Cheese Rolling in Gloucester

On Monday, I drove to Gloucester for the world famous Cheese Rolling event. It was a rainy, windy and cold day when I woke up in the morning, and while it was very tempting to stay inside at home, I decided that it was a once in a lifetime chance for me to see this spectacle, so braved the weather and headed to Cooper´s Hill, just outside of Gloucester.

It took me about an hour to drive along the M5 to my exit, then about another hour to drive the 3 miles from my exit to the carpark (paddock)! In the end, I think I must have missed one or two races because of the traffic congestion- I think they should have Alex here next year to coordinate the traffic into the carpark, they have nothing on Agfest!

I nearly had a heart attack climbing up the hill in the carpark to the bottom of the hill where they run the races. There was no way I would have been able to make it to the top of the Hill!

So I stood in the middle of a paddock, surrounded by all the crazy people who decided to brave the crazy English weather so that we could watch a bunch of even crazier people running, rolling, or sliding down the hill, trying to beat a wheel of cheese to the bottom! There was about a 10 minute wait between some of the races while they stretchered the injured away from the previous race. Just before one of the races, one of the competitors slipped or was pushed and he did flips all the way down the hill! I am amazed that he didn´t break his neck. Here are some photos and videos from the races.

The lesser known "Uphill race"

After the races had been run (rolled), I hopped back in the car and headed straight back home. I had intended to have a look in Gloucester after I´d been to the Cheese Rolling, but I was absolutely soaked through and had mud all the way up my trousers, so went home to change and do some washing!

The Cotswolds

Hiya!

It´s been another Bank Holiday Weekend here, so I´ve been doing a bit more sightseeing. On Sunday, I went to The Cotswolds. My first stop was Chipping Campden, where the main street is lined by golden brick terraced houses, and there are thatched roof cottages in the sidestreets. There is a Market Hall in the main street which dates back to 1627.

The Market Hall

A pig roast

I had another roast lunch (this one was lamb) at one of the restaurants in Chipping Campden then headed to the next town, Broadway.

I spent most of my time in Broadway looking in the Old Fashioned Sweet Shop, and some of the gift shops which line the main street.By the time I got to Stow-on-the-Wold, the shops were starting to close, so I spent just a short time there, walking around the market square and down a couple of the sidestreets.

The Market Square

I then hopped back in the car and drove the short distance to Lower and Upper Slaughter.

There wasn´t really anywhere that I could see to park in Upper Slaughter, so I just parked the car in Lower Slaughter and had a quick walk around the (from what I could see, very small) village.The options that I had after The Slaughters, was to either head back to my flat, or try and find a B&B somewhere to stay the night and do some more sightseeing in the area today. It was pretty wet and a little cold this weekend, so in the end I decided just to head back to the flat.

My Clever Friends (and What´s Your Diagnosis?)

Hi Everyone!

I hope you are all well, wherever you are in the world. It´s been lovely to catch up with some of you via email, and to those of you that I haven´t heard from lately, well I hope that you are having fun at work/holiday/home.

As I´ve mentioned before, I´m currently working at a vet clinic in West Bromwich. I was supposed to work here for 3 months, but the other day they asked me if I could stay a little longer, so at the moment it looks like I´ll be here at least until mid-August.

I have had a rather unusual case at work recently- a dog with a marked, moderately regenerative anaemia. After doing a couple of tests, and talking to the clinical pathologist at the lab here who looked at the dog´s bloods, and failing to find a cause for the anaemia, I got in touch with Brad and Karen in Manhattan (see earlier post in Kansas) to ask for some advice. They asked me to email them the results from the earlier blood test for them to look at. After looking at it, they made some suggestions on what they thought it could be and what tests I could do next (this dog was insured, so money wasn´t really an issue in the process of finding a diagnosis). And guess what? They were right!

So, I really just wanted to brag about how smart my friends are, and also say how grateful I am for all the help and advice they gave me. I can´t wait for them to become specialists (and move back to Australia), when I can refer all my difficult cases to them (or at least pick their brains, then take all the credit from the clients!!).Karen and Brad Acting Intelligent

Now, last year my former boss, Pete, suggested that I include some interesting cases in my blogs. So here it is for you Pete (and any other vets or medical personnel who still read this- so it might just be you Pete!). Perhaps Brad and Karen aren´t as brilliant as I thought, and maybe it´s just that I´m not as smart as the average vet, see how you go:

WARNING: The following contains some content which may be boring to some readers.
What´s Your Diagnosis?
A four and a half year old female neutered, crossbreed dog presented on Tuesday 6th May with a 2 week history of lethargy, inappetance, and weight loss (she weighed 16.6kg and had been 18kg in January and had the body condition of a skinny German Shepherd). She had vomited up bile once during that 2 week period. On clinical exam, her mucous membranes were pale and her temperature was 39.5C, otherwise there was NAD. Bloods were taken.

Results:
Haemoglobin Lo 6.2 g/dL (11.5 - 18.0)*
Red Cell Count Lo 2.57 x 10¹²/L (5.10 - 8.50)*
Packed Cell Volume Lo 0.20 (0.35 - 0.55)*
Mean Cell Volume Hi 77 fL (62 - 76)*
Mean Cell Haemoglobin 24.2 pg (20.0 - 25.0)
Mean Cell Hb Conc. 31.6 g/dL (30.0 - 36.0)
White Cell Count 7.7 x 10^9/L (6.0 - 16.0)
Neutrophils % Lo 50 % (55 - 75)*
Eosinophils % 3% (1 - 9)
Lymphocytes % Hi 43% (12 - 35)*
Monocytes % 4% (1 - 8)
Neutrophils Absolute Nos 3.85 x 10^9/L (3.30 - 12.00)
Eosinophils Absolute Nos 0.23 x 10^9/L (0.06 - 1.40)
Lymphocytes 3.31 x 10^9/L (0.72 - 5.50)
Monocytes 0.31 x 10^9/L (0.06 - 1.28)
Platelets Hi 546 x 10^9/L (200 - 500)*

Comments:
Moderate degree of red cell regeneration, (reticulocytes 5.9%)
Cytology appears poorly preserved
Anisocytosis

ALT/GPT Hi 55 U/L (10 - 40)*
AP 66 U/L (20 - 180)
Total Bilirubin 4.5 umol/L (0.2 - 6.8)
Cholesterol Lo 3.2 mmol/L (3.8 - 7.0)*
Serum Creatinine 94 umol/L (0 - 120)
Creatinine Kinase 107 U/L (30 - 150)
Gamma GT 5 U/L (0 - 28)
Glucose 4.4 mmol/L (3.3 - 5.8)
Total Protein 58 g/L (53 - 73)
Albumin 31 g/L (31 - 45)
Protein Globulin 27 g/L (18 - 38)
Urea 4.2 mmol/L (1.7 - 7.4)
Amylase 692 U/L (100 - 1000)
Inorg. Phosphorous Hi 1.7 mmol/L (0.9 - 1.6)*
Sodium 150.7 mmol/L (139.0 - 154.0)
Potassium 5.4 mmol/L (3.6 - 5.6)
Albumin/Globulin Ratio 1.1 (0.5 - 1.6)
Urea/Creat Ratio 0.04 (0.00 - 0.05)
Sodium/Potassium Ratio 28 (27 - 38)

Chloride 114mmol/L (99 - 115)
Calcium 2.2 mmol/L (2.1 - 3.0)
Bile Acid 6.4 umol/L (0.1 - 9.0)
Calcium/Phos Ratio Lo 1.3 (1.6 - 3.5) *

The results came back on the Wednesday afternoon, and as there was no external signs of haemorrhage, I prescribed prednisone at a dose of 1mg/kg BID whilst I waited to speak to the pathologist as to whether there were any spherocytes noted on morphology.

When I finally got hold of the pathologist on Thursday afternoon, he informed me that although cytology was poor, there was no sign of spherocytes and no evidence of haemolysis (total bilirubin also normal) and this anaemia was most consistent with a haemorrhage.

I phoned the dog´s owners and informed them to stop her prednisone, and to bring her in the next morning for further examination. When I examined the dog on the Friday morning, there was still no external evidence of haemorrhage. On questioning the owner, there was no evidence of melena, no blood noted in the dog´s bilous vomit, and absolutely no access to rat bait. She also reported that the dog had improved the previous day and was eating well again (after pred). So I admitted the dog to do some chest and abdominal radiographs (this clinic has no endoscope in-house). Apart from there being poor serosal detail in the abdominal rads (this dog is very thin, so not much fat for contrast), there was NAD on radiographs.

A stool sample was sent off for Faecal Occult Blood.

At this point, I sent the dog home with Cimetidine at 200mg BID, Sucralfate at 500mg BID, Ampicillin at 250mg BID and told the owner to start back on the prednisone.

It was at this point that I emailed Brad and Karen the above history and blood results.

So, there you have it: all the information that Brad and Karen had to ¨Crack the case¨. Now just ignore all the mistakes that I made, and not think about what you may have done differently from the start... What is your next step? What is the potential diagnosis?

The Faecal Occult Blood results came back on the Monday as Not Detected (I must admit that I didn´t put the dog on a red-meat free diet 5 days before doing this test).

For those of you who are interested in the results, email me, or comment here, and I´ll post what happened next in a future blog.

For those of you who aren´t interested, I apologise for boring you with the above entry and I´ll try to post a more entertaining blog next time!

Love,
Lis x.

The Malvern Hills

On Sunday, it was such a lovely, sunny day that I decided to get out in the sunshine and go for a walk in The Malvern Hills.

I drove to Great Malvern, which is about an hour south west from Halesowen. I stopped at the Tourist Information Centre and bought some maps and walking guides of the area. There are several tracks in the Malvern Hills, so I decided to do the first one in my list of walks which was North Hill.

Here are some photos I took during the walk.

Bank Holiday Weekend

Last weekend, after I finished work on Saturday afternoon, I drove to Chesterfield which is about 60 miles or so north of here. As it was a Bank Holiday Weekend, I had the day off work on Monday, so was able to stay 2 nights. I stayed with Elise, and we spent the weekend walking in the peaks and visiting Sheffield. Here are some photos from our 3 and a half hour walk in the peaks with some of Elise´s friends.

Stratford Upon Avon

Hi There!

On Sunday morning, I decided that it was well and truly time for a day-trip, as I had spent the past 13 days hanging around West Bromwich (where I'm currently working) and Halesowen (where I'm currently living). I decided to drive to Stratford-Upon-Avon, William Shakespeare's birthplace, and about a 45 minute drive South-East of my flat. Once I'd exited the M5, it was a quite a pleasant drive on the A3400, past some lovely country estates, and farms with fields of pastures which looked like green manicured lawns.

When I arrived in Stratford upon Avon, I decided that it was time for lunch, so found a nice old pub on the High Street, called Edward Moon, in which to have a Roast Beef with all the trimmings lunch. The English, I have to say, do a very good Yorkshire Pudding (it is even as good as Mum's!).

After lunch, I headed to the house in which William Shakespeare was born in. I coincidentally chose a good time to visit Stratford Upon Avon, as it was the weekend of his Birthday Celebrations. If only I had known, I could have joined in the marathon that had been run earlier in the day. Alas, I was unaware until I got to the town and so didn't bring my running gear. What a shame!

After visiting The Birthplace, I then headed down the road to Nash's House and the site of New Place. Nash's House was the home of Shakespeare's Grandaughter Elizabeth Nash, which was just next door to New Place, which was Shakespeare´s final place of residence.

Just down the road, and around the corner from this was Hall's Croft, the home of Shakespeare's eldest daughter, Sussanah, and her husband, John Hall, the physician. This house had the nicest garden of the three houses.

After visiting Hall's Croft, I headed back to my flat in Halesowen, but I'll have to go back to Stratford Upon Avon on another day, as I bought a ticket which also allows me entry to Anne Hathaway's Cottage and Mary Arden's Farm.

This weekend is a Bank Holiday, so although I have to work tomorrow morning (Saturday), I do have Monday off work. So I'm going to drive up to Chesterfield to stay with Elise for the weekend.