Pathology I: Immune System

I've got another picture from the book helping me out and will post it as today's pic of the day. The analogy I gave yesterday about the inner workings of the General Motors plant being messed with has more to do with a viral infection, when a virus overtakes the inner workings of a cell. This is known as Cellular Immunity, sometimes referred to as cell-mediated immunity.

Cellular Immunity is a type of adaptive immunity. When this happens the infected cell somewhat literally puts up red flags which poke out of the membrane of the cell which help tag the cell for destruction.

When it comes to protecting our system against foreign invaders we may consider two types of cells, B cells and T cells. These are two types of cells collectively known as Lymphocytes and are sometimes referred to as B Lymphocytes and T Lymphocytes.

They get their designation (B or T) based on where they grow up.

Cells that mature in the Bone marrow are called B cells

Cells that mature in the Tymus are called T cells

T-Cells are the cells that notice the red flags on the buildings and from what I've gathered, these red flags are literally pieces of protein derived from whatever virus has infected the cell.

With my GM analogy, we said that instructions were rewritten to replace the gas pedals with bubble gum. When someone inside the cell (or building) noticed this they took a piece of that bubble gum and stuck it out on the roof of the building as sort of a bubble gum flag and the ever present T-Lymphocytes (T cells) would notice the aberration and bring to light a host of fighters known as effector cells which would then destroy the building all together.

What are Effector Cells? The names of the cells that will destroy the building, so called because their ultimate effect is destruction of the building, the ultimate effect of the immune system.

Anyway, that's some of how it works with T-cells. T-cells deal with the cells in our body that have themselves been infected.

But, what if a microbe such as bacteria doesn't infect a cell but just causes problems outside of the cell. In our ongoing analogy this would be like vandals spray painting the side of the GM building or littering on the grounds or something like that.

Sometimes the police need help in distinguishing the good guys from the bad guys so, in order to be able to put the vandals in the police cars, the bad guys are tagged with antibodies. For whatever reason, the can't get bacterial microbes in their cars unless they are first tagged with an antibody.

In the accompanying picture, this scenario is on the left side of the picture under the heading of Humoral Immunity and Humoral Immunity is what the B cells do.

I'm going to have to fast-forward and get to learning the diseases associated with various aspects of the immune system. I'd like to learn everything well enough that I can talk about it and explain it myself but with so many classes that isn't always an option.

I need to pay attention to some of my other classes. Diversified would be a good one.

Out of all the lymphocytes in our bodies, B cells make up about 10-20% of lymphocytes while the T cells make up about 60-70% of our lymphocytes (Natural Killer cells make up an additional 10-15%)

Pathology I: Immune System

ADCC, Antibody-Dependent Cell-Mediated Cytotoxicity. It's enough to make you cry after countless hours trying to study something only vaguely familiar however, the picture on slide 106 of our pathology power point presentation shows a picture of ADCC and a few elements of confused gases swirling around in my brain have begun to form into something that makes sense based on that picture. I'll post the picture as today's pic of the day.

The human immune system is based on a system of surveillance operating on the simple principle of distinguishing "self" from "non-self" In other words, we have a variety of "soldier cells" capable of destroying other cells and pathogens (foreign bodies) but, these soldiers which protect us need to be able to tell the good guys from the bad guys.

Take a close look at that picture. In it we see the cell in the upper left labeled as a Target cell. Now, this Target would be the bad guy which needs to be taken out BUT - that target very well may have been one of us, a good guy that's gone over to the dark side and now needs to be taken out. In this sense, we come to realize that an individual cell has been infected by some foreign invader, be it H1N1, or even the Aids virus. When a cell is taken over by a hostile (i.e., foreign invader) it may burrow down to the core of the cell and take over the protein processing factory in the cell which we may refer to as the nucleus of the cell.

As an analogy, let's say the nucleus of General Motors is an assembly plant to make cars and a foreign invader comes in and rewrites some of the instructions for making those cars. Let's say instead of using hard plastic for the gas pedals the invader rewrites the instructions to use chewed bubble gum instead of hard plastic for those gas pedals. Then, when those cars are released into the rest of the world and are driving on our highways there are going to be problems.

Basically, whatever was supposed to be produced in that nucleus isn't being properly produced anymore. Heck, maybe instead of cars being produced things might be rewritten to manufacture horse & buggy carriages which again will mess things up by clogging up the highways.

The thing is, when a normal cell from the human body is taken over then there may be tell tale signs that the cell has been compromised. If you look at the picture again, you'll notice spikes protruding out of the membrane of the cell. Now, notice the little black "Y" shaped things floating around in the picture. Those are antibodies. In fact, those are antibodies which are specific to the spikes sticking out of the compromised (Target) cell. The cell at the right side of the picture shows the target cell with the antibodies attached to the spikes of the target cell and THIS is how the cell is labeled for destruction.

The cell at the bottom most portion of the picture is labeled an NK cell. NK stands for Natural Killer and the NK cell has receptor type locks on it's membrane which fit to those particular antibodies. Think of a lock and key. The antibody may be the key and the receptor on the NK cell may be thought of as the lock. When that antibody key clicks w/ the Natural Killer cell lock then the NK cell may take action to destroy the Target cell.

hmmmm.....

That's one way NK cells are able to identify the bad guys in the human body but, how do they know which cells to pass over?

Almost every cell in the human body has what are known as Class I MHC molecules on the surface of their cells and Killer cells have an inhibitory receptor on the surface of their cells which fits with the Class I MHC molecules. Again, we have another key & lock scenario. When the inhibitory receptor lock meets with a Class I MHC key then the Killer cell knows those cells are part of us and moves on.

I think of the movie The Ten Commandments with Charlton Heston as Moses (can you believe that was made in 1956?!) Anyway, during part of that movie there was some kind of plague destined to go through the town and kill children or something but, houses which had blood on the door were passed over by the plague. I'm not sure how accurate I have the movie but, those Class I MHC molecules are like the blood on the door - Killer Cells just pass them by.

ADCC - that's where we started this conversation and remember the AD stands for Antibody dependent. From what I'm understanding immunoglobulins are another type of antibody ...immunoglobulins are designated IgG, IgM, IgA, IgE & IgD.

When it comes to IgG, in particular, I'm thinking of how the military can light up targets with a laser so overhead airplanes can drop bombs on the target. IgG can coat bad cells and there are receptors on Natural Killer cells that can recognize an IgG coating. These receptors are called CD16 & Fc receptors.

CD16? What does the CD stand for? Good question, I don't know. Let me Google it...

That was worthwhile, it looks like CD stands for Clusters of Differentiation :)

here is a link to wikipedia with an incomplete list of 300 or so differend CD molecules.

http://en.wikipedia.org/wiki/List_of_human_clusters_of_differentiation

Talk of CD molecules, which help differentiate cells, are found on the surface or membrane of our cells. There are a few we've covered in class...

CD3 is a molecular complex used for cells to identify T-Lymphocytes which make up about 60-70 percent of the lymphocytes in our blood. Each T cell is genetically programmed to recognize certain membrane bound antigens. So far, I've presupposed antigens can be good or bad depending on whether they are recognized by the body or not as "self" or "non-self" Wikipedia mentions the word Antigen as coming from "antibody generation" which may or may not be true but, it's something to hang my hat on for now.

CD3 is a series of molecules that help relay information into a cell once a T-Cell has connected to an antigen binding site on the cell.

For now and in general - I'm relating things as follows ...

CD3 - T lymphocytes

CD4 - helper T cells

CD8 - T-suppressor or T-cytotoxic cells

CD16, CD56 & Fc go w/ Natural Killer Cells

CD 18+, CD19+, CD20+ go w/ B-Lymphocytes

then we need to recall that with helper T cells there are two subpopulations

T-helper-1

T-helper-2

and, I need to have those associated with things.

Namely,

T-helper-1 goes w/ Interleukin-2 (IL-2) and Interferon gamma (IFN-g)

T-helper-2 goes w/ Interleukin 4 & 5 (IL-4 and IL-5)

Then, we need to get back to the various markers on the regular cells of the body, at least that's where I think the following classes of molecules are found.

We mentioned MHC molecules earlier. MHC stands for Major Histocompatibility complex or for humans, we may also say (or use) HLA which stands for Human Leukocyte Antigen.

We have three classes of MHC -

Class I MHC consist of

HLA-A

HLA-B

HLA-C

and, of course, there are subpopulations of those things

Class II MHC consist of

HLA-DP

HLA-DQ

HLA-DR

or, you might broadly say Class II is associated with D and class I is associated with A, B, C (for memory purposes anyway)

Class III has to do with components of the Complement system and here we associated C2 & C3 with Class III.

Pretty vague & a bit confusing, huh? I hear ya.

I guess a main thing to take away from all these HLA things is that they are markers found on cells and tissues in the human body and one of the most important thing having to do with these markers is in the area of transplants. Most folks are aware that people have different blood types and it's not good to randomly mix peoples blood types because bad things can happen if you do.

Well, it's not a good thing to mix HLA's either. The liver or kidney of one person will have a specific set of HLA markers in the cells which make up their liver or kidney and they can only get a transplant from a person who has similar HLA markers. To mix those markers up means rejection of the transplanted organ.

Also, there are some interesting correlations between different HLA markers and various diseases. For instance, a person with HLA-B27 has a 90 times greater risk of ending up with a disease known as Ankylosing Spondylitis. What is ankylosing spondylitis? I honestly don't know, at this point I just need to konw that HLA-B27 is associated with a 90 times greater risk of ending up with that disease.

Rheumatoid Arthritis is associated with HLA-DR4 and type 1 diabetes is associated with HLA-DR3 and HLA-DR4.

Wow - time flies when you're having fun. I need to take off in 15 minutes to meet my parents for lunch! :D

Thank god - I need a break and decompression time. ;)

Tri-3, Wk12, Days 185 & 186, Tue & Wed - Survival

Made it through those two test on Tuesday and figuring I'd end up taking a hit on my grades I focused a bit more on embryology to help hold the good grade I had in that class and took the hit more in physiology.

I had a nice 6 hour nap after school today and was watching House on my computer for a while afterwards. I'm going to get a couple pathology ponys punched into my Flash My Brain flashcard program and need to do likewise for embryology. Our final test seem to be set so it's just a matter of pulling through now. Wow - just posted what's coming up below and it seems like a lot. I think there will be a few more test before the final, I know we still have plenty of physio to cover and another test to get in for that class. I'm going to knock out some physio now.

Mon 11/30
Tue 12/1 Path Exam
Wed 12/2
Thur 12/3 Diversified Practical (B)
Fri 12/4

Mon 12/7 Diversified Practical (C)
Tue 12/8 Diversified Practical (A)
Wed 12/9 Microbiology Lab Exam at 11
Thur 12/10 Orthopedics Final Practical
Friday 12/11 Basic Final, Public Health Final

Mon 12/14 Diversified Final @ 9 a.m. 156B
Pathology Final @ 2 p.m. Purser
Tue 12/15 Philosophy Final @ 7 a..m.
Microbiology Final @ 11
Wed 12/16 Physiology II Final @ ? a.m.
Embryology Final @ ? a.m. in ?
Thur 12/17 Orthopedics Final @ 7?

Tri-3, Wk12, Day 184, Monday

We have two test scheduled for Tuesday; one in Embryo & one in Physio. We also have two fellow classmates who act as educational coordinators (EC's) for our class and I learned earlier that at least one of those EC's was able to take the embryo test on Monday. I can't help wondering if that person will be gone today or just got the embryo test knocked out so they could wholly focus on physio for Tuesday. I can't help thinking that would have been a fantastic option for everybody because we could have totally focused on studying embryo Sunday night then devote all of our attention to studying physio on Monday night.

Anyway, I'll be very curious to see if our EC is in class today. If they were leaving early for a vacation then it's understandable and I'd imagine they would have taken both test early.

Perhaps I'm just lamenting my own lack of preparation and really wish the test were split up. Still, I can use this as a learning opportunity. I could have easily focused on embryo Sun night and Physio Mon night ...didn't occur to me.

Either way - I'm going to take a hit in both of these classes. Fortunately, these are my two best classes so I do have a bit of a cushion.

It's about 5:22 a.m. and I'll be taking off by 5:30 to avoid traffic and get some extra studying in at the cafeteria.

One other note, I moved a good sized table to my second bedroom and will work at studying in there. I don't smoke in the house so, that will be a plus because it means extra time w/o smoking and perhaps better focus on my studies since I won't have the benefit of distraction that having a cigarette provides. Plus, I guess I'll get a titch more exercise since I'll have to get up and walk out into either the garage or outside to have a smoke. :)

Today's picture is of a rabbits foot. I guess I feel bad for the rabbit but certainly need the luck. I have to wonder if rabbits are actually used for anything other than their feet. I sure hope so. Maybe I'll find a different lucky charm to use next time. Actually, that line of thinking invokes a whole other article.

Pathology I: Immune System (Simple Outline)

What Happens When An Enemy Invades Your Body?

• THE IMMUNE SYSTEM
  
  • The purpose of the Immune System is defense and protection through a system of surveillance
    
  • This surveillance operates on the simple principal of distinguishing "self" from "non-self"
    

Outline Contents:
Effectors of the Immune System
Histocompatibility Genes
Immune Mechanisms
Autoimmune Disorders
Immunodeficiency Diseases

• EFFECTORS OF THE IMMUNE SYSTEM
  
  • Cells & Cytokins
    
  • T Lymphocytes
    
  • B Lymphocytes
    
  • Macrophages
    
  • Dendrtitic & Langerhans Cells
    
  • Natural Killer Cells
    
• T Lymphocytes
  
  • In the blood, T cells constitute 60 to 70% of peripheral lymphocytes
    
• B Lymphocytes
  
  • B lymphocytes constitute 10 to 20% of the circulating peripheral lymphocyte population
    
• MACROPHAGES
  
  • Macrophages play a major role in inflammation, but also have many activities in the immune response. (s28)
    
• Dendric & Langerhan's Cells
  
  • Dendritic cells are widely distributed. They are found in lymphoid tissue and in the interstitium of many nonlymphoid organs, such as the heart and lungs. Similar cells within the epidermis have been called Langerhans' cells (S31)
    
• Natural Killer (NK) Cells
  
  • Approximately 10 to 15% of the peripheral blood lymphocytes do not bear TCR or cell-surface immunoglobulins.
    
• HISTOCOMPATIBILITY GENES /Molecules
  
  • Originally identified as antigens that evoke rejection of transplanted organs, histocompatibility molecules are now extremely important for the induction and regulation of the immune response and for certain nonimmunologic functions (s39)
    
• Cytokines
  
  • The induction and regulation of the multiple immune responses involve multiple interactions among lymphocytes, monocytes, inflammatory cells (neutrophils) and endothelial cells.
    

  
  

• IMMUNE MECHANISM
  (S66)
  
  • Contact with antigen leads not only to induction of a protective immune response, but also to reactions that can be damaging to tissues
    
  • An antigen is a substance that can be specifically recognized by the immune system and cause a response
    
• Tissue Damage (Hypersenstivity) (s76)
  
  • Tissue-damaging immune reactions may be evoked not only by exogenous antigens, but also by those that are intrinsic to the body (endogenous) (s76)
    
• Type I Hypersensitivity (Anaphylactic Type)
  
  • A rapidly developing immunologic reaction occurring within minutes after the combination of an antigen with antibody bound to mast cells or basophils in individuals previously sensitized to the antigen.
    
• Type II Hypersensitivity (Antibody Dependent)
  
  • This type is mediated by antibodies directed toward antigens present on the surface of cells or other tissue components.
    
• Complement-Dependent Reactions
  
  • #1 – Antibody (IgM or IgG) reacts with an antigen present on the surface of the cell, causing activation of the complement system and resulting in the assembly of the membrane attack complex that disrupts membrane integrity by "drilling holes" through the lipid bilayer (s100)
    
  • #2 – Cells become susceptible to phagocytosis by fixation of antibody or C3b fragment to the cell surface (opsonization). (s101)
    
• Antibody-Dependent Cell-Mediated Cytotoxicity
  
  • This form of antibody-mediated cell injury does not involve fixation of complement but instead requires the cooperation of leukocytes.
    
• Antibody-Mediated Cellular Dysfunction
  
  • In some cases, antibodies directed against cell surface receptors impair or dysregulate function without causing cell injury or inflammation. (s107)
    
• Graves' disease
  
  • Graves' disease is the most common cause of hyperthyroidism
    
• Type III Hypersensitivity (Immune Complex–mediated)
  
  • These reaction are induced by antigen-antibody complexes that produce tissue damage as a result of their capacity to activate a variety of serum mediators, principally the complement system. (s114)
    
• Local Immune Complex Disease (Arthus Reaction)
  
  • The Arthus reaction is a localized area of tissue necrosis resulting from acute immune complex vasculitis, usually elicited in the skin 128
    
• Type IV Hypersensitivity (Cell-Mediated)
  
  • This type of hypersensitivity is initiated by specifically sensitized T lymphocytes, rather than by antibodies
    
• Summary of Immune Mechanisms
  
• Graft-versus-Host (GVH) Disease
  
  • GVH disease occurs when immunologically competent cells are transplanted into immunologically crippled recipients. GVH disease occurs most commonly in the setting of allogeneic bone marrow transplantation but may also follow transplantation of solid organs rich in lymphoid cells (e.g., the liver) or following transfusion of unirradiated blood 139
    
• AUTOIMMUNE DISEASES
  
  • Three requirements for autoimmunity:
    
• Immunologic Tolerance
  
  • Immunologic tolerance is a state in which the individual is incapable of developing an immune response to a specific antigen
    
• Clonal Deletion
  
  • This refers to loss of self-reactive T and B lymphocytes during their maturation
    
• Clonal Anergy
  
  • This refers to prolonged or irreversible functional inactivation of lymphocytes, induced by encounter with antigens under certain conditions 144
    
• Peripheral suppression by T cells
  
  • Many factors, both cellular and humoral, that can actively suppress autoreactive lymphocytes have been described.
    
• Mechanisms of Autoimmune Diseases
  
  • The pathogenesis of autoimmunity appears to involve immunologic, genetic, and viral factors interacting through complicated mechanisms that are poorly understood 147
    
• Bypass of Helper T Cell Tolerance
  
  • Tolerance may be broken if the need for helper T cells is bypassed
    
• Molecular Mimicry
  
  • Several infectious agents cross-react with human tissues through their haptenic determinants (B-cell epitopes)
    
• Polyclonal Lymphocyte Activation
  
  • Autoimmunity may occur if such self-reactive but anergic clones are stimulated by antigen-independent mechanisms 151
    
• Imbalance of Suppressor-Helper T-Cell Function
  
  • Any loss of suppressor T-cell function will contribute to autoimmunity, and, conversely, excessive T-cell help may drive B cells to extremely high levels of autoantibody production 152
    
• Emergence of a Sequestered Antigen
  
  • Any self-antigen that is completely sequestered during development is likely to be viewed as foreign if introduced into the circulation, and an immune response will develop.
    
• Consequences of the loss of self-tolerance: autoimmune diseases
  
  • Autoimmune diseases range from those in which the target is a single tissue, such as the autoimmune hemolytic anemias and thyroiditis, to those in which a host of self-antigens evoke a constellation of reactions against many organs and systems 154
    
• Systemic Lupus Erythematosus (SLE) 155
  
  • SLE is the a multisystem disease of autoimmune origin, characterized by a many autoantibodies, particularly antinuclear antibodies (ANAs).
    
• Sjögren's Syndrome
  
  • Sjögren's syndrome is characterized by dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) resulting from immunologically mediated destruction of the lacrimal and salivary glands. 159
    
• Systemic Sclerosis (Scleroderma)
  
  • Characterized by excessive fibrosis throughout the body. The skin is most commonly affected, but the gastrointestinal tract, kidneys, heart, muscles, and lungs also are frequently involved 162
    
• IMMUNOLOGIC DEFICIENCY SYNDROMES
  
  
  • Traditionally, immunodeficiency disorders are considered according to the primary component or components involved (i.e., the B cell, the T cell, the undifferentiated stem cell, or complement); however, in view of the extensive cell interactions between T and B lymphocytes and macrophages, these distinctions are not always clear-cut 167
    
• Expansion of Immunologic Deficiency Syndromes

Tri-3, Wk11, Day 183, Friday

This was a pretty bad week for attendance mainly due to illness. Emesis on Tuesday and made it to one class. Near emesis on Thursday and simply felt nauseous with movement.

Weekly Attendance, 62%

I've got an embryology & physio II test on Tuesday so I'll need to get moving on those things. Two labs are due Monday for physio so that will be a good place to start. We get credit for the labs as long as we turn them in on time so it's an easy 3/3 points per lab. You could write down "Mary had a little lamb" as answers to all the questions and still get credit but, they are invaluable (to me, anyway) when it comes to learning the material so I'll spend a few hours on those after I post this blog.

I have several outlines I've worked on for various classes and have been wanting to post the outlines but they are quite long and didn't finish either one prior to my test. I've got a new one now I'm working on for pathology. I'm making the outline from the powerpoint presentation which is 175 slides long. I'm through slide 134 which is about 20+ pages worth of outline. Once I get that initial outline done then I want to make a kind of contents for the outline to help me grasp everything better.

On to Renal! :)

Tri-3, Wk11, Days 180, 181, 182 - Tue, Wed, Thur

This will not be a good week for attendance. I've been feeling pretty rough. Right now, I'm just trying to avoid throwing up or, emesis as we say in school. :)

Current projections for getting through this semester are around 55%. I need to work at bolstering that self derived projection in a more positive direction.

Anyway, up a little later today than normal but, pulling an all-nighter for Wednesday's microbiology II exam isn't exactly normal either. I did pass my micro test and I'm passing Pathology which is my other tough class. But - I am passing. The other class I need to devote some extra attention to is my Diversified II or adjusting class.

I was getting ready for my 10:10 a.m. embryology class but each movement made me more nauseous so I've fallen a little behind in getting to that class today. I've still got Public Health & Physiology left for the day so I've got another little break until classes resume at noon.

My blood pressure has come down since Monday. systole dropped to 166 on Tue & in the 140s today. My diastole pressure was higher on Tuesday with 108 but today it's a much more appealing 80.

I can't help wondering if the time away from the stressor, i.e., school is what's allowed my bp to drop. I wonder if the resistance to school is part of the body's natural defense since it has had a profound positive effect on my bp.

I need to read over my Public Health notes for our test tomorrow while I have the time. Embryology & Physiology test are both next Tuesday then we have a half day next Wednesday and FOUR DAYS OFF!!!!

I need that time off like I've never needed time off before. I have to make good use of that time with plenty of studying otherwise the pressure will only continue to mount.

Tri-3, Wk11, Day 179 - Super HIGH BP

I could tell by the way I've been feeling and my agitation levels that my blood pressure was probably high but, I had no idea how high - I checked my blood pressure after I got home AND after just sitting still for a good 10-15 minutes it still read an astounding 212 over 106 with a heart rate of 95 bpm. No wonder I've been wanting to get my hands on some Valium lately!

More study & good grades could go a long way in easing tensions but, my current state isn't all that conducive to a high rate of retention. Non-the-less, we have a Micro test on Wednesday that I have to study for. There's a vaccine seminar tonight & I wish it was only 20 minutes long but I believe it's 2 hours long ....

There were a fair number of people that skipped this morning's Public Health class to study for our 2nd hour Pathology test. I went to my class. I'd like 100% attendance for the week so I have *something* to feel good about. :)

- Today's Class Summaries -

Public Health - We got a new handout on Healthy People 2010. Apparently, new goals are set every 10 years by Health & Human Services as to what our Nation should be striving for in terms of health. The US has never met any of the Healthy People goals.

Pathology - I'm on the bubble. I got about as low of a grade as I could while still passing. I thought I did a little better than my final grade reflected. Right now I'll give myself about a 60% chance of making it on to Tri-4

Diversified II - I just have a lot of work to do for this class & still need to catch the teacher to inquire about my midterm grade.

Basic I - We started with x-ray marking and the class was rather interesting. We learned how the x-ray machine needs to be dead on straight and not off to one side or the other. It reminded me of watching a baseball game. If the camera showing you the pitches is off to one side then you get a skewed view of the strike zone so, pitches that may actually be a ball might look like a strike from a perspective that isn't directly in front of or behind the catcher.

Anyway - the x-ray film needs to be centered with the tube and the tube needs to be centered with the "bucky". What the heck is a bucky? I don't know, haven't learned that yet. I'm not even sure if I'm spelling it correctly at this point. Also, the floor needs to be level as well.

Physiology II - We went through slides #7 through #33 today on our third Renal ppt.

I think I might almost like the extreme detail we go into in Physiology more than the somewhat more conceptual take we're getting in Pathology. For Pathology, it looks like it's enough to know that endocarditis & cardiomyopathy are predisposing factors for heart Thrombosis without actually knowing too much about endocarditis or cardiomyopathy. But, this is our first pathology class so I'm sure there's a lot of groundwork that needs to be laid before we delve into a lot of detail. For me, just having words without meaning makes it hard for me to memorize those words and make them mine. I'll figure something out - hopefully sooner rather than later.

It's time for Micro! Today's pic ...hmmm, let's look for a bucky!!!

looks like a Bucky is a device that moves the grid while an x-ray is being taken.

According to the caption - this pic is a Siemens X-ray bucky table Typ Multix TOP manufactured 1998.

Tri-3, Wk10, Day 178 - Friday :)

Weekly Attendance, 91%

Attendance was a bit weak, making 31 out of 34 hours of class.  I was up too late Sunday night and missed my first two classes and Friday morning I missed the first hour of Pathology.

It's early Saturday morning and, since I need to organize all my classes anyway, I'll probably give a short synopsis of each class.  Next week we have exams in Pathology (Mon), Microbiology (Wed), Public Health (Fri) and the following week we should have a test in Embryology & Physiology before our Thanksgiving break.  

Public Health – Test Friday. I have a decent grade in this class & need to maintain it.

Pathology I – Exam #3 Monday, Studying for this exam is a HUGE priority for this weekend.

Diversified II – I checked my midterm grade for this class and it's listed as an "I" which I'm assuming stands for incomplete. My attendance record shows only two days missed so I'm not sure what's up with that grade. I'll have to check w/ the teacher & follow up.

Logan Basic I – We're supposed to look ahead in our book and get familiar with x-ray marking techniques before Monday's class.

Physiology II – just took a simple online test on the renal system and scored a 43%. This is just a starting point or baseline. I have much to learn and the test illustrated the need to really know the anatomy of the renal system like the back of my hand.

Orthopedics – I need to find my doctor bag and get some practice in with other people to get to know some exam basics as well as get several orthopedics test memorized.

Embryology – I've got one of my strongest grades in this class and simply need to keep up the effort. I'm thinking one or two hours over this weekend will be helpful.

Microbiology II Lab – We're soon coming up on a lab where we determine an unknown bacteria. I need to get my lab sheets organized and correlated with lab data.

Microbiology II Lecture – Test this coming Wednesday. I should spend at least an hour or two on Sat & Sun studying for this exam.

Professional Development – My group still has to give their presentation and I need to volunteer at least three hours to finish fulfilling the requirements for this class.

Philosophy III – I'll need to look through our textbook soon and get some flashcards made up. I think we just have a final left, maybe one more test then a final – good things to find out.

Tri-3, Wk10, Day 177 - Thursday :)

Let's see...what happened today....

Class Summary

Diversified & Orthopedics

Spent the first three hours in a gown going over adjustments and orthopedics testing

We were looking at x-rays the other day in orthopedics of a patient who had Harrington Rods put in his vertebrae and an amazing part about the x-rays was in a follow up x-ray taken two months later. In a typical x-ray of the spine, the place occupied by our disc is usually black, those disc don't show up on x-ray because they are so hydrophilic and are generally at least 70% water. Once this pt's lumbar disc were fused with Harrington Rods, they became immobile and the follow up x-ray showed calcification on the lumbar disc. So, instead of being transparent on the x-ray we could easily see the disc due to calcium buildup taking place on the disc itself.

Motion, movement and regular chiropractic care can go a long ways in helping stave off or even prevent such things from occurring in most people - at least, that's the take I'm beginning to get from all the knowledge I've gained at Logan thus far.

Embryology -

Interesting as always. The teacher brought up Albumin, which is a protein and I was just reading about albumin in my pathology book last night and then we saw albumin again in physio today while discussing the renal system. You should not be finding Albumin in your urine. Decreased colloid osmotic pressure is one of the reasons for edema - albumin is a big player in that scenario.

Public Health -

Just got some more basic info regarding public health. I think we talked about accidents and other exciting things today ....

Physiology -

Dr. Iggy sure can rattle things off. It's a bit disquieting but, I recorded the class and am burning a DVD right now so I can go back over the class lecture and pause when necessary in order to more fully get everything he's talking about.

That's it - gotta get back to studying pathology. Might get to bed early tonight, I'm pretty tired now and might to go bed *very* early and just hit the studying when i get up which should be around midnight or 1 a.m. if I go to bed now.

Today's pic is an x-ray of a vertebrae with Harrington Rods inserted. Scary stuff but, sometimes necessary.

Tri-3, Wk10, Day 176 - Wednesday

Got a Rock Solid 88% on yesterdays physio exam!!! :)

The highest score was 59 correct and I had 52 - not too shabby. I've been studying pathology tonight. We had two more exams pop up for next week in Micro & public health and will be having our next physio test before the Thanksgiving break.

I'm pretty exhausted and am heading to bed ;)

Tri-3, Wk10, Day 174, 175 - Monday & Tuesday

No blog yesterday but I haven't really had much sleep since the four hours I got Sunday night except for an hour an a half after school yesterday and 45 minutes very early this morning before leaving for school.

After hearing all the horror stories, I was stunned by today's Physiology test because I thought it was one of the easiest physio test I've taken to date. After the test I was thinking I had a decent shot of maybe even scoring a solid B however, I haven't been able to confirm that because the test scores aren't posted yet.

A lot of other people I've talked with thought the test was pretty hard or they failed it or that it was tricky so I'm not quite sure what to think or how accurate my perception is but, I'll find out soon enough.

I've been thinking of these longer school days - Tuesdays, Thursdays & Fridays where I'll leave before 6 a.m. and get home by 5 p.m. My thought is that I really need to try to take advantage of the time that is available and work to get at least 3 good hours of school work done on each of those nights to help bolster my studies. Well, maybe not this Friday since it looks like I'll be meeting with some old work buddies for some drinks but, at least on Tuesdays & Thursdays :)

I had a great conversation with Dr. Sanders after pathology today. I met him outside after our class and asked him a little bit about TIBC test results. TIBC stands for Total Iron Binding Count and the whole conversation was just fascinating. Dr. Sanders is really a brilliant individual and, after 10 minutes conversing with him, I was really starting to think and feel more like a doctor.

Everything just makes me want to do more and try that much harder in order to get closer to the cerebral level that people like Dr. Sanders is already at. :)

No pic today, I just want to get to studying. We're starting the renal system tomorrow in physio and that's traditionally the toughest material at any chiro, med or DO school. I also need to start making headway for our next pathology test which will be next Monday.

Sunday Studies - day 173 2/3 :)

It's just been physiology today with a nice break in between to have breakfast with my parents.

forgot to post my attendance grade from last week ...

Week 9 Attendance = 97%

3 workouts = 100%

of course, i can get all three workouts in under an hour total time ....

I wanted to go over the disorders pertaining to many of the hormones we're studying in physio, I haven't done that yet and thought it might make for an interesting post. Basically, a disorder exist when we have too much (hyper) of a hormone or too little (hypo) of a hormone and sometimes, the disorder depends on how old we are when we have too much or too little - Let's see what we've got!

Diabetes Insipidus - Lack of antidiuretic hormone ADH (vasopresson) from the posterior pituitary

Hormones from the Anterior Pituitary

Grown Hormone Disorders -

1. Acromegaly - too much growh hormone GH after puberty
2. Gigantism - too much grown hormone GH before puberty
3. Pituitary Dwarfism - decreased levels of GH before puberty
4. Diabetes Mellitus - because of increased glucose levels we see diabetogenic effects that can become diabetes if insulin activity can't occur.

Adrenocorticotropic Hormone (ACTH)

1. Addison's Disease - decreased levels of corticohormones
2. Cushing's Disease - increased levels of corticohormones

ACTH stimulates cells of the adrenal cortex that produce clucocorticoids, especially cortisol which is how ACTH is ultimately responsible for those aforementioned diseases.

Thyroid-Stimulating Hormone (TSH)

1. Myxedema - decreased levels of TSH in adults (hypothyroidism)
2. Cretinism - decreased levels of TSH in children (hypothyroidism)
3. Hyperthyroidism - increased levels of TSH

Melatonin (from Pineal Gland)

1. Seasonal Affective Disorder (SAD)
2. Jet Lag

Thyroid hormones (T3 & T4)

1. Hypothyroidism
2. Hyperthyroidism
3. Graves Disease, autoimmune hyperthyroidism
4. Goiter (from either hyper or hypothyroidism)

Parathyroid Gland

1. Hyperparathyroidism

Adrenal Glands

1. hyperplasia
2. Addison's & Cushings dz would also be listed here but the impetus for increase or decrease of corticohormones is from the ACTH previously mentioned

Pancreatic Islets

1. Beta cells, Insulin - Diabetes Mellitus
2. Type I - defective beta cells, hence, decrease in insulin productive, could be due to autoimmune disorder or viral infection
3. Type II - decreased sensitivity to insulin

I guess that's good enough for now, it's almost 2 a.m. and I am WAY past my bedtime.

Tri-3, Wk9, Day 173 - FRIDAY! :)

To my friend out in Virginia (I think it's Virgina - maybe West Virginia) who is starting the DC program in January - I've copied all my resources - about 25,000 files to the hard drive of a fellow student who will also be starting in January right along with you. His name is Nicholas Starman. If you'd like to touch base with a future collegue you can reach him at the standard school email address of nicholas.starman@logan.edu

He seems like a really nice guy and is currently finishing up his prerequisites at Logan in their Accelerated Science Program. I also know of a young lady who will be starting Tri-1 in December - she used to do an early morning boot camp with me - can't recall her name but I'll try to get it for you so you know some more people when you start ...

It's kinda scary enough to begin with, isn't it???? :)

Fast-forward to Tri-3 and I've got a Make OR Break Physio Test on Tuesday - A couple people that were in the Tri ahead of me actually found it impossible to come back after this endocrine test because they scored so low. It's a global killer and can wipe a person out with one shot ....

I may be able to score a bit better on the kidneys and renal system because that is more conceptual but the final will be the hardest and drops a lot of people an entire letter grade -

I can't guarantee I'll get through each tri or this one but I'm certainly going to do my best & won't go down without a fight.

OK _ PhySIO - Sort the Powerpoints - What have we covered - what's on the exam ....

• Wk Day - Material

• 8 M - Endocrine System
• 8 T - Hypo & Pituitary
• 8 W - Hypo & Pituitary / Pineal / Thyroid
• 8 R - Thyroid
• 8 F - Adrenal

• 9 M -Parathyroid / Pancreas
• 9 T - Pancreas
• 9 W - Calcium Homeostasis & endocrine handout
• 9 R - Diagnosis Handout
• 9 F - time off for Lab work

• 10 M - Physio Lab Due

OK, to summarize, the following is what I need to know about

1. Endocrine System
2. Hypothalamus & Pituitary
3. Pineal
4. Thyroid
5. Adrenal
6. Parathyroid
7. Pancreas
8. Calcium Homeostasis

Tri-3, Wk9, Day 172 - Thursday :)

Heck, I've squandered about 3 hours now, that is, I haven't studied since getting home. I'm starting to get the notion that I can't afford as much decompression time as I've been used to in the past.

Physiology was my fifth class today but, I'm going to start w/ that class and try to recap the power points we've gone over so I know what I'm going to need to study. Basically, we played like the Dr's on House, M.D. today and had to diagnose a patient based on a set of symptoms. I was able to make a correct diagnosis of Addison's dz but had trouble accounting for the "why's" of many of the symptoms. Mainly, I was able to match up the symptom of hyperpigmentation along w/ hypoglycemia to lead me to Addison's. Anyway, let's get started.

1. Physiology -

oops - didn't get this posted last night and got sidetracked ....

Tri-3, Wk9, Day 171 - Wednesday :)

It's just been in the last week or so that I've come to realize how much time I spend at school. Just with my classes & lunch breaks, I spend 40 hours a week at school. Add to that 2 hours a day commuting and we're up to 50 hrs/wk. I just have to be on top of my scheduling.

I have a public Health test tomorrow then a HUGE physiology test on Tuesday. I'm hoping I can get enough done between tomorrow and Tuesday to pull out a decent grade in Physio - it's a formidable class.

Today's Class Summary

1. Philosophy III - (2 hrs)

2. Diversified II

3. Logan Basic I

4. Physiology II - (2 hrs)

5. Microbiology II Lecture

6. Microbiology II Dry Lab

We did a lot today.

Today's picture is how I feel right now. :)

Good night :)

Tri-3, Wk9, Day 170 - Tuesday :)

I think I could fall asleep in a matter of minutes if went to bed now. Of course, I guess I've been up since about 2 a.m. so that could account for some of it. I was wanting to call my parents tonight to share some decent news with them but I'm not sure where my phone's at and now that I think of it, I'm not sure if I've had my phone since the end of last week ...

I'll have to look for that this weekend.

I got some nice news regarding our last Pathology test and did rather well on today's Microbiology exam. I got a 66% on the last Path test which was an improvement over the first test by a few points. I'd found out that another student that sits a few rows behind me got the same score. The other guy is a very serious and smart student so I felt pretty good about being able to match his score. For him, it was also an improvement over the first test. Today our Path teacher told us that most people did worse on the 2nd test and the class average was a 67%. So, I was right in the game and improving to boot! :)

I recall the biochem final having a class average of 50%, calculus at U of I having an average in the 40% range and organic chem having a 45 or so percentage average at most universities so it kind of depends on the difficulty of the class and these are no Mickey Mouse classes we're taking here.

Micro was very nice and I scored a straight up 74%. This is our third semester with this same Microbiology book and the improvements have been very satisfying. I remember starting out with some grades as low as 44%, then moving up into the 60% range and finally passing without needing the teachers curve and now I'm up to a C all on my own. If I keep this up I should finish the class with a solid B. That would be absolutely fantastic! :)

What did we do today? I don't even remember my classes & will have to check my notes :)

Today's Class Summary

1. Pathology - Still on Hemodynamics :)

We only covered six slides in our Hemodynamics ppt today but spent the entire hour talking about those six slides. Here's a good one - DIC, and that stands for disseminated intravascular coagualtion. What's that? Well, according to our powerpoint, it's a microangiopathic hemolytic anemia or consumption coagulopaty. Now, aren't you glad you asked?

Let's see... DIC is not a disease but rather a complication and as I recall it's a condition of bleeding and clotting at the same time - aka - hemorrhage & thrombosis. I really don't know much more about it than that. I recall the teacher using an analogy at one point of pressing a tomato through a screen and you'd get a lot of gunk & juice out of the other side and maybe this was the condition he was talking about - I'm not sure.

We have something known as Virchow's Triad which cites three related reasons for Thrombosis, those reasons being

1) Endothelial Injury, which I talked about yesterday

2) Abnormal Blood Flow

3) Hypercoagulability

We studied the characteristics of patients at high risk for thrombosis ...ideally, I should be able to relate which piece of the Virchow's Triad goes with each characteristic - I'll do the best I can with that part but, here are a list of characteristics

1. Tissue damage (surgery, burns)
2. Prolonged immobilization
3. Myocardial infarction
4. Neoplasms - solid or hematopoetic
5. Trousseau syndrome - pancreatic adenoCA
6. Prosthetic heart valves
7. DIC (we mentioned this one already) ;)
8. Smokers - endothelial disruption
9. pregancy/postpartum - hypertension, therefore endothelial
10. Oral birth control pills - endothelial
11. hyperlipidemia -
12. Sickle cell dz - microvascular occlusions
13. atrial fibrillation - turbulence (abnormal blood flow)

Predisposing factors for thrombosis

1. endocarditis
2. myocardial infarction
3. atrial fibrillation
4. cardiomyopathy

2. Orthopedics - Working w/ the Petrometer

Using two little compass looking devices called Petrometers we can accurately measure lumbar flexion, extension & rotation. I understand a similar device is available at hardware stores for around 8 bucks but, those don't have a means of "zeroing out" the device and aren't quite as good in legal proceedings. So, to make lawyers & judges happy (as well as providing pts with the very finest eqpt available) we paid $135 for our Petrometers. Actually, that $135 was cheaper than what last semester students paid. We were able to negotiate a better price by committing to buy at least 50 Petrometers. :)

These are really nifty little devices. When flexing forward, the sacrum tilts and using the Petrometer we can eliminate the contribution of the sacrum and isolate lumbar flexion.

I'm looking forward to testing my parents and getting some baseline numbers for them. The degrees of motion we're looking for with each motion are as follows

• Lumbar Flexion - 60 degrees
• Lumbar Extension - 25 degrees
• Lumbar Lateral Bending - 25 degrees
• Lumbar Rotation - 45 degrees

any motions less than those recommended ranges probably indicate an issue.

3. Diversified II

We met in the classroom today and simply looked over x-rays all hour. We haven't had a single class in radiography but we sure have spent a lot of time looking over x-rays. It was rather interesting. Some things, like the trachea, show up as shadows as well as any gas or air pockets in the intestines.

4. Embryology -

hmmm ....hmmm - OK - I opted out of this class to study for Microbiology and finish up a powerpoint presentation we were supposed to give for our professional development class. I've got a solid B going in Embryology and not such a strong grade in Micro so, I opted for Micro.

5. Physiology -

It looks like our next test, Exam 4, will be next Tuesday :)

What the heck did we cover today??? I remember hearing about a lot of hormones I'd never heard of before in my life ...

I know a little bit about the pancreas, here are what some of the cells in the pancreas secrete -

• Alpha cells secrete glucagon
• Beta cells secrete insulin
• Delta cells secrete somatostatin
• F-cells secrete pancreatic polypeptide

Glucagon is 29 amino acids long and stimulates liver glycogenolysis, increases gluconeogenesis and stimulates lipolysis

...so much stuff here -

We need to know the ins and outs and differences between Diabetes Mellitus & Diabetes Insipidis

Some miscellaneous hormones are known as eicosanoids which are 20 carbon faccy acids and water soluble (i think) - two broad families are Leukotrienes and prostaglandins.

We also have prostacyclins & thromboxanes. Besides T-cells we have four other hormones from the tymus and a half a dozen more growth factor hormones.

At the end of the powerpoint, we have NINE tables worth of hormones to know ....far too many to list here tonight. I'll learn them though, just not tonight.

6. Microbiology II Lab -

We played with Streptococcus today and innoculated 12 different test tubes and 6 petri dishes

7. Microbiology II Lecture -

Did well on our test today :)

8. Professional Development -

Well, we were scheduled to give our presentation today but, it just didn't happen so I'm sure we'll go next week -

That's it. It's almost 9 p.m. and I am really ready for bed ....

debating if I should make up some flashcards before bed. ...thinking 30 minutes devoted to physio flashcards ....mmmm - got a Public Health test on Thursday - OK, I'll make up flashcards for that :) Heck - other than tonight, i only have tomorrow to prep for that test!

Today's picture is of a Petrometer.

Tri-3, Wk9, Day 169 - Monday :)

I have a Microbiology Test tomorrow and a presentation to do with a few of my classmates for Professional Development. We're supposed to provide a presentation such as we might give to a bank in the hopes of obtaining a $200,000 loan to start a new chiropractic business.

Today's Class Summary

1. Public Health

• I'm thinking this teacher may have had a rough weekend because he sounded a bit morose today. I guess we all have those kinds of days from time to time. This will be the last semester of teacher for Dr. Anand who first started around 1974. Looooong tenure! :)

2. Pathology I

• This is a tough class and I would sound really smart if I knew everything being taught. We're still covering hemodynamic disorders.
• We covered a lot dealing with Thrombosis. To paraphrase one of our powerpoint slides, "Arterial thrombosis is the most common cause of death in the Western industrialized countries. Most often, thrombosis occurs in the coronary arteries, leading to myocardial infarction (#1 cause of death). However, it may also occur in the heart or carotid system, causing stroke (#2 cause of death)"
• A thrombosis is a coagulation of blood somewhere in a blood vessel. One *very* interesting factoid thrown our way was that a blood clot (which, is basically a synonym for thrombosis) is that a blockage consisting of a blood clot can grow from half a millimeter to 2.5 centimeters within about 20 minutes - that's fast!
• Another very interesting thing talked about today was how endothelial injury is the most prevalent mechanism by which blood clots form. Now, the term, endothelial, simply refers to the type of cell which lines our blood vessels. Under those cells is what's called a basement membrane which, among other things is made up of collagen. The way our blood vessels work is that if a blood vessel is punctured and blood starts flowing out of any hole in the vessel wall, then a mechanism is set up such that when platelet cells flowing in our blood plasma come in contact with the collagen in the basement membrane, then a coagulation cascade starts to occur which essentially plugs the hold in our blood vessel.
• But, what if there isn't a hole in the blood vessel. another way this clotting process can start is if the cells lining the blood vessel get worn away somehow. Then, the basement membrane would be exposed and, as expected, platelets that come in contact w/ the membranous layer of the vessel would start to clot where ever the missing endothelial cell used to be.

3. Diversified II Lab

• We practiced all our adjusting moves again today. I'm going to have to get a lot more practice in so I know the techniques better.

4. Logan Basic I

• We had our first class with a second teacher who teaches Basic. We learned a lot of very interesting things about scoliosis. When you view a person's spine from the spine there are supposed to be curves in the spine. It's a brilliant design and how it's supposed to be. But, if you view a person head on or from the back then the spine should be lined up straight. If the spine is not lined up straight when viewed from the front or back but rather curved then we refer to that as a scoliosis.
• Scoliosis is a very serious condition and, if it's bad enough, can be life threatening and require surgery to correct simply to keep the patient alive. Most of the time, scoliosis is not so serious as to require immediate surgical intervention.
• The difference in the way MDs and DCs view scoliosis is rather astounding. According to this class, an MD will deem scoliosis as having an idiopathic cause, that is a fancy way of saying, there is no cause. An MD will also refer to many lesser scoliosis as being within a "normal variance" which is to say, enough people have curves to their spine which shouldn't be there but, since enough people have this condition then it's simply a normal variance.
• I'm thinking .... a lot of people have cavities also but I would hate to be under the care of a dentist who simply told me that the cavity was a normal variance and not to worry about it!
• An MD considers stopping the progression of the scoliosis a success while a DC considers reducing the scoliosis a success.
• Having said all this, these generalizations probably don't apply to everyone in either health care profession because the DC who was teaching the class has several MDs as patients including a few surgeons who get care to help avoid carpal tunnel syndrome.

5. Physiology

• We finished up Adrenal glands by seeing a few pictures of pts with Cushings & Addison's dz then completed a ppt on Parathyroid Glands then started in on the Pancreas.
• A bit of good news - we won't be tested this latest chapter until next week. Several of the students cheered out loud because it would be a huge stretch to get everything memorized by the end of this week.

For tonight, I still need to study for Micro and complete a ppt presentation for tomorrow.

Today's pic is of scoliosis.