Monday, April 19, 2010

For the greater good

Now that I have had a thorough streak of EMS, a little lab divergence is needed, though apologies are needed for the general lack of posting. I am neck deep in work, applications, and the firehouse.

Disclaimer: If you do not want to hear about the nitty gritty of laboratory research with lab animals (aka mice) do not read any further. I have heard and understand both sides of the lab animal argument and this is not a post about that.

When I started my job, my project was heavily focused on bone marrow transplants and finding new pathways/potential treatment options for graft versus host disease, a possible side effect of a non-self bone marrow transplant (if you want to know more about these in general, leave a comment and I will write a post).

Now, my project is focused on non-standard chemotherapy drug screening for cancers. The theory behind it is awesome, as these drugs don’t destroy rapidly growing cells, but instead make the immune system better at fighting off cancer. Now I am talking about small amounts of cancer in the setting of someone who has had a tumor/cancer removed but may be a high risk for relapse. These drugs would help with the relapse (perhaps more, but that will be another post :) ).

In order to have the most clinically relevant results possible at this stage, we decided to give these drugs orally instead of injecting them, as most patients would take the final form of this in pill form, not necessarily an IV drip. So I inject my mice with tumor, wait a few days and then start treating them with my drugs to see if any will ultimately kill the cancer. Easy you think.

Think again.

Giving a mouse a specific amount of a drug orally is no easy task. It involves much dissolving, aliquoting, and mixing of said to start with. Then there is the actual problem of giving the mouse the drug, seeing as just having them drink the small volume will never fly in the scientific world. This leads to EMT GFP taking very small metal feeding needles (they are blunt tipped, not sharp at all) attached to a 1cc syringe and accurately dosing each and every mouse.

After scuffing the mouse so it will theoretically not move.

And navigating a mouse’s pharynx blind to avoid a trachea (hey! its the reverse of intubation! Well kind of) and not puncture the esophagus.

It stresses me out, because try as I might, there is always one mouse that manages to squirm and pull, causing me to tighten my grip and occasionally accidently start to strangle to mouse. The second I see this I always put the mouse down but it still stresses me out that I did it. I think the mice are cute and I don’t want to be hurting them. But they are the ones who are squirming, though I know telling them to hold still does absolutely no good.

And then they pee on me, which, while I am wearing gloves and a gown (and booties and a mask and a hair cover), I still dislike.

Or the ones that try to struggle and struggle despite my good grip on them and freak out like they can’t breath even though I know they have an airway (if you are squeaking, you have an airway).

And then each and every tumor has to be measured. At least twice a week. More when the tumors get big. Not as bad as giving them drugs, but tedious. Oh so tedious and not entertaining as the mice try to struggle. Again.

Bone marrow transplants are so much less stressful…

But, if I can get through these compounds, if I can surviving being a human high through put machine, I may find something that helps. I may find a new drug to fight cancer. And at the very least, I can cure mice of cancer. In the end, it will be worth it.

Tuesday, April 6, 2010

Lessons Learned and Thoughts Provoked

I was rather excited to discover that my area as a whole may have learned a few things after the Blizzard of 2009 for the Blizzard of 2010. For the large part, no one was out. This is in sharp contrast to the 2009 blizzard in which many people were out driving in cars that could not handle snow and on roads that really were not good for cars, ambulances too for that matter, period. Its was eerily quiet on the medical side of the fence where I was. Unfortunately, I know that our engine had to go out numerous times for downed lines and tree limbs despite the weather. Further, I know several other stations in the area around us were running numerous medical and engine calls in drifts of snow that were waist deep almost the whole blizzard.

Now, right at the beginning of the 2010 blizzard, my crew and I did get a call which made me think. It was after dark and the snow was just starting to really come down. There was maybe four inches of snow on the ground, enough for us to take twice as long getting to the house as it would have normally, even with chains on the tires.

When we get there, we find a patient and his wife in the bedroom. He hasn't been feeling well and was throwing up a bit earlier. His vital signs were stable and he had been able to keep some water down earlier. Now, I am no doctor but I was fairly confident that he was not about to code, have serious dehydration, or die on us in the next hour at the very least. In fact, he looked rather good for being sick, maybe a bit warm and a bit weak, but that is expected if someone if fighting off the flu, be it regular or stomach.

Now here comes the sticky part, when we look out the window, its snowing cats, dogs, mice, rabbits, and maybe a few horses thrown in for good measure, significantly heavier than when we had arrived at the house. Now, we had no qualms about transporting the patient to hospital, but we were worried about his ability to get back home after he was discharged. If this was the "nice" end of the storm, the middle was sure to be horrible (and it was, nearly white out conditions by morning. They actually stopped plowing a bit at one point) and driving was going to be nearly impossible.

After some conversation and discussion about what we could and could not do (sorry, we can't treat you, we really only can transport you as an Basic unit and even an ALS unit could not have done much more for you but have your tried calling your doctor or pharmacy?), the patient decided that it was probably best to wait out the night and see if he felt any better in the morning. He would call us if anything got worse, encouraged by us really to call if anything got worse, and call his doctor in the morning. I don't like refusals in general, as I feel that if someone called 911 there probably was a reason, but I did agree with this patient that perhaps the risk of leaving his house was greater than staying in with a currently non-life threatening illness.

This is where I do truly envy the system over in the UK where medics are able to contact other forms of medicine than just the ER to help their patients. As an EMT, I can only encourage people to contact their doctors, not call one for them. It would be great to have other options beyond transport or not transport, particularly when the call is not life threatening and the patient really wants someone to help him figure out what to do or just get a ride to the local ER. Particularly in the middle of snow storm!

Friday, April 2, 2010

In like a Lion, Out like a... Lion

Seeing as its just now April and the weather has decided to not be lambish, the past few weeks have been interesting. First, there is STILL snow on the ground where there had been large piles and shade, even after warm weather. I was so glad when it transitioned from the grey, cold, rather depressing beginning to March to at least sunlight. I function much better with sunlight. Don’t get me wrong, I love snow, but the weather had been getting to me after a massive snow storm in February and the grey weather to start March.

A few weekends ago when my friends had come in for a visit, the weather was absolutely wonderful, cloudless skies, sunny blazing down and 70 degrees! Of course, this also led to the downside of nearly sunburning myself (hazards of Irish ancestry, I don’t tan well at all, just burn), but it was totally worth it to be outside with friends.

And then last weekend it not only rains, but its cold! As in overnight lows near freezing! I can expect this from central NY, but not down here! Its not supposed to be so cold down here. Needless to say, I am ready for some nice, consistent, warm, spring-like weather. We finally are getting hints at the nice weather but I am holding out my hope till it stays this way for over two weeks before I get my hopes up. This EMT needs her sunlight and warmth! Plus, it means I can stop wearing two to three layers when I go on shift.