Last summer I had a great research job and I learned so much there. One thing I learned was how to earn a nickname...all I had to do was show up to work and let the maintenance guys do the work. One day, my co-worker pulled me aside dying of laughter and said, "You'll never believe the nickname these guys have for you!" I was so afraid that it would be something awful that I wouldn't let him tell me for a week....finally he broke me down - "Scientist Barbie." Grief. I don't even look like a Barbie...
Anyway, today's post deals with another adventure with Scientist Barbie. Today we're learning about CF, or cystic fibrosis, and what their sputum looks like on agar.This is what sputum is - you're coughing up all of the gunk in your lungs, putting it in a transport tube and we get to plate it. Below is what bacteria looks like on agar. Seriously, we get all sorts of nasty, nasty, nasty crap in Microbiology.
Today I saw some nice runny, green-yellowish stool (aka poo). I told my teaching specialist I wasn't going to plate it. Ew. I let him do it.
A majority of today dealt with looking at the plates of agar a few days after they'd been growing and deciding upon what the colonies looked like. You can identify bacteria sometimes by their hemolysis - the bacteria lyses or busts apart the sheep blood agar (heme = blood, lyse = burst); there are three kinds. Beta (the B up there on the plate shows a clear zone around the bacteria - sometimes you can see all the way through the plate), Alpha (the green-bruised color; its harder to see), and gamma which means there really isn't any. These hemolytic characteristics are really important to notice as a technologist - this helps you figure out what the patient is colonized with. This is Streptococcus penumoniae, and if you enlarge the picture, you can view the beta hemolysis around the tanish-mucoid colonies. Some of these bugs have distincitive smells/odors also - Pseudomonas aeurginosa smells like grape kool-aid or tortilla chips :D Its easy to distinguish from CF patients, because its all mucoid and it has a metallic sheen on the colonies, appearing like an oil slick. This is a pretty exaggerated picture, but you can see the sheen across the top of the colonies. If the bug on the plate has the metallic sheen, characteristic odor, and zone of hemolysis, then the technologist can go ahead and report out that we have P. aeruginosa. This helps the physician - imagine having that slimey stuff in your lungs....not fun.
So, that's what we did today :) looked at lots of plates, decided what the bugs were, did some biochemical tests, and wha-la, the day is over!
The past few days have been amazingly bonkers, which is the way my life usually goes, so yah!
I can't remember what I blogged about last, so I'll give a quick rundown on Thurs and Fri :) Thursday was a pretty short day also. We reviewed for our final exam most of the afternoon and did "baby diffs." Differentials are the exercise where we count all of the cells on a blood smear (you push a drop of blood across a glass slide and then stain it) and classify them. The most interesting part about this is the end result. We have normal ranges for adults, etc, and you should see 70% PMNs, 10% lymphs, 10% monos, etc. But with a child, its an inverse differential. You should see a lot of lymphs (like 70%) and everything looks a little skewed.This is a picture of lymphs in different species (the last two are unsusal kinds in humans). So, there we went again, counting 100 cells, matching to the expected results - hopefully! It was really fun. The sad part was on my 2nd slide. This baby boy didn't have an inverse diff - it was exactly like an adults. Apparently, this slide had been from a patient at Primary Childrens Medical Center - we then realized that the poor thing probaby had a leukemia, cancer, etc. Its so sombering.
Friday, we took our exams and exit interviews. Our instructor BILL, was amazing - he was funny and shared funny stories, invested in our futures, and explained things until he was suffering from dry-mouth...ew. Thanks Bill! He pulled us out 1 by 1 to give us our grades and reviews (like an exit interview) and I was slightly nervous. You never know what type of impression you make on someone, even if they tell you in front of lots of people. Saving face is hard to do in the end. Either way, he said I didn't have any weaknesses (he obviously hasn't known me very long...only a month haha) and would make an excellent co-worker. The head-honcho even remembers who I am and asks Bill about what my plans are, etc, so they're pushing to hire :) If only I could be so lucky! So, he hands me this little list of my grades.....and.......I GOT AN "A"!!!!!!!!!!!!!!!!!! Whew. I just wanted to pass, but this will definitely do! He mentioned that he hadn't filled out my review on paper because he had written a letter of recommendation / letter of reference on an official letterhead and would attach it. I signed off on the final document, and relished the thought of a looooooong weekend.
So, when I invited people to this BBQ, we asked that they bring a side to share and their own meat. HOLY HEAVENS. We had soooooooooooooo much extra food, and people were so generous. I love when people go above and beyond to make your event a success :) we had some issues with troll neighbors at the beginning, which resulted in me speaking my mind, them apologizing and Tyler smoothing things over! Typical pattern. I couldn't help it that they were out of line and I was right....seriously lol
After we grilled, the boys set up a floor in the basketball court and we ran an extension cord through someone's front window and the dancing was on!
This is Jeremy doing hand-hops....I think. haha He's so good at this move!
This is Hugh, who most recently finally came back to the US of A after serving 2 years in the Korean military. He's sooooooo happy to be back and we're stoked to have him. We've missed him! Welcome home Hugh!
This is Ty, doing Russians, or something else super cool. I've tried this and landed 3 feet away from where I started....obviously, I was doing something completely wrong...haha Way to go Ty! You were amazing! I loved the tribute to MJ at the end....we had such a great time! Thanks to all who came out and a shout-out to the bboy crew for being amazing as well as for helping clean up. Hooray!
Thanks to Bethany for these pictures - I stole them off of her blog because my camera is still -sigh- broken. haha So the weekend was wonderful - chuch was fun as always, and we're looking forward to another long week filled with activity, school (Micro this month), and love. Enjoy!
-New music for the month : Greg Laswell - almost like Coldplay, and Matt Nathanson - let me know what you think! Its so chill :)
We ran more samples on the analyzer. Looked at crazy bacteria, searched more urine for STDs (but they have to be motile for positive identification that way), and FINALLY got a body fluid, other than urine, to run. We spun down a peritoneal fluid this morning and looked on the slide for all sorts of stuff. 80-90% of the slide should be represented by monocytes, which look like this: I found some cellular material, which isn't unusual, but isn't common either. We learned how to diff these types of slides and when to pass them on to the pathologist for review. Then, after working all morning, we took a hot chocolate break, and wha-la. Review time. That = end of the day! Hooray! All in all, the work flow of a hospital varies because the patient volume varies. Its been really fascinating to get back into that environment and feel like you're really doing something - tracking your patients, making sure their results are correct, and then learning to differentiate and combine results to make sense of them. For instance, if you have bilirubin and tyrosine crystals together in your urine, you probably have a hepatic (liver) problem. We have to be able to critically think and put 2+2 together to = a diagnosis consistent with our findings. Awesome.
IN OTHER NEWS: Ty and I are still getting ready for the big party. In honor of that, we headed down to the Treehouse, where Nate (our unofficial crew leader) teaches dance classes. Apparently the lady who choreographs all of the HSM movies runs/teaches/etc there and these guys have been jammin there for a long time too. So, tonight, I did homework in the dance room, while Ty and Nate busted out some sick routines. I wish our stage this weekend was going to be that big - I would love to film that! haha
Anyway, final on Friday, test Thurs-Sun, and homework galore until then. I would love to have a job. And no homework. One day....ONE DAY MORE! haha
Sometimes, I want to drop my head, and instead of screaming, just weep. Sometimes, I've had enough. Enough of being kind, of overlooking others' lack of consideration, overlooking their flaws, and enough of swallowing all of mine to try and keep peace. I know. I've been trying to change for such a long time. I've been trying so hard. Hard to be the better person, to look past the inconsideration, to look past it all. Gall. Is it too much to ask for common courtesy?! Today was the ultimate, the ultimate blow. I know we're all tired and exhausted, so get over it. Be nice, dangit! haha
Today at school = another loooooooooooong day. Took my hematology final :) went great! Thanks for all of you that kept me in mind! Afterwards, we had a break; then, more urinalysis! haha Remember those old slide projectors you used to use in elementary school? Well, we used one older than that - it looked like an R2D2 model. Random! It burned itself out in five minutes, and we tried to jimmy-rig it; then, we found the slide projector and slid in some slides! haha So ghetto - we projected it up against the wall (our room is like 15' long by 5' wide) and tried to guess what was in people's urine!These are really cool crystals that form in your urine - called, calcium oxalate :) You can see these things in your urine when your body is having trouble absorbing calcium. We take a drop of urine, place it on a glass slide, coverslip it, and then examine these under the microscope. We can see a lot of junk, so you learn to classify (again) all of the little crystals, casts, red blood cells, STDs, etc. So fun! If you don't believe me, rent a microscope, get some slides and put a drop of your urine and look at it under 20 or 40x. You'll be able to look at it for hours! haha This was one of my favorite labs in college - I know it sounds gross, but seriously? Its fascinating what your body produces to combat what we eat, don't absorb, and hence - pass on!
This is gross though. Mucus. Oh, and the worst thing I've seen : a SCAB. I don't even know how you would pee one out in your urine...ugh...Puke now - ugh.
We spent 3 hours this morning taking our practical and our teaching specialist was nice enough to move our other final to tomorrow morning, hence why this will be so short! More studying for moi!
We ran more urine samples today on the Iris and learned how to differentiate between clean catch samples and not-so-clean samples. Its really interesting to see how much information the clinician gets from a little bit of pee :)
Also, today when reviewing a pleural fluid (that's the fluid from around your lungs) we ran into a really interesting cell - mesothelial cell, I think. Its on its way to maturation yet it looked so different in the patient then it does in a text = how interesting it is to be the interpreter of what people have inside of them. We also learned about Granulocytic Satellitism, which is something none of us had heard of before - its a funny condition where people's granulocytes will form aggregates of 4-5 around the blood smear. Weird.
Anyway, today Ty and I went running! It was awesome, for the parts that I could breathe, anyway! haha I've re-discovered a truth = when you work out, you're motivated to eat healthier! So, I made this amazing grilled chicken salad (even with tomatoes - people who know me will know what an accomplishment that is!!! But, if you eat a lot of red fruits/veggies, and greens you are really doing your part in preventing cancer!) with parmasean steak rolls, corn, watermelon, etc! Yummy! I think I might be getting the hang of being domestic! Hooray for Tyler!!!
This weekend our BBQ is coming up and I'm so so so so nervous. I'm a geek. Love it! Anyone and Everyone is welcome to come! Let me know what your plans are for Saturday! Ciao for now!
To be very honest, I do not really remember what happened yesterday at school. I got there early, as usual, and we went into the lab to process samples. The techs in the lab have gotten used to us hanging around and are always pulling samples aside for us to look at! They pulled a urine sample aside and waited for us to make a wet prep out of it. What was inside?! A little creature, swimming along while waiving back at us - they're so fun to see in the urine...well, fun for us.This is Mr. Trichomonas.... aka STD. Both men and women can be infected, and its not too much fun. Well, what STD really is? They're super cute to watch under the microscope until you realize what it means to the patient when you report it out.... The whispy flagella are their motor system, and they move across your microscope slide :) You get to follow them around and see where they go. Ah, the joys of being a nerd.
Our practical went really well. I think I finally understand how to function in a clinical hematology laboratory! After our practical, we took a little break and headed back to the lab. We started working on what's called the Iris IQ.This is the Iris. You put samples on the right side, and the machine measures color, turbidity, clarity, specific gravity, as well as a whole slew of chemistry tests, such as glucose, ketones, pH, etc. This helps us know what's wrong if anything. There are quite a few methods that are applied within the testing for urine samples. Lets say that you have a positive protein result on your urinalysis - you don't just report it out; you get to do the SSA confirmatory test. So, its not as easy as just pushing "GO" but almost :)
The techs yesterday also pulled aside a urine sample for us to observe - a waxy cast was found on the urine wet prep. A waxy cast... hm...how to explain! Waxy casts are indicative of renal failure, renal meaning kidney. We don't like to see these:
The IRIS is a really cool instrument. It takes 500 pictures per minute, classifies the elements in the urine, and then shoots those pictures over to the analyzer. I never really understood how you could automate urinalysis, but I guess this is how. The analyzer measures and inspects the contents of the elements as it photographs them - then you review the pictues to make sure it called bacteria bacteria and not mucus strands. Because of this set-up, we can attach pictures to our report, giving the physician a clear picture of what contents are really in the urine!!
FUN STUFF: So, now onto real life :) I took a beautiful 2 hour nap yesterday after leaving school! Wonderful! I woke up, took a shower, and Ty finally came home from work. We decided to hit up Rumbi's - which I definitely recommend - for dinner! Then, we went to a concert in Brigham Young Park, just east of Temple Square - for FREE!
They had chairs set up and everything - so we pickniced in the park with our yummy dinners! The show lasted almost an hour and a half and it was so fun! The weather was spectacular! The performers were from a barbershop-chorus, and featured a female quartet that took 8th in their novice division after having only been together for 9 weeks :) Im not necessarily biased, but I perfer men over women's barbershop any day, even though both groups performed so well! Our favorite part was the tribute to the armed forces : they brought out the flags for the Army, Navy, Coast Guard, Marines, and Air Force (in that order) and placed the American flag in the middle. They started with a medly of "America the Beautiful" and then branched out, singing one anthem at a time - when they sang the Army anthem, all of those in the audience that had served were to stand up! Did I mention that we were the youngest couple in the park by nearly 40-50 years? As each song was sung, everyone would turn around and look at who had served - the Air Force swept the audience with those who stood! It was so emotional, I had to try the entire time not to tear up. I had just been thinking about how our generation knows nothing of the sacrifice of an entire World War. Sure, we know all about the war in Iraq - I sent a marine to that fight in 2003 - trust me. But we don't know war in our own country, on our own people - 9/11 was the first taste our genereation had. Today, we feel like we deserve something for sacrificing. Those men and women who served during the World Wars came home and simply said that they sacrificed because it was their duty and their honor. I feel honored to have those gentlemen in my own family. It was a wonderful experience.
The concerts are every Friday and Tuesday in the park - everyone is welcome :) Check out the schedule - this Tuesday, Broadway tunes will be the theme!
Tyler and I were going to go running today (trying to fit into my wedding dress = needed exercise) but its pouring....rain, rain - go away! haha
Tomorrow we have a practical exam on this analyzer - Its called an Advia Centuar. We process all of the incoming hematology samples according to what the doctor orders. Its a really interesting instrument - ours looks a little different. Its a bench-top analyzer and has a series of almost blue-LED looking lights and a series of clear "veins" that you can watch your sample get processed through, etc. It lines up the sample with reagent and then pipes the cells from your blood through a very fine laser - this allows the cells to by analyzed one by one, giving an increadibly accurate reading/composition. The granulocytes, or white blood cells, get stained. Why? Well, inside their cytoplasm are certain granules that tell you a lot about the stage of a cell (dealing with maturation) which can give you a clue as to a disease state or even if the cell itself is infected due to a serious viral infection, etc. These granules have a distinct composition, so the machine dyes them, for lack of a better term, and then when they react, the machine knows what they are. There are some cells that the analyzer doesn't pick up; it has a hard time differentiating the different stages of neutrophilic maturation, so that's where we come in. Remember how I have to classify all of those cells? That's why. It helps the physician make a diagnosis - also, the resident pathologist gets called in on the really weird stuff.... This is the most artistic part of our trade. Its making a definite decision - and its never definite because no two people are the same. That's why we sit at microscopes for hours :) I love it!
What I do not love, however, is this picture above. I have a love-hate relationship with my hemocytometer. You use what's called the Unopette system. In essence, you add a specific amount of blood from an EDTA tube to a unopette - it contains a solution (ammonium oxalate) which lyses, or "kills" the red blood cells in the sample. In turn, it leaves the WBC (white blood cells) and the platelets. You perform a series of incubation steps and the horrid "charging" step, which is where you load your sample onto a hemocytometer. That's the hemocytometer down below. You count that square thing (picture above) and you load your sample through a very small tube, capillary tube, into those triangle thingies. Its such a small area! We count the WBCs and platelets; WBCs we count all of the squares, while with the platelets we count the middle square, which contains 25 smaller squares. They are extremely tiny and they're refractile, meaning they refract light; and they wiggle. That's how you know they're platelets.
This is a picture of what it looks like - all of those circles are WBCs - and that would be an extremely elevated count! I've never seen that many in one field. When you finish counting them, you perform calculations and get a result - you compare it to the analyzer's printout of the sample to see if that's really what's going on :) Its fun....but today.....
Today, I got so car sick. You are looking for tiny platelets, which look like specs of dirt, quickly. You move so fast and try and focus up and down, your eyes are focusing, straining, etc. I was going to lose the lunch I hadn't even eaten at that point. Luckily, you don't have to do this all day everyday in hematology, so that's wonderful news!
Having an elevated WBC count can mean infection, etc; having a decreasd platelet count can infer that you may be clotting somewhere and we need to find out why in both cases. Its extremely useful information - especially if you're experiencing a decrease in RBC, WBC, platelets, etc - that could be an indicaiton of a leukemia or bone-marrow anemia, etc.
In fun news, today we took a tour of the Huntsman Cancer Institute. To the left is the patient care center - where all of the patient rooms are. Its a magnificent facility with marble floors, glass everything - its like staing in the Hilton in NYC. Grand. Anyway, to the right is the research center and The Point. The research center is where we all hang out: the lab geeks (haha), drs, pathologists, and fellows. Its really neat. On the very, very tippy top to the right, where that big point is = The Point. Its a fancy-schmancy resturant and our teaching specialist treated us to a drink and we sat right out there on the top floor and looked over the valley. Grand indeed. I love the Huntsman. This week at church we met a really amazing patient who is currently in the Huntsman with a terminal illness. So sad. And the patient has an amazing attitude; so humble. It really puts life in perspective. Every day that I go to school, I try to think of those patients and what I can do to make a difference. Not many people know what our profession does - if they did, I think a lot more respect would come our way. How can people give respect if they never see the faces behind their diagnosis? Well, luckily we don't do it for the respect. We do it for the love of the game. Its freakin rad.
I have an exam tomorrow and 2 finals on Monday - keep your fingers crossed for me!!!!
- For one of my classes this summer, I have to keep a reflective journal of what I'm learning.... I decided that I'll just post updates online each day (for 6 weeks) so you guys know what I'm doing too. I'll try and not be too scientific, and post links to what I'm talking about. So, here's to a day in the life! Currently I'm doing my clinical rotations through ARUP, an enormous reference laboratory. Apparently, they're in the same league as the Mayo Health Clinic; before I moved to Utah, I'd never heard of ARUP, but my mom used to diagnose us out of the Mayo Health Clinic book! haha So, here's a summer filled with diagnosing...in a different way then you'd think. I think of myself as a Medical Researcher. For a moment, think of a doctor as a consultant - you present to the Dr., tell him what's wrong, and he deicdes to order a battery of tests. The nurse comes in and draws the necessary sample. The doctor peaces out and the nurse sends the samples off. Where do your lab tests go? Right to me. A good friend of mine once quoted a famous surgeon, saying "If you want to change one life at a time, become a Dr. If you want to change thousands of lives, become a researcher." My role is to figure out why you're sick, how sick you really are, how you got that way (in a sense), and what will make you all better. When the medical field/staff are working correctly, we should all confer together - lab, dr, nursing staff. This ensures best treatment for the patient. And, here's a look at what I do allllllll day long! This month, I'm rotating through the University of Utah Hospital's laboratories. This includes the University Hospital and the Hunstman Cancer Institute. Since both of my parents have had cancer, its really interesting to see the clinical viewpoint, having been on the patient end. I'm in hematology this month - that's the study of blood. And, its way more interesting then you'll ever know!
Today, we trekked over to ARUP labs to investigate hemoglobin electrophoresis. Hemoglobin is what comprises your red blood cells. We receive samples from all over the world, and this is where it gets interesting. There's a fancy machine abbreviated HPLC (high pressure liquid chromatography) that separates hemoglobin content out by charge, dependent upon pH, etc. HPLC machine!
There are over 900 hemoglobin variants - when we say that people are unique, we're not kidding. Each hemoglobin molecule is compsed differently, and this can be dependent upon race. You may have a certain composition and I may have another - and you and I are totally normal. Some people aren't - disorders and diseases can arise from deletions in the genome (and I'm getting really scientific here, aren't I?!) and make life miserable. So anyway, back to HPLC. We run the blood through this machine, and it prints out super cool graphs - which we have to interpret. Peaks come off the machine at certain times. Peak correlations with time tell us what hemoglobin variants make up your blood. HbF (hemoglobin F), for instance, is called Fetal Hemoglobin. You have a ton of this as a baby, yet by the time you reach adulthood, you've only got 2% left and your bone marrow has switched to making HbA.
Some people inherit blood disorders because of their ethnicity - so when you fill out that medical questionaire, don't think about race in a negative sense - you're giving us vital info! For instance, if you're of African descent, you have a high probability of inheriting HbS. This stands for Sickle Cell Anemia. Remember reading about that in biology?
See the regular, round red blood cells? They carry oxygen to your tissues, etc. The sickle shape, or cresent, has some issues. They can congregate in your capilaries and cause "vaso-occlusive crisis" which is extremely painful. Its like cutting off an arm...well, maybe not that bad, but its no picnic either.
So, we look at those peaks, and lets say you have a peak in the S window, indicating to us that we've got to do another test for Sickle Cell. We do a fun, simple test called sickle sol, which stands for solubilty. You add some buffer to a tube with come chemicals in it, add 50 lambda of your patient sample, mix and wha-la! Compare. If you can read through the tube, you don't have sickle cell! Congrats! If you're like the tube on the right, you're a pretty good looking candidate for having Sickle Cell.
Electrophoresis (running a sample through a gel mechanism) follows as well. Its like the confimatory test, and we run an acid and an alkaline gel - different hemoglobins migrate differently. And they can be tricky! HbS, D, G, & LePore all migrate the same on an Alkaine gel...so how do you know which one you have? Run an acid, and they'll separate. The HbD and G will migrate towards the A region...and you've got 'em caught.
This week we've also spent countless hours looking through a microscope, looking at blood smears from cancer patients.This is a picture of a patient's blood smear - we count all of those purple things, called neutrophils, and we have to classify 100 cells. Then we look at those fleshy-red looking cells, or the red blood cells, and classify their morphology. This is extremely informative. For instance, the arrow there is pointing to a BAND neutrophil. That's not good to see in someone; well, if you only have 1, not a big deal. Bands usually accompany other immautre cells, like "blasts" which mean -CANCER- like a leukemia, etc. They're really interesting to see, but as excited as you get, you also feel a pang of sadness for the patient.
INTERESTING: Today, we were processing samples in the hematology area of the lab when we received a notice for a intrauterine transfusion hematocrit. What the heck is that? Well, "intrauterine" deals with the fetus that's still present in the mom... transfusion? They're going to infuse blood into the fetus to prevent distress, HDN, etc. Hematocrit? This deals with the amount of RBC inside the fetus. We measure all of these things in order to ensure welfare of the baby. Today, the nurse ran down with the sample in her hand, and it was a STAT test because the mom was still up in the Operating Room, with a needle stuck in her belly...scary enough for me to run that sample soooo fast. Everything turned out to be ok! Hooray! Way to go baby!
Anyway, hope you enjoy today's day in the life.... Hopefully, tomorow will bring another exciting event! I'll keep you posted!!! Any comments would be great (espeically since I have to hand this in! haha)!!!!!!
"Are we not the framers of our own destiny? Are we not the arbitrators of our fate? . . . It is our privilege to determine our own exaltation or degradation; it is our privilege to determine our own happiness or misery in the world to come." John Taylor
"We have committed the Golden Rule to memory; now let us commit it to life."