a subscription service given how many people I know that use it (sorta like they did with neuropetvet.com), but if you aren't close to a book and need a quick answer or differentials, that's where tell the students to look.

 

[DVMDream]

(And I <think> @JaynaAli basically said I was right.)

It is probably the closest you will get to a pathologist agreeing with you, so take it now while you can.

 

[LetItSnow]

It is probably the closest you will get to a pathologist agreeing with you, so take it now while you can.

Pretty sure I make Sharkey roll over in her proverbial grave on a regular basis. Last time I talked to her she eye rolled and uttered "I thought I trained you better."

 

[JaynaAli]

It is probably the closest you will get to a pathologist agreeing with you, so take it now while you can.

"Interpret [pathologist] findings in combination with the clinical impression and results of other diagnostic testing, as indicated, for complete interpretation."

 

[DVMDream]

"Interpret [pathologist] findings in combination with the clinical impression and results of other diagnostic testing, as indicated, for complete interpretation."

The pathologist's "open" as a differential.

 

[LetItSnow]

The pathologist's "open" as a differential.

Pathologists and radiologists: tag-teaming to make clinicians lives' hell.

 

[Trilt]

Pathologists and radiologists: tag-teaming to make clinicians lives' hell.

I had a radiologist strongly suspect lungworms on some x-rays yesterday. Repeatedly stated it, mentioned other differentials as lower likelihood; seriously put his stake in the ground for it. And I was so shocked I mentioned the report to all the other doctors (and DVMD and the snap group) because it was so delightfully non-hedge-y and I'm so used to "consider yada and yada and yada and yada and do 17 more tests thanks good luck *copy/paste*"

 

[supershorty]

Epi final down. Don't even know how many left. Don't care.

Missed the A in small animal medicine, but I have a lot of personal stuff going on this semester and I bombed the first exam, so really glad that I was able to claw my way up to a B (straight grading).

 

[WildZoo]

4 down, three to go.

All 4 this week were classes where I had very low As and needed an A on the final to keep them. Pretty sure I didn't do that in any case. It's fine

 

[missdarjeeling]

That is awful. Like, why would anyone think that was a good idea??

We don't believe in good ideas. There is a long tradition of not having good ideas, and we're not going to just suddenly change things.

 

[raf2769]

we do love our traditions

 

[vetmedhead]

we do love our traditions

As is tradition

 

[Squeaksmom]

Last day of lectures for the semester done. Now to brace for exams....

 

[cheathac]

Pure curiosity: Do they talk much about indirect/unconjugated bilirubin vs direct/conjugated in that class? Or do they just sorta stick with total bili?

We don't usually measure IBili/DBili (just TBili, because at the end of the day, having the split doesn't really practically change much), and I saw it on some rDVM bloodwork recently in a patient with TBili of 32 and it occurred to me that I didn't remember the last time I saw it broken out.

And then I had flashbacks to pathways of unconjugated non-water-soluble albumin-carried bilirubin being conjugated with glucuronic acid to become water soluble and ...

... my eyes glazed over and I went and got a beer and turned on Netflix.

I actually understand the language you speak!!!!!!!!!!!!!!!!! How about some pre-hepatic, hepatic, and post hepatic stuff going on with that too? Oh and how about the ALT inc to give us hepatocellular injurt or the ALP and GGT to give us cholestasis.. which in that case could correspond with whether the unconjugated vs conjugated levels are increased (hopefully I didn't sound like a *****)

 

[WildZoo]

Munching on Chinese takeout while hopelessly cramming 44 lectures worth of anatomic pathology for Monday's final. I've been at it since 4:30 AM or so.

Totally living the dream here.

Jeez. My gen path exam is Monday but it's like...10 lectures. 44 on one exam is hella excessive.

 

[WildZoo]

It's cumulative for the entire semester, unfortunately. All of our finals are.

Ouch

 

[Caiter92]

It's cumulative for the entire semester, unfortunately. All of our finals are.

Damn. I was going to ask. Our tests have been 25 lectures for path, and that’s bad enough :/

 

[flameshock]

We have one final since new curriculum, but we don't yet know how cumulative it will be. 28% of 10? 11? credits. Sigh

 

[alohacat319]

When you're in the middle of your anat path 2 final, you see a photo of proliferative enteritis in a cow, and are asked what is the organism that causes it... and you know that it's referring to Johne's dz... but you stupidly mix up Mycobacterium avium ssp. paratuberculosis and Corynebacterium pseudotuberculosis and you put down the complete wrong answer. And you don't realize until you're at home trying to nap.

One of the easiest things on that exam by a mile, and of course I missed it. Talk about embarrassing.

Uh, i just had my infectious disease final today so clearly I should know what you’re talking about, but that all sounds like Russian to me. So I don’t think you need to be embarrassed by that, you’re not stupid. Scientific names are just really hard to keep straight.

 

[Trilt]

When you're in the middle of your anat path 2 final, you see a gross specimen of proliferative enteritis in a cow, and are asked what is the organism that causes it... and you know that it's referring to Johne's dz... but you stupidly mix up Mycobacterium avium ssp. paratuberculosis and Corynebacterium pseudotuberculosis and you put down the complete wrong answer. And you don't realize until you're at home trying to nap.

One of the easiest things on that exam by a mile, and of course I missed it. Talk about embarrassing.

yah **** that

 

[WildZoo]

Yeah I wouldn't even have remembered that the lesion was caused by Johnne's

And I know that for a fact because that was on my gen path exam this morning, and thank God we only had to do a morphologic diagnosis

 

[KCgophervet]

We don't believe in good ideas. There is a long tradition of not having good ideas, and we're not going to just suddenly change things.

we do love our traditions

As is tradition

 

[WildZoo]

Aaah, lucky. On most of our gross and projected specimens, we had to give a morph and something additional, like outlining the pathogenesis or writing out the scientific name of the organism(s) that cause the lesions if it was infectious. Sometimes both. I don't recall any "morph only" questions.

Maybe our professors know that we all suck at bacteriology

 

[DVMDream]

When you're in the middle of your anat path 2 final, you see a gross specimen of proliferative enteritis in a cow, and are asked what is the organism that causes it... and you know that it's referring to Johne's dz... but you stupidly mix up Mycobacterium avium ssp. paratuberculosis and Corynebacterium pseudotuberculosis and you put down the complete wrong answer. And you don't realize until you're at home trying to nap.

One of the easiest things on that exam by a mile, and of course I missed it. Talk about embarrassing.

The only thing I recall about mycobaterium.....

Not really a "learned in vet school", but something that I have realized....

I don't know why but Ziehl-Neelsen staining always reminds me of Liam Neeson...

"Mycobacterium, I can't see you, but I have acquired a very specific stain. A stain that makes me a nightmare for bacteria like you. If you leave that macrophage now, that will be the end of it, I will not look for you. But if you don't, I will use this stain, I will find you, and I will kill you."

 

[supershorty]

4 exams left.

 

[WildZoo]

One. More. Exam.

 

[LyraGardenia]

Two more here! And of course they're the hardest ones, ugh. Luckily I'm very comfortably passing everything, so if I bomb my remaining finals it's fine.

 

[WildZoo]

I'm dooone and freeeee and gonna get soooooo hydrated!

 

[LyraGardenia]

I survived the cumulative parasit final! I *think* I did well enough to keep my B in that class. Just pharm left, which is over half the semester's material, i.e. over 100 different drugs.

 

[supershorty]

2.

left.

 

[WildZoo]

2.

left.

You can do it!!!

Finally done. What an awful week it has been. I do at least think that I ended things off on a high note with parasitology... but we'll see.

Hopefully I passed and was able to get off of probation. The suckitude of this semester has really brought our class together and I would hate to have to leave now when we're all just starting to really warm up to each other.

Time to enjoy your break Fingers crossed you get off probation

 

[supershorty]

DONE DONE DONE DONE DONE!

Time to go sleep for 3 years.

 

[Squeaksmom]

Last exam for the semester was yesterday, and I'm now home with my family. It's been too long!

 

[deleted676737]

Officially no longer a vet student.

Keep on keepin' on, c/o 2020!

 

[DVMDream]

@Elkhart I am so sorry to hear. PM me if you need anything

 

[supershorty]

I'm so sorry to hear that, @Elkhart

 

[Squeaksmom]

@Elkhart I'm so sorry!

 

[Cephal0pod]

Oh @Elkhart... so sad to hear this.

All the hugs in the world.

 

[Lupin21]

I am certain you'll find your path, elk. The future is bright with such a tenacious, good-hearted soul such as yours!

 

[JaynaAli]

I hope you keep hanging out with us wherever life takes you (if it isn’t too much of a bummer/reminder), @Elkhart!


Sent from my iPad using SDN mobile

 

[Squeaksmom]

Don't really want to go back to reality tomorrow morning. I mean, part of me is looking forward to it (seeing everyone etc.) but it would be nicer if I hadn't had the flu for pretty much my whole break!

I have to drive back down today. I suppose that means that at some point I should get out of bed and shower and stuff....

 

[LetItSnow]

I actually understand the language you speak!!!!!!!!!!!!!!!!! How about some pre-hepatic, hepatic, and post hepatic stuff going on with that too? Oh and how about the ALT inc to give us hepatocellular injurt or the ALP and GGT to give us cholestasis.. which in that case could correspond with whether the unconjugated vs conjugated levels are increased (hopefully I didn't sound like a *****)

No, not at all a *****.

But out in real life it turns into more of a "whelp, this is liver 'n gallbladder stuff - time to ultrasound and send out lepto titers" rather than "Ah-HA! This is more likely gallbladder with a smidge of liver vs this is more likely liver with a smidge of gallbladder."

 

[cheathac]

No, not at all a *****.

But out in real life it turns into more of a "whelp, this is liver 'n gallbladder stuff - time to ultrasound and send out lepto titers" rather than "Ah-HA! This is more likely gallbladder with a smidge of liver vs this is more likely liver with a smidge of gallbladder."

Oh gotcha! We have this awesome case class at Purdue. In the first semester we are able to read CBC, chemistry, UA, basic radiographs, having to come up with a diagnosis and pathways. This class has really shown me that I like reading the tests and problem solving with putting everything together. Some of the cases we had were IVDD, zinc disc, rat poisoning, endocarditis with sepsis, copper toxicity, feline injection site sarcoma, etc. We are working on researching treatments, but they don't expect us to come up with them on our own yet!!

 

[missdarjeeling]

Day 1, and I'm already extremely irritated by the way our semester is going.