Sunday, September 24, 2017

Diary of a Third-Year Vet Student: I, Surgeon

I know, it's been over a month since I posted anything. It's not like there has been nothing going on at CircusK9, but I haven't felt that the goings-on were all that blog-worthy. I gave my laying hen/ovarian cancer talk (well received, lots of positive faculty questions and feedback), I testified in a sexual discrimination/tenure revocation case for the university (I may post on this later but I'll just leave it like this for now), and classes started back up last week. Archie got his second Excellent Jumpers Q yesterday with a very fine run (I am determined to keep up his classes and competition). And I perform my first surgery on Monday afternoon, an elective neuter on a shelter dog. Since this is a post in the recurring series "Diary of a Vet Student", let's unpack that one a bit more.

After we took our Principles of Surgery lab final exam at the end of the spring term, one of the things we had to do was record our height on a spreadsheet. The student teaching lab manager used that information and her own personal observations of us during the spring term to divide us into groups of three. The team of three will rotate through three positions: surgeon, assistant, and anesthesiologist. Each of us will take each role for a dog neuter, a cat neuter, and a dog or cat spay. But why height? The surgery tables are adjustable, and are set to fit the needs of the surgeon. But if the surgeon's assistant or the anesthesiologist are much taller or shorter than that surgeon, they might have difficulty doing their jobs for that particular surgery. So, for a very reasonable reason, our lab partners this term are similar to us in height.  

Here's where things get interesting. From my team of three, I was chosen to be the surgeon for the first surgery of the term. Monday. Tomorrow. I assumed that was random, since we all get to do it eventually. But I found out today that it might not have been random at all. I trust my source for this intel but I'm not sure the person she got it from wasn't maybe pulling her leg. My friend told me that those of us picked to be surgeons for the first surgery were chosen because we were deemed to be the most level-headed of our team, the ones who, it was thought, would hold up better under the stress that this first surgery is going to put on us all. Experience didn't factor in. I sort of want this to be true, since I've never cut into a live animal before (that is, I have no direct surgical experience) and one of my teammates has. But when I look at them, smart and clever and not at all flappable, I wonder, am I really more level-headed than they are?

For some weeks now, I've been practicing suture patterns and knots until my hands get sore, watching videos, reading the recommended texts. I think I am ready. It won't be perfect but I trust my teammates to catch me if I fall. Exactly as I would do for them. 

Got to cut this one short. I need to watch the video about how to make buried knots again before I go to bed.

Monday, August 21, 2017

Apoc-Eclipse at CircusK9: The Happening

Because Corvallis was in the path of totality, I was able to sit comfortably in my driveway and watch the entire thing. I built a camera obscura, or pinhole camera, and took some photos of the event. Well, I took 117 photos, to be precise, but quickly deleted about one-fourth of those upon first review--out of focus, weird angle, didn't get the entire pinhole pattern in the image. Since I knew exactly, to the second, when it would begin, I spent about 20 minutes fooling around with the pinhole camera, experimenting with my imaging setup: how far to hold the pinholes from my viewing paper, what was the best angle for the pinholes so sunlight would hit the holes as perpendicularly as possible, where to hold the digital camera, how close to the viewing paper the camera needed to be to get a clean image. Here is my setup:

Yep: a piece of white paper taped to a flattened cardboard box propped up against a chair, a piece of cardboard from some junk mail with a hole covered with a piece of foil, and two rulers taped on to hold it nice and straight. That's some high-tech shit right there. In a nod to whimsy, I decided to poke a pattern of holes into the foil, not just one.

It was a neat event and I'm glad I got to observe it.

This one is my favorite. I only cropped it down a bit, no other edits.

Stupid plane flew by just before totality, leaving a con-trail in the sky. You can see my shitty little camera trying hard to find that dark spot of the moon in the center.

Thursday, August 17, 2017

Laying Hens and Epithelial Ovarian Cancer

Re Apoc-eclipse, stores around here are running out of bottled water and plastic gas cans, and gas stations in rural eastern Oregon are running low on gasoline. The internet is starting to bog down too (they are also predicting possible cell service outages on Monday due to the increase in users). Just look at this google map of traffic trying to get out of Portland. Sheesh, it's only 3:30pm on Thursday.

But that's not what I wanted to rant about. I wanted to post about my research project. I've been working on this project for three years now. I've cobbled together funding from several sources, and the entire thing has been run on a shoestring budget. This is my last free summer while in vet school, and I have to get everything wrapped up by the end of September, or at least as wrapped up as research ever gets. Which is really never if your project is exciting and you enjoy doing serendipitous discovery-driven science. 

For three years, I've been using laying hens to study ovarian cancer. Yeah, I know, that's pretty weird. Laying hens are not exactly the kind of laboratory animal you think of first. But they spontaneously develop tumors in the surface epithelium of their ovaries, and these tumors are microscopically and chemically similar to those that develop in women. Risk of this cancer in hens increases with age, just as it does in women. And the disease progression is very similar, such that advanced disease stages in hens are accompanied by metastases to other peritoneal organs and ascites, or fluid in the peritoneal cavity.

Why do hens get this type of cancer? Two easy reasons jump out: we have genetically selected commercial strains of hens to lay about an egg a day, which means an ovulation every 24 hours or so, and we manipulate the photoperiod of their environment to keep them in a continually active reproductive state. So after 24 months or so of this, they begin to get epithelial ovarian cancer. 

The big problem with this disease in women is that symptoms are non-specific and it is usually diagnosed late. The five-year survival rate of this disease following diagnosis, irrespective of treatment, is sadly low. Early detection is an elusive goal. But it is hard to get data on early expression of this disease in women. We can't just go around and sample ovaries of 20-year-old women to see what's going on. What are we looking for anyway?

When I learned that hens are a robust model for this disease, I thought, well, I know a little bit about chickens and maybe I can contribute something of value to this problem. Yeah, I know, it sounds crazy. Cancer research is big business with big-name players. Who the hell am I to get involved in that.

Well, I'll tell you. I am a scientist. I always have been. I am driven to learn about the world around me by my curiosity. I am not afraid to tackle new things because I know how to learn. The road to hell is paved with good intentions but I decided to head on down there with my ideas anyway.

Last summer, when I was looking at microscope slide after slide of hen ovaries, I realized that there was no detailed description of what a normal laying hen ovary looked like. Plenty of papers described gnarly cancerous ovaries. But where were the references for normal? What was the range of normal? I went to my collaborators and they all said, yeah, looks like you'll have to write that yourself. So I did. I hope to have a manuscript on the "histopathology of the normal laying hen ovary" submitted to an online journal in a couple of weeks. Submitted doesn't mean accepted but it's a necessary first step. I'm first author with three established names behind mine. It is a good paper and I will be extremely proud to see that one published (eventually....).

With that out of the way, I returned to my original plan: what does early expression of ovarian cancer look like in hens? Were there any proteins that I could measure in the blood of the hens that I could associate with disease before it forms grossly visible tumors? If so, was that protein also measurable in women?

While describing all those normal ovaries, I began to notice a few ovaries that seemed a bit abnormal. With more careful looking, my collaborators and I decided that we did in fact have a pathology in those ovaries that had not been described before. The pathology is associated with an increase in a specific type of immune cell, the heterophil, and an absence of small follicles. Heterophils in birds act like neutrophils in mammals: they are first responders to the site of tissue injury or a microbacterial invasions. They are usually associated with acute inflammation, and are mostly gone after about 24 hours when other immune cells take over. But there was no evidence that the heterophils in the abnormal ovaries were acting like that. So what the heck were they doing? 

I dived back into the cancer research literature, this time reading up on cancer and inflammation. A rich topic indeed. And I discovered that epithelial ovarian cancer in particular is associated with an increase in a key inflammatory protein that has also been associated with avian heterophils. So I ran a fancy test on the hen serum then statistics on the results and found that the hens with abnormal ovaries had elevated levels of this particular protein in their serum. So for our second manuscript, I'm proposing a link between early neoplastic changes, an increase in this inflammatory protein (it is secreted by cancerous epithelial cells), and the increase in heterophils and absence of small follicles in the affected hen ovaries. It's a link that has not been made before. 

I may not ever return to this project, although much more work can be done with it. I've learned a lot about laying hen anatomy (gross and micro) and reproduction, and I've learned a lot about ovarian cancer. Oh, and that rabbit-hole I dived into to learn about inflammation was time well spent. It is exciting to find things that nobody else has stumbled across yet. It is affirming to make even these small contributions to our body of scientific knowledge.