Reflection on April and the A to Z Challenge

The past month has been a crazy one. After signing up for the A to Z Challenge, I was very excited to put together a great list of diseases and write about them. The list making was easy as were many of the posts. I enjoy bringing knowledge to people who want to learn more. I learned quite a bit myself as well. Some of my posts were very emotional for me. I cried and relived experiences that have changed who I am and how I see the world.

I have enjoyed learning about other people lives and visiting far off lands via the blogs of others. I firmly believe that the only way we can improve our world is to become more connected. To build communities based not on always agreeing, but on mutual respect and caring. This blogging challenge may not seem like it would make that happen, but it does. To know what makes someone tick in India, what makes someone happy in Sweden, to know the sadness and fear in Venezuela brings us closer together. Anything that helps us to feel empathy and to inspire change in our lives is a good thing in my humble opinion.

Outside of the blogging challenge, a lot of things happened. Tragedy struck many people and touched the periphery of my life. I am thankful that the tragedies were not in my family, but my heart aches specifically for two families that lost the parents leaving 7 children to be raised by their aunts and uncles. The continued violence around the world. The natural disasters that have brought devastation to many lives. Jobs lost, jobs gained. Birth, death. Happiness, sadness. Elation, depression. The world continued to spin and lives were changed.

I am thankful that I took part in this challenge. I am grateful that I gained a new appreciation for writing and for the world and people around me. I am pleased that people liked my posts and commented. I hope that I will have more to say and that people will come back.

I don’t know what life has in store for me, but I welcome whatever challenges are ahead.

Thank you for your support and on this Star Wars Day, May the Fourth be with you!

A2Z survivor badge 2014

Z is for Zoonotic Diseases

Z is for Zoonotic Diseases

A to Z 2014

A to Z 2014

This is my final 2014 A to Z Blogging Challenge posting. Today we will come full circle as many of my topics have been zoonotic diseases.  It has been an interesting and informative month for me, I hope it has been for you!

zoonotic disease is a disease that is transferred from animals to people either directly from saliva, urine, feces, or tissues to vector transmission (ticks, mosquitoes) to ingesting infected food or beverage. This past month zoonotic diseases have been discussed at length here at “Days In the Life of A Christian Veterinarian” including: Anthrax, Ebola, Tularemia, Giardia, Leptospirosis, Monkeypox, Q Fever, Rabies, West Nile Virus, and Yersinia pestisBlastomycosis was also discussed, although technically isn’t really a zoonotic disease, as it is a fungus from the environment, but can be spread with animal contact (beaver dams, etc.). There are many more out there, so please keep educating yourself. You can speak with your human medical doctor and/or your veterinarian about what is common in your area. You can get a lot of great information on the Center for Disease Control and Mayo Clinic websites, there is even an A to Z listing of many animal transmitted diseases on the Washington State Department of Health website. Be cautious when doing generic internet searches though as there is a lot of misinformation or out there.

Red-eyed Frogs (Photo Credit: Scott Robinson)

Red-eyed Frogs (Photo Credit: Scott Robinson)

To bring you back to A, I would like to introduce a term that is not commonly used: anthroponosis – infection spreading from humans to other animals. Some people just call this revere zoonosis, but really that is not nearly as much fun! An example of this, is when you handle a frog with your bare hands (no gloves) you can transmit a fungus from your skin to the frog causing the disease Chytridiomycosis. Many people have commented their surprise at the diseases we have discussed and their detriment to people. This disease that we spread has decimated and caused extinction of amphibian populations around the globe.

Boots and I bid you Farewell, and hope to see you again!

Boots and I bid you adieu, and hope to see you again!

Thank you for joining me this past month, and I hope you visit again. I may not write as often, but will update when I feel like I have something of value to say, or at least just need to share. I appreciate feedback, likes, comments, and shares! I am more than happy to answer generic questions, but will always recommend that you see or speak with your veterinarian or doctor for specific information. For me to give out specific diagnostic and treatment advice could potentially result in the lose of my veterinary license, so please don’t make that a problem for me (or any medical professional in the blogosphere).

Photo Credit:

Red Eyed Frogs: Scott Robinson via Photopin.com under Creative Commons Licenses

Y is for Yersinia Pestis

Y is for Yersinia Pestis

Salem Friendship (Photo credit: Josh McGinn)

Salem Friendship (Photo credit: Josh McGinn)

Fall 1347 – I begged my parents to allow me to bring the harvest to town today. I have always loved watching the ships come into harbor and see the wares offloaded. The fabrics and fruits from The East ensnaring my attention, even though I know I will never have them. I visualize the colors dancing before my eyes. I watch the flags wave in the wind and the rats scurry down the hold lines. I hear the calls from the sailors to the shore, there is a flurry of activity and shouting. I don’t have time to investigate, I need to sell what I can and get home before nightfall.

As I return home with an empty cart, I mindless scratch at my ankles and legs, picking off the fleas and crushing them. Today’s produce sales were good. My parents will be proud. For the next two days, my parents allow me to bring the produce to town, but on the third day, I can barely walk. My mother applies poultices to my ankles and legs where the skin is torn and bleeding. There are swellings in my groin and armpits that stretch the skin painfully, finally bursting to drain pus and blood. Despite extra blankets and laying near the hearth, I shake from chills and fevers. The cough begins a few days later. I look down, I am covered in blood. As I lean back into my blankets, I smell smoke in the air.

†  †  †

Yersinia pestis model at the Smithsonian Natural History Museum (photo credit: Tim Evanson)

Yersinia pestis model at the Smithsonian Natural History Museum (photo credit: Tim Evanson)

Yersinia pestis, a gram negative rod-shaped coccobacillus, is the bacteria responsible for The Plague. In October 1347, 12 ships arrived in a Sicilian port, the crews were dead or dying, despite the attempts to turn them away, it was too late. The Black Death had arrived. The rats that traveled on merchant ships from Asia began to die off as well. The fleas that infested them needed a new source of food, so they began to feed off of humans. In the process, the fleas transmitted Yersinia pestis when they would vomit the rat’s blood into their human victim. The bacteria replicated at the site of flea bites and then spread through the lymphatic vessels, causing lymph nodes to swell (buboes) before erupting. Sometimes, the bacteria would cause sepsis (a severe blood infection) or spread to the lungs. These are the three forms of Plague: Bubonic, Septicemic, and Pneumonic.

From 1347 to 1353, one-third of Europe’s population died from “The Black Death” (the name given to this second Yersinia pestis pandemic). There was no escape from The Black Death in Europe. The cities were full of death, people would flea to the countryside, but the fleas followed infecting people and animals. Entire towns died off. In an attempt to prevent spread of disease and because there were few to bury the remains, homes and bodies were burned.

Today, although outbreaks still occur, Yersinia pestis can be treated with antibiotics.

Yersinia pestis found in a liver - note yellow spots (Photo credit: Jennifer Stewart, DVM)

Yersinia pestis found in a liver – note yellow spots (Photo credit: Jennifer Stewart, DVM)

Animals are also at risk, although cats are more prone to having and spreading infection compared to dogs.

Prevention is the best protection though.

  • Be aware if you live in an endemic area
  • In endemic areas, keep dogs and cats protected with flea prevention medications year round
  • In endemic area, do not allow dogs and cats to sleep in bed with you
  • Decrease rodent populations around homes, barns, businesses, and recreation areas
  • Use insect repellents when in areas that fleas are common
  • Wear gloves and other appropriate gear when handling animals or specimens that may be infected with Yersinia pestis

 

Photo Credit:

Yersinia Pestis Model at Smithsonian Museum of Natural History by Tim Evanson http://www.flickr.com/photos/23165290@N00/7283938624/ via Photopin.com http://photopin.com with Creative Common License https://creativecommons.org/licenses/by-sa/2.0/

Ship Josh McGinn http://www.flickr.com/photos/svenstorm/1548728822/ via Photopin.com http://photpin.com with Creative Common License https://creativecommons.org/licenses/by-nd/2.0/

Yersinia pestis in a liver by Jennifer Stewart, BS, DVM, DAVCP, MRCVS

X is for Xylitol Toxicity

X is for Xylitol Toxicity

A number of years ago, I received a telephone call while on-call. The person informed me that her dog ate a piece of chocolate cake. I asked some more specific questions: What size is your dog? How much chocolate cake did it get? Was it a cake made from a box or from a gourmet bakery? Etc. Based upon her answers, I informed the woman that the likelihood of her dog having any problems was minimal (pretty much zero) as it only took a small bite and it was a box mix which does not have much chocolate in it. The woman than said, “I don’t know if you know this, but chocolate is toxic to dogs.” I thanked her for the information, and yes, I was aware, but the toxicity is based on type of chocolate (milk chocolate is not as bad as dark chocolate which is not as bad as baker’s chocolate), size of the dog, and the amount of chocolate eaten (a bigger dog can eat more than a small dog with less complications). I told her what to watch for in case there were any problems and asked her to call again if she noticed any. There have been other times in my career that I have had a very different conversation when it comes to toxicity. In 2004, the conversations about toxicity started to grow as a new toxin emerged on the veterinary scene: Xylitol.

Xylitol used for baking (SocialAlex and www.mixedfitness.com)

Xylitol used for baking (SocialAlex and http://www.mixedfitness.com)

Xylitol is a chemical compound that is made most commonly from birch trees and is used as a sugar substitute. It is most commonly found in sugar-free gum, candies, and in many forms of toothpaste. Some people, especially diabetics, use it as a sugar substitute in cooking. Due to the slow absorption in people, there are very few side effects, although some people complain of diarrhea after ingestion of even small amounts. When reading labels you may also see xylitol listed as Eutrit, Kannit, Newtol, Xylite, Torch, or Xyliton.

In dogs there is a very fast absorption rate, often within 30 minutes, and signs and symptoms of xylitol poisoning can develop rapidly. That being said, since toxicity normally develops from eating the gum which is meant to be chewed, it can take up to 12 hours for symptoms to develop since dogs rarely chew and just swallow the gum. The most commonly seen sign is severe hypoglycemia (low blood sugar) that comes as a result of rapid release of insulin from the pancreas into the blood stream. If the dog’s blood sugar drops low enough, coma and death can occur rapidly as well. Other side effects include liver disease with secondary bleeding, liver failure, and death. Cows, goats, and rabbits also show a significant release of insulin in response to xylitol. At this time, it is unknown how cats respond to xylitol.

How much xylitol does it take to make a dog sick?

Spry sugar-free gum

We know that as little as 100 mg/kg (45 mg/lb) requires decontamination and monitoring, with dogs receiving more than this requiring supportive care. In the case of baking xylitol (the granulated form), 1 cup weights 190 grams. When it comes to gum and candy, the difficult part is that manufacturers do not always list how much xylitol is in their products. Estimates range from 0.9-1,000 mg per piece of xylitol containing gum. Clinically, we can see toxicity in a 20 pound (9 kg) dog with as little as 1 small piece of gum. Therefore, it is essential to contact your veterinarian (or veterinary emergency clinic) immediately upon knowledge or suspicion of ingestion of sugar-free products. If possible, have the packaging available when you speak with the veterinarian or bring it with you if going straight to a veterinary clinic or hospital. In the United States, you can contact the Pet Poison Hotline at 800-213-6680 or the ASPCA Poison Hotline at (888) 426-4435, although there is a fee associated with the call it may save you some money when going to the veterinarian.

What should I expect when I get to the veterinary clinic?

Photo courtesy of Sean94110 https://www.flickr.com/photos/sean94110/

Photo courtesy of Sean94110 https://www.flickr.com/photos/sean94110/

You should expect to have a history and complete examination performed. If your dog is not showing symptoms and the ingestion was recent, he or she may be given medication to induce vomiting which will hopefully remove the ingested substance from the stomach and then do appropriate diagnostics and supportive care. If your dog is already showing signs of toxicity, the veterinary team may obtain blood and urine samples and place an IV catheter. Blood tests should include chemistry, electrolytes, and complete blood count (CBC). They may also check clotting times (PT and aPTT) and fibrinogen levels, especially if there are already signs of bleeding. Once low blood sugar has been documented, then IV fluids containing dextrose will be started. Your dog may need to remain on IV fluids for 24-72 hours or until the blood glucose has stabilized. Multiple checks of glucose will be performed (usually only needing a few drops of blood) and liver values will also be monitored to make sure there is no worsening or liver disease.

If caught early in the process or if it is a mild case, the prognosis is generally very good. Waiting to seek medical attention until after symptoms start or in ingestion of large amounts of xylitol, prognosis worsens significantly.

Ways to prevent xylitol toxicity include not having xylitol containing products in the home or keeping them far out of reach of animals (which can be difficult if there are children in the home) and knowing what is in the products you have. Double check all products labeled as sugar-free.

Remember that although this can be fatal, it is usually treatable. What should you do if you suspect or know that your pet has been poisoned? Click HERE.

For a list of the Top 10 Pet Poisons of 2013 click HERE and for an alphabetical list of animal poisons click HERE.

Xylitol photo credit: SocialAlex at Photopin.com using Creative Commons Licenses

Spry photo credit: Katherine of Chicago at Photopin.com using Creative Commons Licenses

Dog photo credit: Sean94110 at Photopin.com using Creative Commons Licenses

W is for West Nile Virus

W is for West Nile Virus

Mosquito Bite1937 Omogo, Uganda (West Nile District) – During research on Yellow Fever, a 37 year old woman is the first known patient to have West Nile Virus (WNV) isolated from her blood.

1957 Israel – An outbreak of WNV is shown to produce meningioencephalitis in elderly patients.

1960s – Horses are effected in Egypt, France, and throughout Europe, southwest Asia, and Australia.

1999 College Point, Queens (New York City) – Horses, dogs, cats, and humans infected with WNV

From that initial point of contact in the USA, West Nile Virus, a mosquito-borne arbovirus spread rapidly across the country. Birds, specifically crows and Blue Jays, were found dead throughout the country. Local and state agencies began testing the birds and found West Nile Virus. Surprisingly, as it is a disease of temperate and tropical locations, not what comes to mind when you think of Wisconsin and Minnesota! For many years, the question of how WNV spread so quickly went unanswered. It was well documented that birds are the only species that can build up enough WNV to allow transmission to other species via mosquitoes. Migratory routes and other factors were taken into effect, but it still didn’t make sense. The crows and Blue Jays were dying, so how was the disease still spreading? The culprit was finally found in 2011 – the American Robin.

American Robin (Keith Williams)

American Robin (Keith Williams)

The American robin has a unique feature in that the mosquitoes that carry WNV love to feed on their blood (I wonder if I am part robin as they appear to feast upon me quite readily as well). The robin is a mainstay in the upper Midwest and has a large migratory pathway. Between the mosquitoes and the robins, they were able to quickly spread across country and since robins weren’t dying from the disease regularly, they were flying under the radar for testing.

Most people that contract WNV never have any symptoms. One in five people will develop flu like symptoms with fever, muscle aches, and lethargy being the biggest signs, and they can hang on for weeks to months, sometimes these may require hospitalization for IV fluids and other medications. Only 1% of all people infected will develop severe disease including meningitis and encephalitis. Of those individuals that develop neurologic signs, 10% will die.

There are no vaccinations for people, although there are WNV vaccines for horses.

V is for von Willebrand’s Disease

V is for Von Willebrand’s Disease

Von Willebrand’s Disease (vWD) is another disease that is usually inherited from parents, although can also come from a spontaneous mutation. It is a defect in the clotting cascade in which the Von Willebrand factor is either missing completely or mutated so that it does not function properly. The end result of this mutation is that the individual affected is unable to clot properly and has excessive or inappropriate bleeding. In the United States it is estimated that 1% of the population (1 in every 100 people) has vWD, many go undiagnosed or misdiagnosed for an extended period of time.

There are many types of vWD:

  • Type 1 is the most common, also the mildest form, is when there are just low levels of the von Willebrand factor (vWF), there may or may not also be a decrease in factor VIII levels (hemophilia is when factor VIII levels are low or absent and vWF levels are normal).
  • Type 2 is actually a grouping of four subtypes 2A, 2B, 2M, and 2N in which there are normal amounts of vWF, but it does not function properly. Each subtype has a different mutation, therefore treatment for each subtype is also different.
  • Type 3, the most severe form, there is low to no production of vWF and there are low levels of factor VIII.

Signs and Symptoms:

  • Frequent nosebleeds – start spontaneously, 5 or more in a year, require medical attention to stop, and/or take more than 10 minutes to stop
  • Bruising – frequent (1-4+ times per month), little to no trauma, is elevated and larger than an American quarter
  • Women may have heavy bleeding with menstruation that includes large clots
  • Prolonged bleeding after injury, surgery, childbirth, or dental work
  • Less frequently, one may also have blood in stool, urine, or joints and internal organs (severe cases)

Treatments can include:

  • Desmopressin tablets or nasal spray
  • Replacement therapy of missing factors
  • Antibrinolytic medications
  • Birth control pills for women to decrease blood loss

In veterinary medicine, we do see vWD cases as well. According to the University of Cornell School of Veterinary Medicine, vWD is most common in the Doberman Pinscher, Pembroke Welsh Corgi, Airedale Terrier, Scottish Terrier, and Shetland Sheepdog, although it is found in over 50 breeds of dogs. To lesser degrees it can also be found in pigs, rabbits, cats, and horses. Dobermans are the one that I have seen most frequently, to the point that prior to any major surgery I often recommend vWD testing for them, especially if there is a known history of it in family lines or if there is no history available. When obtaining a dog, especially when purchasing, it is important to ask about family history, specifically any known diseases or conditions, including vWD.

Shotgun (Photo courtesy of Destiny Verhoeven)

Shotgun (Photo courtesy of Destiny Verhoeven)

According to Veterinary Partner the most common breeds for each type are as follows:

  • Type 1: Doberman Pinscher, Shetland Sheepdog, German Shepherd Dog, and Standard Poodle
  • Type 2: German Short-haired and German Wire-haired Pointers.
  • Type 3: Scottish Terriers, Chesapeake Bay Retrievers, and Shetland Sheepdogs.

If you do have a dog (or other species) with vWD, it is not recommended to breed them and they should be spayed or neutered. That being said, when it comes time for surgery, ideally, plans should be made ahead of time for medications to be on hand in case of hemorrhage.

U is for Urea Cycle Disorder

U is Urea Cycle Disorders

U is for urea cycle disorders, specifically Carbamoyl Phosphate Synthetase I Deficiency (CPS I). CPS I is a genetic condition that results in the inability to break down ammonia in the liver. It is a recessive disease, which means that to have the disease one must have inherited the defective genes from both parents. Although a strict diet can be used to prevent worsening of disease, the only treatment is a liver transplant.

Today, I am going to share Liam’s story, paraphrased from his parents, Rob and Jenn.

Liam just after birth

Liam just after birth

After 29 hours of labor, Liam was born on April 30, 2013 at 7:50 am. Jenn and Rob loved Liam from first sight. He was strong and active. Due to the prolonged labor and increased risk of infection, he was required to remain hospitalized for 48 hours. This ended up being a miracle for them all.

On the night of May 1st, Liam began showing signs of discomfort and agitation. He began struggling for breath. The next morning, he was transferred to the neonatal intensive care unit (NICU). By 3:00 am on May 2nd, Liam was having seizures and became non-responsive. At this point, test results were coming back and he was transferred to University of New Mexico Hospital (UNMH) to treat elevated ammonia levels in his blood. He was also transferred from the NICU to the PICU (pediatric intensive care unit) so that he could undergo dialysis to clean the ammonia from his blood. He had dialysis daily but there was little response to his comatose state until after his third treatment on May 4th, Liam opened his eyes.

Liam just after his seizures.

Liam just after his seizures.

Liam's ambulance ride to UNMH

Liam’s ambulance ride to UNMH

It was determined that Liam had a urea cycle disorder, initially, it was thought to the be an Ornithine transcarbamylase deficiency (OTCD) which occurs in one out ever every 80,000 births. Further genetic testing showed that Liam actually had a much rarer urea cycle disorder, Carbamoyl Phosphate Synthetase I Deficiency (CPS I).

Jenn and Liam

Jenn and Liam

In September 2013, Liam had multiple procedures performed including injection of stem cells into his portal vein (a large blood vessel that goes through the liver) to help his body deal with the ammonia levels for the time being and the placement of a feeding tube. He still had struggles, but was doing really well given the circumstances. Discussions started to take place and planning for a future liver transplant began. 

Liam's first Halloween

Liam’s first Halloween

 

In October he started a cycle of vomiting every other day.

In November he was back in the hospital for 5 days trying to get his ammonia levels under control.

Liam's first Christmas - lots of toys, but he wants to play with the nasal aspirator!

Liam’s first Christmas – lots of toys, but he wants to play with the nasal aspirator!

In mid-December, Liam was again hospitalized, this time he was in longer and spent his first Christmas in the hospital. He was finally sent home on January 6, 2014. Despite the only cure for CPS I being a liver transplant, insurancecoverage for his transplant was denied. Jenn and Rob finally found a lawyer that was willing to represent Liam, Mr. Roepke.

 

On February 1, Rob and Jenn sent out the following message, “[The insurance company] called Jenn on Friday to say that they had overturned the denial and that we will be approved to go to Stanford.Jenn and I would like to express our deepest gratitude to our doctors for their perfectly executed contributions to our appeal, their sacrifice of time, and their obvious care and concern for Liam. Dr. Joel Berger is Liam’s pediatrition, Dr. Sarah Bluefeather is from the Department of Pediatrics at UNMH, and Dr. Heidenreich is Liam’s Biochemical Geneticist from the Metabolic Program at UNMH and the individual most responsible for Liam being alive today. We are overwhelmed by the dedication of these professionals. We also owe a great deal of thanks to Mr. Roepke who took on the challenge of representing Liam, put hours of labor into reading, research, meetings and phone calls, and then refused to charge us for any of his work. Jenn and I feel truly blessed with the good fortune of knowing these individuals, and we are amazed at their compassion and selflessness.

A recent Liam picture!

A recent Liam picture!

Once the transplant was accepted by the insurance company, things began moving much faster. Additional testing had to be done and a central line placed to make blood draws and IV medications easier on Liam. One of the tests was an echocardiogram (ultrasound of the heart) that was rechecked as a patent foramen ovale (PFO) was found, but was not found to be a hindrance to transplant surgery.

On April 23, 2014, I received word that Liam was having his transplant. As of the writing of this post, Liam is in surgery, his liver has been removed and they are preparing to place the new liver. Please keep Liam, Jenn, Rob, the rest of the family, the medical staff, and the donor and donor’s family in your thoughts and prayers.

A donation fund has been set up to help with expenses not covered by insurance – estimated to be around $65,000.00. If you are willing and able please consider a donation to http://cota.donorpages.com/PatientOnlineDonation/COTAforLiamL/

Consider organ donation. One organ donor can save 8 lives and effect the lives of more than 50 people. 18 people die every day while waiting for an organ transplant. You can even be a living donor, like my friend Kelly Wright.

UPDATE: Liam got out of surgery about 11:30 pm last night (California time).  He is heavily sedated and they hope to extubate (remove the breathing tube) tomorrow. The donor liver was a little big, so they had to trim it. Other than rejection of the liver, the biggest concerns are bleeding, blood clots, infection, and fluid retention. The little guy is swollen from all of the fluids and blood products he received, but he is alive!

Image thanks to Lizzie Hug. For image information or use please contact  lizzie_hug@hotmail.com

Image thanks to Lizzie Hug. For image information or use please contact lizzie_hug@hotmail.com

T is for Teratoma

T is for Teratoma

My April 18th blog introduced you to my sister, Jolene, and part 1 of her story. Today, we will learn more about Jolene and Sam, her son. Another miracle. Spoiler alert, you may need tissues.

†  †  †

Sam was a very happy child, and we were ready to move on, literally, we put our house on the market by owner, and we were general contracting the building of our new house. At 1 ½ years, Sam, started to be very lethargic and was vomiting. The first visit to the Doctor, we thought he was dehydrated from a flu bug, so we took him in for IV fluids. Why are all of my friends kids getting in trouble and running all day, and mine isn’t? The second visit, he tested positive for strep, so we put him on antibiotics. The third visit, Sam was sleeping 20 hours a day and he didn’t flinch as the doctor examined him. At this point we were all concerned. Our doctor sent us to Children’s Hospital of Wisconsin and prepared us that we may be there overnight. I went home where Aaron was going to meet us, as I had to do payroll and book a trip for a friend (I was assuming Sam had a little infection that would require overnight iv medication).

Sam was placed on oxygen immediately after arriving in the ER. He had no energy and barely moved on the bed. After a clear chest x-ray, he was taken to the CT scan. When the scan was done, and we were still in the room the nurse came and took our lead vests. We could see the chief of radiology in the control room looking at Sam and then looking at the scan repeatedly; he then came in with 3 others in tow. He grabbed my hands. The nurse grabbed my shoulders. The tears started even before I heard, “Your son has a brain tumor, and we need to operate immediately”. When he asked if we had any questions, I said, “Can I hold him?” As I sat holding him, the doctor told me to take a deep breath, the next 24 hours are going to be the hardest, but it is operable. The only brain tumor that I knew about before this, was Pastor Mitch’s son who passed away when he was 12, so my panic button was pushed. I needed that “slap in the face” to calm down. Aaron then asked to see the scan, and the nurses took Sam. I was then escorted to a new room where I could make a couple of phone calls.

The first person I wanted to call was my mom, and I realized that she and my sister were on their way home from camp. So I then decided to call my dad. I was asked what his phone number was…what?! God, in his love, put my father’s work number in my head which I have not called in years. The nurse called and asked for him, she then said, “Hello, Mr. Metz, this is Sharon from Children’s Hospital. Your daughter, Jolene, is here and she is a little upset” Oh boy, “Dad” At this point I sobbed again. After another deep breath, I told him what was going on. Bless my father, he said he would pick up my mom and sister and head down to the hospital (by that time we will have more information). He then prayed with me. I do not recall my dad ever really praying spur of the moment before, and I needed it. I then called my best friend whom I was throwing a bridal shower for on that Sunday (yes, in two days). She, of course, cried with me and then said forget the shower. We have a baby to take care of. She came to the hospital every day and brought me breakfast. 

After those phone calls, they took Aaron, Sam, and I back to the ER. By that point, every staff member knew what was happening. The kindness that poured from each of them made a difficult situation a little easier. They let us use the unused nurse station to call family and friends, since almost everything was long distance. We were then moved to another location in the Emergency room to prep him for an MRI. We were given some more instruction, and Aaron’s mom and sisters arrived. The nurse then cut off a lock of his hair, gave it to us, and asked us to say goodbye. They took him away for a tracheostomy. Dr. Kaufman came in at 9pm and asked if we wanted him to talk to just us or our family too. We said speak to the group, as that evening we had 40 family and friends supporting us in the PICU waiting room. Due to the delicacy of the surgery, he was going to perform it the following day so he could be well rested. We were then allowed to go and see Sam. We went in, along with our parents, and Pastor Mitch.

Sam in his hospital bed

Sam in his hospital bed

As we walked in the room, we all did a double take, as we looked at the rocking chair. I looked at Mitch, and said, “is that your son?” The rocking chair had a plaque in honor of Travis Schultz, his son’s name. It was his name, but different dates, and his son died in Georgia. What he was even going through, I cannot tell you, but it broke my heart that he relived it, and at the same time, was a comfort to have someone there who experienced this first hand. As I looked at the rocking chair, in my heart, I heard, “I love him even more than you.” After a really rough night, I dressed in scrubs, and carried Sam to the operating room. As I was holding him, the doctor gave him anesthetic, and he went limp in my arms.

Sam's scar

Sam’s scar

At that moment, I knew that he was God’s son, before mine. I had to give him to the Lord. I didn’t know the outcome, but He did. The surgery was expected to last 4-7 hours. It lasted 11. When it was over, Dr. Kaufmann came in to give us the final update. It was a very large mass, the main tumor was the size of a golf ball with cysts all around which made the total about the size of a baseball. If they would have even waited a day, the outcome would not be the same. Sam had a teratoma – a tumor that although not cancerous was malignant due to its location in his brain. He also said, “We had to go through the emotions part of his brain, he may never smile again.” I was prepared for brain damage, blindness, etc, but to never see my baby smile again was a hard thing to swallow. When they wheeled little Sammy in from surgery, I fell to my knees and sobbed, gut wrenching sobs. Sam’s surgery was on a Saturday. Monday, I was told to go home, take a shower and a good long nap. So I did, but I longed to be at the hospital. On my way, I turned on the radio and this song started playing. I had never heard it before, but it exemplifies everything that we were feeling. “He’s My Son” by Mark Schultz

http://www.youtube.com/watch?v=3YK3JR-4Wpg

Sam was discharged on Wednesday, 4 days after his brain surgery. We got home and Aaron and I were so excited to go to sleep in our own bed. Well, Sam was on steroids. We went from a child who slept 20 hours a day to being awake 20 hours a day. Aaron and I were running on fumes. On Thursday, I had to give Sam all of his medicines. As soon as I gave Sam his anti-seizure medication, Aaron asked what I gave him. I told him, and then he said, “how much?” NO!! Instead of 2 mL, I gave Sam 2 Teaspoons, or 10 mL, 5 times the dosage. Aaron yelled at me to call the doctor, and I panicked. My son can survive brain surgery, but he cannot survive the 1st 24 hours home with his mother. I called the neurosurgeon, and the Doctor on call asked me to take a deep breath and explain what happened. I did, and she answered and told me that he will be okay, I need to skip the next dose, call someone to come over, and go to bed. I did. My mom came over, and Aaron and I slept. The next few months were a little difficult, as I tried to keep him from bumping his head. We had another surgery to place a drain in his head, but overall Sam did remarkably well.

The following April we decided to take him to Disney World, where 13 hours after landing, Sam had a seizure. We spent 3 days in the hospital, and then 2 days at a friend’s, and then 3 days in our room at Disney. In spring of 2008, Sam was 5. He was doing so well, and we went to see the Neurosurgeon for a checkup, and he walked in with 3 interns. It isn’t always good when he brings in others. The remaining cyst appears to be growing. They were not sure how aggressive it was, so they wanted to let Sam be a kid for the summer and we would go back in August. They had already discussed how they were going to remove it. 

Sam's Wish

Sam’s Wish

This was the summer that Sam became a part of Make-A-Wish. The day that his wish granters came, I got the phone call from the Doctor saying that the tumor hasn’t changed, so they were not going to operate. I then told the wish granters, and they were so kind, they said that he is going through more than most kids, and once you are in the program, you stay in the program. So they sat down with Sam to learn more about his wish. Sam asked to sing the National Anthem at a Milwaukee Brewers baseball game. He got his wish the following summer. On July 12, 2009, he sang to a sold out crowd at Miller Park.

 

 

Sam still needs prayers, as does the rest of the family. He has more testing coming up soon, with the potential for another surgery. Please keep him, his family, and all of the medical staff in your prayers. We know Sam can keep doing wonderful things and is growing into an amazing young man!

 

Please take a look at my next post as well “Transplant Needed” posted today – fundraiser in Albuquerque, New Mexico for my friend’s son that needs a liver transplant.

 

S is for Salmonella Typhi

S is for Salmonella Typhi

 

Salmonella typhi GiantMicrobe

Salmonella typhi GiantMicrobe

Salmonella typhi is the causative agent of typhoid fever. Typhoid is carried by people in their blood and intestinal tract. It is spread through fecal contamination. Therefore, maintaining good hygiene and avoiding contaminated food and water is essential in preventing new and spreading disease.

Typhoid is most common in the developing world with about 21.5 million cases each year worldwide. The United States has an estimated 5,700 cases, with up to 75% of those diseases obtained while traveling internationally. There are two types of vaccines available in the USA, an injection that lasts for two years and a series of oral tablets that last for 5 years before needing to be boostered. Neither vaccine is 100% protective, so maintaining good hygiene, only drinking bottled or boiled water (rolling boil for at least 1 minute) and not tap water is necessary. Also, being vigilant about food is imperative. Eating only fully cooked foods, avoiding raw fruits and vegetables that you cannot peel yourself, and avoid street food and ice cubes will go a long way to protect yourself.

The symptoms of Typhoid fever are progressive. If you suspect that you may have developed Typhoid, it is recommended to seek medical care as quickly as possible. The most common signs are fever (103-104 F/39.4-40 C), weakness, fatigue, abdominal pain, diarrhea or constipation, and rash. These are seen the first week with progression of the disease through the second and third weeks when complications can result in death. Treatment is generally with antibiotics – ciprofloxacin is the most common and is often given to be used if diarrhea develops while traveling. Treatment of dehydration and other symptoms are also important.

Typhoid carrier. Food pollution. "In this manner the famous 'Typhoid Mary' infected family after family." (originally posted to Flickr as Reeve 40328)

Typhoid carrier. Food pollution. “In this manner the famous ‘Typhoid Mary’ infected family after family.” (originally posted to Flickr as Reeve 40328)

Mary Mallon, also known as “Typhoid Mary.” She was the first known asymptomatic carrier in the USA. She was born in Ireland and immigrated to the United States where she began working as a cook. Over the years, there were many typhoid outbreaks. A researcher was able to trace the infections to Mary, but she would not agree to any testing to connect her to the outbreaks. Eventually, she was arrested and samples were taken proving that she was an asymptomatic carrier. She was placed in quarantine for 3 years and was instructed to never work with food since she refused to wash her hands and maintaining proper hygiene when cooking. She was given a job as a laundress, but left, changed her name to Molly Brown, and began working as a cook. Everywhere she worked, more outbreaks followed, but she would move between jobs regularly. After an outbreak at the New York’s Sloane Hospital for Women in which infected 25 individuals and killed 2, it was found that a woman matching Mary’s description had disappeared from the kitchen, they were on her trail again. She was then found working in an estate kitchen on Long Island. She was placed back into quarantine until her death in 1938 from pneumonia.

 

R is for Rabies

R is for Rabies

Global distribution risk of humans contracting rabies (www.who.int)

Global distribution risk of humans contracting rabies (www.who.int)

Rabies, a word that is feared in much of the world, accepted as a part of life in others, and in others considered nothing to worry about. Sadly, all of these reactions to the word are dangerous. The first two are understandable as vaccination of animals is not high on the list of requirements for life, although would greatly improve the quality of life for millions, by allowing them to have a life. Approximately 60,000 people die from rabies annually. More than 15 million people receive post exposure prophylaxis (PEP)each year, preventing millions of deaths. The “nothing to worry about” view is most often found in western countries. This is so sad, because rabies is preventable, but when not prevented, it is fatal. I have posted about rabies previously, World Rabies Day: September 28, 2013. I am posting again, one because rabies is interesting, but also because people still are not paying attention!!!

In the last couple of weeks, I have read at least two articles on people being exposed to rabid cats in the USA. One was in Oneida County, New York when a man was bit by a rabid cat that he found stumbling in his driveway. The other was in Norfolk, Virginia where an individual was bit while trying to feed a stray cat that was rabid, the cat also attacked another person that was trying to get to their car. Most of the United States has laws about dogs being vaccinated for rabies, but cats are not always required to be which in my mind is CRAZY! People will often recognize a dog not acting right, but a cat not acting right doesn’t always produce a red flag of warning for people as many do not even recognize normal cat behavior.

The rabies virus is unique in that it replicates at the site of a bite and then travels along the nerves to the brain, then replicates again before traveling to the salivary glands where it is released in saliva. Therefore, cleaning of a bite wound immediately with hot water and soap is a major component of preventing disease. After that, it is important to then seek medical attention, not only due to rabies, but also other infections. If the animal that has bit someone is available for testing, it is ideal to do. This requires testing of the brain, so unfortunately, it does mean death for the animal in question. If the animal is not available for testing, then the person that has been bitten should under go PEP treatment. When an animal such as a dog, cat, horse, or cow is shedding rabies virus in its saliva, it will die within 10 days from the disease.

People usually think of the ferocious form of rabies – foaming at the mouth and viciously attacking, like “Old Yeller,” but there is also the dumb form of rabies where the patient stumbles around as if drunk with little coordination, with or without foaming at the mouth. Other symptoms can include blindness, hydrophobia (fear of water), the inability to swallow (thus foaming from the mouth), and aerophobia (fear of air), seizures, and paralysis to name a few. Although death comes swiftly, it is not swift enough to protect individuals from the pain and horror of this disease. There have been a few cases of people that have survived without post exposure prophylaxis, it is unknown why they have survived.

PLEASE HAVE YOUR PETS VACCINATED FOR RABIES!

Know your local laws for frequency of vaccination. Even it if is not required, please vaccinate as doing so may save a life.