Tuesday, 27 May 2008

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.

Saturday, 17 May 2008

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.

Tuesday, 13 May 2008

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.

Monday, 12 May 2008

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.

Friday, 2 May 2008

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.

Sunday, 13 April 2008

Snow!

I've just finished a two week stint of work at the same vet clinic in Romford that I worked at for 4 weeks when I first arrived in England. I got to drive the same BMW around, but (thankfully) I didn't have to stay at the house with the landlords from hell next door! A few things have changed since I worked here last:

Firstly, the vet that I worked with before has quit. I think there was a clash of personalities between her and the new vet who is working here now.

Secondly, the new vet who was living where I stayed when I was here previously has moved. Apparently the landlords from hell were just too much. The father used to let himself into the house when the vet wasn't home and have a sticky beak around the place- he even confiscated some fireworks, saying that they were a fire hazard.

Thirdly, the Boss has started "chemo" for his "wife cancer" ie. they are now separated. Apart from that, everything was still pretty much the same. The nurses were all the same, lovely, helpful people that I had worked with before. And this time I got to stay right next door, so I could have a sleep in every day of the first week! In the second week, I was working at the other branch practice, which meant a 20 minute drive in the morning to get there. I was sharing the flat with another Aussie locum, Amelia, from Sydney. She was also lovely and easy to get along with. We worked together at the same clinic in the second week which meant we could take in turns driving.

Last Sunday, I was very excited to wake up to snow! They had been predicting it all week and I was looking forward to it, but half expecting it not to happen. Well, we actually had the highest snow fall of the year!

Thursday, 10 April 2008

The Big Apple

I arrived at JFK airport at around 3:30 in the afternoon, and by the time I picked up my bags, caught the Airtrain to Jamaica station, then switched to the Long Island Rail Road, it was about 5pm by the time I got into Manhattan. I hit a crowd of people as soon as I got off the train- they were waiting on the platform to board the train I had just disembarked. I hit another crowd of people as I got into the main part of the train station- it seemed to me that I was swimming against the current, as they were all headed in the opposite direction. I made it up to the street and hit another crowd of people, this time they were going in all different directions, on their way home from work, I guess.

My hotel in Manhattan, The Americana, was only a short walk from Penn Station, and because of the numbered avenues and streets, I was able to find it without a problem. I spent a little bit of time in my hotel room; freshening up, having something to eat (which was actually the breakfast that Fay had sent me to the airport with- a blueberry muffin), trying to decide what I should do all by myself for one night in Manhattan, and trying to psyche myself up to go outside. I think I have a mild case of agrophobia. It takes me a little while to psyche myself up sometimes when I'm alone in a new city and getting ready to explore it. I'm fine once I get going and am excited about what I'm going to see, but sometimes it just takes a few moments to build up the excitement.

It was about 6:30 when I ventured out onto the streets of Manhattan again. I headed up 6th Avenue, looking for the Rockefeller Centre. I was just consulting my pocket guide when a man in a uniform asked me if I needed any help. I told him that I was looking for the Rockefeller Centre, and he started laughing and pointed across the street saying "It's right there!" So then I crossed the road and went to The Rockefeller Centre. There were loads of people around, some of them iceskating at the rink there, some of them eating at the cafes and some were taking photos, like me. After the Rockefeller Centre, I started walking towards 2nd Avenue, as there was a spanish restaurant that I thought I might go to for dinner that was mentioned in my guidebook. Unfortunately, when I got there I couldn't find it! Perhaps it had closed down since my book had been published. I walked back the way I had come from, and headed to Times Square instead.
Times Square is so full of lights that it seems to glow in the dark. It was also full of people, and Broadway shows, and restaurants. I found a restaurant here to have dinner at called Ruby Tuesday's. I had a delicious piece of salmon with a peanut and soy glaze, and vegetables. It was delicious! I had a home made strawberry lemonade to go with it.

After dinner, I walked to the Empire State Building which was only a few blocks away from my hotel. I decided to go up to the top as the line wasn't too long and I thought it would be good to see the view of New York at night. It was very cold, and a little bit drizzly at the top, but the view was worth the discomfort.

I walked back to my hotel at about 11pm and spent the rest of the night planning what I was going to do the next day- I only had one day in New York and I didn't want to waste a minute of it. Of course, you can't do everything in New York in one day, but I managed to squeeze what seemed like a lot into 24 hours.

The first thing I did after checking out of my hotel the next morning, was to buy a Metro Fun Pass, which allowed me to use the bus and subway an unlimited amount of times in one day. I then caught line number 1 to South Ferry. I had intended to catch a ferry to see the Statue of Liberty, but when I got to the ferry port, I found that I could see her from there. Ok, so she was a fair distance away, but I think the end of the line for the ferry was just about equidistance away, and I decided that I didn't want to spend my one day in New York in a queue and was satisfied with taking a few pictures from the shore.

Battery Park is just next to the ferry terminal, so I had a little walk around there. There is a monument there called The Sphere, symbolising peace, it had originally been outside the World Trade Centre before September 11 2001. It had been damaged in the 9/11 attacks, but was left largely intact, and was relocated to it's current location in March 2002.

I then headed to The Bowling Green and checked out The Charging Bull Statue. The Bull Statue is in the financial district, and is supposed to reflect the strength of the US economy.



Not far up the street is Ground Zero. There is a lot of work going on at the moment there, and they have the plans on display for the new World Trade Centre. They are going to build 5 towers, each of varying height, which descend in a spiral. They are also building some gardens and memorials. Across the road from the site, is firehouse 10, which has a bronze plaque remembering the firefighters from that station who died in 9/11. Around the corner from this is another bronze memorial dedicated to all those who died in 9/11. It was a very sobering experience to visit Ground Zero.

Feeling a bit numb after visiting Ground Zero, and needing a pick-up, I decided to catch the subway to Greenwich and get a famous cupcake from Magnolia Bakery. When I got there, I decided to get two! I bought a chocolate one, and a red velvet one (I'm not sure what flavour red velvet was supposed to be exactly, but it tasted good, and had a very soft and velvety texture!). I ate my Red Velvet cupcake at a square just across the road from the bakery, then walked towards Washington Square to have a look and eat my chocolate cupcake. I had seen a couple of movies in Seattle; I am Legend and August Rush, both of which featured Washington Square quite prominently. Unfortunately, there was a fence around much of Washington Square as there seemed to be a bit of building or landscaping going on there, but I was able to find a seat at least to eat my cupcake!


I then headed back to the metro station and caught another train to 86th Street, which took me to about the halfway point of Central Park. I spent a few hours walking through Central Park. I went up the tower of Belvedere Castle, meandered through The Ramble, crossed the
bridge over The Lake, visited
Strawberry Fields (the memorial to John Lennon), and caught a glimpse of the outdoor exhibits of The Zoo. This took me to the
exit on Fifth Avenue, which just happens to be the shopping capital of Manhattan!
I wandered slowly down Fifth Avenue, mainly checking out the outside of the shops, but I did go into Abercrombie and Fitch. Walking into this store, you could be forgiven for thinking you had walked into a nightclub. It's crowded, the lighting is dim, the smell of aftershave is overwhelming, the music is so loud that you can barely hear the shop assistants ask if they can help you, and it seems only beautiful people are allowed to work there (not forgetting the two bouncer-like young men standing at the door greeting-or ignoring- you as you walk in). I bought a t-shirt from here, and as I wandered back out of the store, I almost ran into the male model standing in the doorway! I'm not sure why he was there, and exactly what piece of clothing he was advertising... it may have been jeans, it may have been shorts, it may have been underwear - to be honest, I have no idea what he was actually wearing, I was too dazzled by his perfect, naked, smooth, mocha-coloured torso to pay any attention to the clothes he may have had on (I did notice his face though, and that was pretty perfect too)! It was the most spectacular sight I had seen in New York, and unfortunately, it was only after I got halfway down the street that I thought that perhaps I should have taken a photo so as to share the experience with female readers of this blog (and any male readers who are that way inclined). I contemplated turning around and heading back to the store to get a photo, but didn't want to appear like a weird stalker chic and so kept walking (I'm really sorry Helen, I know that you at least would have appreciated it!).

Here's a picture of a horse statue instead.

I popped into a few shops here and there down the street, before heading back to my hotel in the early evening to pick up my bag and head to JFK airport via the Long Island Rail Road and Airtrain. I flew with Lufthansa, a German airline, and as such I had to fly to Frankfurt, then backtrack to London. I arrived in at Heathrow on Saturday the 29th March, and found that the weather was not much different from when I had left in December!

Thanks to all those who sent emails, I really appreciate them!!

Love,
Lis x.