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Posts Tagged ‘pathology’

I hadn’t been feeling very well for several weeks and then last night it happened. This post is a description of what it’s like to be an epileptic, written simply to document my experience. My goal here is to do that, almost in a dispassionate scientific way, and if it helps others going through similar experiences — feedback I often receive from such posts — that’s wonderful. My post is not a call for sympathy or help, although those are understandable and kind responses, and it’s not a complaint either. It just is, because what I am is what it is.

I’ve realized that my blog has become about not just documenting how amazing, freakish and immensely fallible that anatomy can be in other species, but also about my own experiences with my anatomy (and physiology) failing, as per these two prior posts about my shoulder and brain (more links therein). Sharing these experiences gives me strength and clarity, even if some of that emerges from partly detaching myself from the emotional nature of the experience and trying to look at it from outside of myself. I can be a private person, so feeling like I can discuss something uncomfortable and vulnerable makes me feel like I am growing, much as I innately resist that.

Stomach-Churning Rating: 1/10; no fun events described, but no images either.

I’ve had enough experience now as an epileptic that I look back on my seizures with disappointment (“Oh damn, not again.”) but also familiarity (“OK that happened; I know how things will go now.”). They are terrifying at the time, especially for my family, and my disorientation when emerging from unconsciousness with strangers around and with a gap in my memory is nightmarish.

I was watching a documentary about the Jutland battle in WWI while my daughter was put to bed. Then… I woke up, maybe 20 minutes later, unsure what was going on. There were two “first responders” (emergency non-paramedics) present, one of whom I eventually recognized from my prior emergency experiences in recent months, trying to talk to me with my wife. I was impressed to later hear that they’d come within 5 minutes of being called; not bad for life in a small English town. I came to realize that my right shoulder hurt again (from violent spasms), reducing it to almost a one-degree-of-freedom joint (mostly able to move fore and aft; almost zero pronation/supination without intense pain), reminscent of Ichthyostega‘s. I was surrounded by tissues wet with blood from my lip, where I’d again bitten myself during my fit. I could sense my racing heartbeat and fluctuating temperature, other hallmarks of my pre- and post-seizure symptoms. My vision was blurry, with my eyes usually becoming dilated during a seizure.

But the predominant feeling that takes an uncomfortably long time to pass is the “post-ictal state“, a mind clouded by confusion, slowly becoming aware that my neurons are misfiring but are beginning to sort themselves out. I sometimes irrationally want to just go back to sleep and not talk, and need some rational insistence from carers that we can’t do that right now. It is this vacillation between consciousness and unconsciousness, in a grey area in between, that I find most disturbing, as I cannot completely trust my own mind, disbelieving what is happening (“Is this real?”), and sometimes I lapse back into seizure(s) again. This is a powerful example of the frightfulness of uncertainty. As a scientist, so reliant on my mind, it is horrifying to feel like it is out of control. It also conjures up memories of observing my mother’s mind declining with Alzheimer’s syndrome, and those are vastly painful.

As I became able to put words together semi-coherently, and as the medics poked and prodded me to do tests on my symptoms (I had a cannula in my left arm’s blood vessel by now), discussion turned to whether to take me to the hospital once the paramedics arrived with the ambulance. In the past, there was no question of the need for a trip to Accident & Emergency (A&E in the UK; same as the ER in the USA).

Yet now, with almost 2 years of experiences behind me, I (and my carers) have come to know my better seizures from my worst ones. And given that A&E normally involves >4 hours of lying around in a noisy room, constantly disturbed by checkups or screaming patients, it is far from restful and rest is what I tend to need most. After an hour of vigilance, my symptoms faded and I became more able to answer queries, even to talk over options. We agreed that I could stay home, try to rest, and go to A&E if I had another seizure.

I am glad to say that I got a full night of rest and I feel a lot better today. That I am able to think clearly enough to write this post gives me reassurance. After past seizures, I’d often be unable to do much except take naps and gawk slack-jawed at the TV screen, with my vision still blurred (one eye even seemed to change shape post-seizure once, and I began seeing things in the corner of my field of view that are not truly there). So the bright side of this post is, maybe my medications are working better now, and maybe we will get this epilepsy under control, but I keep saying that every 2-3 months and then being proven wrong by another seizure, so a lot of uncertainty looms.

Nonetheless, seizures involve a “refractory period” that makes further seizures less likely for some time period, so odds are good that I can feel more secure while I recover from this event, which usually takes two weeks or so to get my brain feeling closer to “normal”. Even so, my mind remains clouded by these post-ictal feelings, weighting me down with fatigue that is the most chronic challenge I struggle against now as an epileptic. It leaves me unable to do as much as I once could, with a backlog of work growing behind me like never before. This is the “diminishing” that I lamented before; it is not just old age.

That’s what one experience was like for me, and I’m glad that it was far from the worst “neural storms” I’ve suffered. I hope that readers find it interesting. Now that my battle is over for now, I’ll take some time to find out how that Jutland battle turned out.

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I was recently featured on Daily Planet, a great Canadian science show on TV that lamentably is not broadcast more globally. It is always high quality science communication, aided by the superb hosts Ziya Tong and Dan Riskin (and a talented crew!). What were we doing? Dissecting an elephant’s foot, of course!

Stomach-Churning Rating: 9/10; no-holds-barred dismantling of elephant feet, from the video onwards, and this post is heavy on moist, goopy photos afterwards, with some nasty pathologies. Not nice at all. I’ll give you a chance to turn around while contemplating the cart that we use to carry elephant feet around campus (each foot is 20-30kg; up to 70lbs; so we need the help!), before the video.

no_poo

Here is a snippet of the full segment from Daily Planet:

And here is more of some of my recent dissections. I’ll walk you through two dissections, via photos. This goes back to the roots of this blog: unflinching, gritty examinations of real anatomy! Of course, no elephants were harmed for this work. They died at EU zoos/parks and were sent to me for postmortem examination and research, so we hope that this benefits the future care of elephants. We’re currently finishing up a grand overview paper that describes all of the odd pathologies we’ve observed in elephant feet, for the benefit of zoo keepers and vets who are trying to detect, diagnose and monitor any foot problems.

As the post’s title alludes, elephant feet (and more proximal parts of the limbs) are no stranger to this blog. If you’ve forgotten or are unfamiliar, here are some of my past proboscidean-posts: on elephant foot pathologies (a close sister post to this one), our “six-toed” elephants paper, how to make a computer simulation of an elephant’s limb (umm, paper yet to come!), how we boil and bleach bones to clean them up, and a few others. Last but not least, there was the post that went viral in the early #JohnsFreezer/WIJF days: dissecting an elephant with the “Inside Nature’s Giants” show.

There are two feet in this post, both front right feet (manus is the technical term; singular and plural). The first one is the messier (unhealthy and bloodier, less fresh and clean) one, from the show/video. It is an Asian elephant (Elephas maximus). I kick off with photos I took after the filming, so the foot is already deconstructed:

Skinned foot, oblique front/inside view.

Skinned foot, oblique front/inside view. The wrist is on the right side of the photo; the toes on the left.

Sole ("slipper"), with a hole on the fourth toe showing where the abscess is that let infection in/pus drain out.

Sole (“slipper”), with a hole on the fourth toe showing where the abscess is that let infection in/pus drain out. The slipper here is upside-down.

Top-down view of the sole of the foot, once the slipper is removed.

Top-down view of the sole of the foot, once the slipper is removed; flipped over and rotated 90 degrees clockwise from the above photo. Some of the fat pad of the foot is on the right side of the image; it’s very hard to separate from the keratinous sole of the foot.

Looking down into the fourth toe's abscess on the other side of the above view.

Looking down into the fourth toe’s (ring finger) abscess on the other side of the above view.

Looking down into the third (middle) toe, same view as above. Some redness and greyness where this toe had some of its own pathological issues.

Looking down into the second toe (index finger), same view as above. Some redness and greyness where this toe had some of its own pathological issues like infection and a smaller abscess.

Looking up from the slipper at the fat pad and toes of the foot, where they interface with the sole/slipper. The fat pad is toward the bottom and left side; the five toes are on the upper/right side (knobby subcircular regions on the perimeter of the foot).

Looking up from the slipper (removed) at the fat pad and toes of the foot, where they interface with the sole/slipper. The fat pad is toward the bottom and left side; the five toes are on the upper/right side (knobby subcircular regions on the perimeter of the foot). The very bad infection on the fourth toe is visible on the bottom right.

The sproingy fat pad is worth a video!

And one good wiggle deserves another!

A view down onto the wrist joint. The carpal (wrist) bones are visible at the bottom of the image, whereas the flexor (palmar) tendons and muscles on the back of the "hand" are at the top. There is a LOT of musculotendinous tissue on the back side of an elephant's foot.

A view down onto the wrist joint. The carpal (wrist) bones are visible at the bottom of the image, whereas the flexor (palmar) tendons and muscles on the back of the “hand” are at the top. There is a LOT of musculotendinous tissue on the back side of an elephant’s foot. As you will see in my dissection of the second foot, further below!

Looking down onto the medial (inner/"thumb") border of the foot, where I've exposed the prepollex, or false "sixth finger" by removing the first metacarpal (knuckle) bone.

Looking down onto the medial (inner/”thumb”) border of the foot, where I’ve exposed the prepollex, or false “sixth finger”, by removing the first metacarpal (knuckle) bone.

Removed the prepollex from the foot. The white oval structure is the top of the prepollex; white is cartilage, whereas the red "islands" are blood vessels that have invaded the cartilage and are starting to turn it into patches of bone. So this prepollex is at a very early stage of bone formation, still almost entirely cartilaginous, whereas some older elephants have the prepollex largely formed of bone.

I’ve removed the prepollex from the foot. The white oval structure (bottom right) is the top of the conical prepollex, where it connected to the rest of the foot. White is cartilage, whereas the red “islands” are blood vessels that have invaded the cartilage and are starting to turn it into patches of bone. So this prepollex is at a very early stage of bone formation, still almost entirely cartilaginous, whereas some older elephants have the prepollex largely formed of bone. The fleshy pink tissue adhering to the surface of the prepollex here is a remnant of “abductor” muscle that connects it to the thumb and thus could allow some active control of the prepollex’s mobility.

Well, that was one very pathological elephant’s foot; one of the worst I have ever seen. Every foot I dissect is different and tells me a unique story about that animal’s development, history and health. This one told a very sad tale. What does a somewhat normal elephant’s foot look like? I thawed one out for comparison, and to thin out my overstuffed freezer stock. This one starts off from an intact (if severed) foot so you can witness the stages of dissection:

Whole foot. African elephant (Loxodonta africana).

Whole foot. African elephant (Loxodonta africana). You may spot in later photos that the second and fourth toes’ nails are cracked longitudinally. This happens sometimes in elephants without any obvious health problems such as infection, but if it lasts long enough and conditions are bad enough (e.g. unsanitary conditions getting bacteria into the crack; spreading the crack to let them into the foot tissue), it could worsen.

Nice clean sole.

Nice clean sole. No abscesses or other problems. You can faintly see the cracked toenails here.

Gorgeous white cartilage surfaces of the wrist joints. Nice and healthy-looking. A young animal, in this case.

Gorgeous white cartilage surfaces of the wrist joints. Nice and healthy-looking. A young animal, in this case.

Removing the skin; nice soft whitish connective tissue underneath.

Removing the skin; nice soft whitish connective tissue underneath.

Skinned foot; rear view. The yellowish fat pad is wonderfully visible through the connective tissue sheath.

Skinned foot; rear view. The yellowish fat pad is wonderfully visible through the connective tissue sheath.

Skinned foot; front view. The thin, broad extensor tendons that would draw the fingers forward in life are visible here as longitudinal lines along the foot's surface, running to the toes.

Skinned foot; front view. The thin, broad extensor tendons that would draw the fingers forward in life are visible here as longitudinal lines along the foot’s surface, running to the toes.

Ahh, my favourite thing! I've cut around the prepollex and am pointing at it. It's almost impossible otherwise to see through all the fatty tissue of the fat pad that surrounds it.

Ahh, my favourite thing! I’ve cut around the prepollex and am pointing at it. It’s almost impossible otherwise to see through all the fatty tissue of the fat pad that surrounds it.

Removing the prepollex. It's tiny and enmeshed in connective tissue; harder to see than in the first elephant (photos above).

Removing the prepollex. It’s tiny and enmeshed in connective tissue; harder to see than in the first elephant (photos above).

There is the prepollex! Maybe 12cm long. A little bit of cartilage (white) visible where it connected to the foot. These "sesamoid bones" vary tremendously in elephants I've inspected. I am still getting my head around that, after >10 years of staring at them in >75 feet!

There is the prepollex! Maybe 12cm long. A little bit of cartilage (white) visible where it connected to the foot. These “sesamoid bones” vary tremendously in elephants I’ve inspected. I am still getting my head around that, after >10 years of staring at them in >75 feet!

Gap left by removal of the prepollex, on the median border of the foot; thumb region. Imagine having a little extra thumb growing off the base of your thumb and sticking toward your palm. That's what elephants have.

Gap left by removal of the prepollex, on the median border of the foot; thumb region. Imagine having a little extra thumb growing off the base of your thumb and sticking toward your palm. That’s what elephants have.

Here, removing the slipper/sole of the foot, from the back side forwards. Hard work!

Here, removing the slipper/sole of the foot, from the back side forwards. Hard work!

The slipper. Compare with the image above (same orientation). Nothing wrong here that I could see.

The slipper. Compare with the image above (same orientation). Nothing wrong here that I could see.

Front view of the toes, where they connect to the toenails. This specimen was so fresh that they were surprisingly easy to cut through and remove the foot from the sole.

Front view of the toes, where they connect to the toenails. This specimen was so fresh that they were surprisingly easy to cut through and remove the foot from the sole.

Looking up at the palm. You can see the bulbous fat pad (yellower tissue) bulging out in the centre of the palm, and segments of it extending between each finger, separated by fibrous tracts. I love this anatomy. I can stare at it for hours and still be fascinated after all these years. So complex!

Looking up at the palm. You can see the bulbous fat pad (yellower tissue) bulging out in the centre of the palm, and segments of it extending between each finger, separated by fibrous tracts. I love this anatomy. I can stare at it for hours and still be fascinated after all these years. So complex!

Looking down onto the inside of the toenails, toes 3 and 4. Healthy, relatively intact tissue; no swelling or bleeding or other pathology.

Looking down onto the inside of the toenails, toes 3 and 4. Healthy, relatively intact tissue; no swelling or bleeding or other pathology.

Skinned foot, oblique front/inside view again, as above.

Skinned foot, oblique front/inside view again, as above.

Fat pad removed, looking up through where it was at the palm of the "hands", where the tendons and ligaments connect to the five toes. Each arc-like structure is a toe; the "thumb" (first toe) is on the upper left.

Fat pad removed, looking up through where it was at the palm of the “hands”, where the tendons and ligaments connect to the five toes. Each arc-like structure is a toe; the “thumb” (first toe) is on the upper left.

Elephant's-eye-view looking down onto the fat pad, where the palm of the foot in the image below would be placed in life.

Elephant’s-eye-view looking down onto the fat pad, where the palm of the foot in the image below would be placed in life (i.e. the limb would be coming down vertically, perpendicular to the plane of the image). The fat pad of the foot is visibly thicker toward the back of the foot (bottom of the image), as you’d expect, because the toes occupy most of the front parts.

Palmar tendons and muscles; the common digital extensor muscle group. Clenches the toes. Not a small muscle, either!

Palmar tendons and muscles; the common digital extensor muscle group, which clenches the toes. Not a small muscle, either!

Tendons of the digital flexor muscle exposed.

Tendons of the digital flexor muscle exposed.

Removed the digital flexor muscle so the three major tendons can be seen (the two short side branches to the first and fifth toes have been cut off).

I removed the digital flexor muscle so the three major tendons can be seen (the two short side branches to the first and fifth toes have been cut off).

Forefoot with flexor tendons removed, revealing the channels that they coursed through.

Forefoot with flexor tendons removed, revealing the channels that they coursed through.

Closeup of the glistening channels for the flexor tendons. They are lined with lubricative tissue to help the tendons glide through them. And the tendons do need to be able to glide- although elephant feet look very solid from the outside, and are to an extent, but we've done studies showing that they do move if you apply even a moderate load to them in a cadaver, and thus would move in life, too.

Closeup of the glistening channels for the flexor tendons. They are lined with lubricative tissue to help the tendons glide through them. And the tendons do need to be able to glide- although elephant feet look very solid from the outside, and are to an extent, but we’ve done studies showing that they do move if you apply even a moderate load to them in a cadaver, and thus would move in life, too.

Let’s finish off with some osteology, shall we? First the unhealthy Asian elephant, then the healthy African elephant; same front right feet, just the bones (from my CT scans):

Ouch, indeed!

Much better. And that’s the end!

Wow, that was an elephantine post! I wanted to take yet another opportunity to share the amazing anatomy of elephant feet with you. You’re all now qualified experts if you made it this far!

Any questions?

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I awoke on the floor in the aisle of my United Airlines flight to Los Angeles, with three unfamiliar men crouched around me, bearing serious expressions as they looked down on my prone body.

I was next to my seat. My daughter was crying inconsolably in her seat next to mine, and my wife was calling to me with an urgent tone from the next seat over.

Gradually, as my confusion faded and the men let go of me (I’d been cursing them out, in mangled words because I had bitten my tongue), I became aware that I was in intense pain, I could not move much, and my wife’s words became clearer:

I’d had a seizure. And so our relaxing family holiday, which had only just begun, ended. And so my waking nightmare began.

Stomach-Churning Rating: 5/10; lots of Anatomy Fail CT/x-ray images and gruesome descriptions, and a photo of some bruising.

I was helped back into my seat as I regained my senses, I noticed blood on me from my tongue, and I learned that we were 2 hours away from L.A. As I was acting more normal, and we were 5/6 of our journey along, there was no need to prematurely land the flight. I had fallen asleep while watching “22 Jump Street”, about 1.5 hrs in, and that’s when my seizure struck– much like the previous two seizures I’d had. Jonah Hill could be ruled out as a culprit, but going to sleep was an enabling factor. I got some over-the-counter painkillers and sat in a daze as time ticked by, we landed, and paramedics boarded the plane to whisk me off to the hospital with my family.

Two gruelling days and nights in a California hospital later, with my first night spent in a haze of clinical tests, begging for painkillers, yelling in pain every time I moved, and otherwise keeping my hospital roommate awake, the story became clearer: my seizure was so intense that I’d dislocated my right shoulder (unfortunately I’d not had much pain relief when the emergency room staff popped it back into my glenoid), probably dislocated my left shoulder too but then relocated it myself admist my thrashing, and done this (cue Anatomy Fail images):

Left shoulder, with the offending greater tubercle/tuberosity of the humerus showing fracture(s).

Left shoulder, with the offending greater tubercle/tuberosity of the humerus showing fracture(s).

Right shoulder x-ray, showing dislocation of the head of the humerus from the glenoid. Compare with above image- humerus has been shifted down. BUT no fractures, yay!

Right shoulder x-ray, showing dislocation of the head of the humerus from the glenoid. Compare with above image- humerus has been shifted down, the shoulder joint is facing you. BUT no fractures, yay!

CT scan axial slice showing my neck (on left), then scapula with fractured coracoid process ("bad") and displaced, fractured greater tubercle of humerus on right side.

CT scan axial slice showing my spine (on left), then scapula with fractured coracoid process (“Bad”) and displaced, fractured greater tubercle of humerus on right side (“V bad”).

So, that explains most of the pain I was in.

What’s amazing is that the fractures most likely occurred purely via my own uncontrolled muscle contractions. All the karate and weight-training I’d been doing certainly had made me stronger in my rotator cuff muscles, which attach to the greater tubercle of the humerus. And with inhibition of my motoneurons turned off during my seizure, and both agonist and antagonist muscles near-maximally turned on, rapid motions of my shoulders by my spasming muscles would have dislocated my shoulders and then wrenched apart some of the bony attachments of those same muscles. I’m glad I don’t remember this happening.

I had also complained of pain in my neck, so they did a CT scan and x-ray there too:

X-ray: No broken neck. This is good.

X-ray: No broken neck. This is good. Just muscle strain, which soon faded.

The left shoulder injuries created a hematoma, or mass of blood beneath my skin, and soon that surfaced and began draining down my arm (via the lymphatic system under gravity’s pull), creating fascinating patterns:

Bruises migrating; no pain associated with these, just superficial drainage of old blood.

Bruises migrating; no pain associated with these, just superficial drainage of old blood. This is tame, tame, tame compared to what my left ribcage looked like. I’ve spared you that.

But then more fundamentally there was the question of, why a seizure? With no clear warning? As I’ve explained before, I’d had a stroke ~12 yrs ago that caused a similar seizure but with no injuries to my postcranial body. So a series of MRI and CT scans ensued (the radiation I’ve had from the latter is good fodder for a superhero/villain origin tale? Marvel, I’ll await your call), and there was no clear damage or bleeding, and hence no stroke evident. Good news.

There are, however, at least two sizeable calcifications in my brain that are likely to be hardened scar tissue from my stroke. These may or may not have an identifiable affect on me or linkage with the seizure. Brain calcifications can happen for a variety of reasons, sometimes without clear ill effects.

Calcification in ?ventricle? of my cerebrum.

Calcification in parietal lobe of my cerebrum, from axial CT scan slice. But no bleeding (zone of altered density/contrast).

That is the state of the evidence. I’ve since had what semblance of a L.A. family holiday I could manage, benefitting from a touching surge of support from my family, friends and colleagues that has kept me from sinking entirely into despair and has brought quite a few smiles.

The plane flight home was tense. We were in the same seats again and one of the flight attendants recognized us and came to chat, eager to learn what had happened after we left the plane a week ago. He was very nice and the doctors had given me an “OK to fly” letter. But it was an evening flight. I needed to sleep, yet it was clear to me that sleep was no longer the fortress of regenerative sanctity that I was used to it being. Sleep had taken on a certain menace, because it was a state in which I’d now had three seizures. Warily, I drifted off to sleep after having some hearty chuckles at the ending to “22 Jump Street”. And while it was not very restful slumber, it was the friendly kind of slumber that held no convulsive violence within its embrace. We returned home safely.

In a rush, I cancelled my attendance at the Society of Vertebrate Paleontology conference this week, turning over the symposium I’d convened to honour one of my scientific heroes, biomechanist R. McNeill Alexander (who also could not attend due to ill health), to my co-convenors Eric Snively and Andreas Christian (by accounts I heard, all went well). I missed out on a lot of fun and the joy of watching 2 of my PhD students present posters on preliminary results of their research. Thanks to social media and email, however, I’ve been able to catch a lot of the highlights and excitement from that conference in Berlin.That has helped distract me somewhat from other goings-on.

Meanwhile, I’ve been resting, doing a minimal amount of catching up with work, having a lot of meetings with doctors to arrange treatment, and pondering my situation– a lot.

I know this much: I’ve had two violent seizures in a month (the previous one was milder but still bad, and not a story I need to tell here), and so I’m now an epileptic, technically. When and if I’ll have another seizure is totally uncertain, but to boost the odds in my favour I’m on anti-convulsant drugs for a long time now.

In about half of seizure cases, it’s never clear what caused the seizures. What caused my 2002 stroke is somewhat clear, but the mechanism behind that remains a mystery, and my other health problems likewise have a lot of question marks regarding their genesis and mutually causative relationships, if any. The outcome of this new development in my medical history is likely to be: “maybe your brain calcifications and scar tissue helped stimulate your new seizures, but we can’t be sure. The treatment is the same regardless: stay on anti-convulsants for a while, try going off them later, and see if seizures manifest themselves again or not.” Brains are freaking complicated; when they go haywire it can be perplexing why.

As a scientist, I thrill at finding uncertainty in my research topics because that always means there is work left to be done. But in my own life outside of science, stubborn, independent, strong-willed control freak that I can certainly be at times, I am not such a fan of uncertainty. In both cases the goal is to minimize that uncertainty by gathering more information, but in our lives we often encounter unscalable walls of uncertainty that persist because of lack of knowledge regarding a problem that vexes us, especially a medical problem. We then can feel in a helpless state, adrift on the horizon of science, waiting for explorers to push that horizon further and with it advance our treatment or at least our insight into ourselves.

When the subject of that uncertainty is not some detached, objective, unthreatening, exciting research topic but rather ourselves and our own future constitution and mortality, it thus becomes deeply personal and disconcerting. I’m grateful that I don’t have brain cancer or some other clear and present threat to my immediate vitality. Things could be a lot worse; I am here writing this blog after all. I’ll never forget now being in the ambulance and thinking “this may be the end of it all; I might not last much longer”, and choking out a farewell to my wife just in case things took a bad turn. I’m grateful for the amazing things that modern medicine and imaging techniques can do– these have saved my life so many times over, I cannot fathom how to quantify it. And I’m grateful for the people that have helped me through this so far. Fiercely independent as I may be, I can’t face everything alone.

I am reminded of words I read recently by Baruch Spinoza, “The highest activity a human being can attain is learning for understanding, because to understand is to be free.” To further paraphrase him, we love truth because it is knowledge that enables us to stay alive- without it, we are flying blind and soon will crash. With the freedom it brings, we know the landscape of our own life and where the frontiers of uncertainty lie (“here be dragons”).

here_be_dragons

The past two weeks have been horrendous for me. I’d been feeling healthy and stronger than ever in many ways, and my life as of my birthday a month ago felt pretty damn good. But now everything has come crashing down in disaster, and I have been suffering from the realization, once again, of how vulnerable I am and how little I can control, and the darkness that ushers in as the odds begin to stack up against our future lives. I am acutely aware now of where the “dragons” are.

I am taking one important step forward, though, in wresting life back onto the rails again- this week I undergo surgery to put my left shoulder back together. While that’s scary, to be sliced open and have my rotator cuff and bones carpentered back where they should be, I know I’m in good hands with a top UK shoulder surgeon and methods that are tried-and-true. The risks are small, although the recovery time will be long. There won’t be any hefting of big frozen elephant feet in my research soon, not for me, and so my enjoyable anatomy studies are going to have to change their track for coming months while I regain my strength and rely on others’ help.

(do you know the movie reference?)

(do you know the movie reference? I have a new empathy for Ash.)

Then we’re on to the frightening task of tackling the spasmodic-gorilla-in-the-room with neurologists. We’ll see where that journey leads.

One thing is certain: I’m still me and there’s still a lot of fight left in me, because I have a lot left to fight for, and people and knowledge to aid me in that fight. I can shoulder the burden of uncertainty in my life because I have all that. Off I go…

20 November UPDATE:

I’ve had surgery to put my greater tuberosity back where it belongs. Thanks to a skilled surgeon’s team, some sutures and nickel-titanium staples, I am back closer to my normal morphology and can begin recovering my (currently negligible) shoulder joint’s range of motion via some physiotherapy. Surgery went very well; I was just in hospital for ~30 hours; but the 9 days of recovery since have been brutally hard due to problems switching medications around. Today I got my stitches out and a beautiful x-ray showing plentiful healing; yay!

This is a slightly oblique anterior (front) view of my left shoulder/chest. Fracture callus means healing is working well!  Four surgical staples (bright white thingies on upper RH side of image): forever now a part of my anatomy.

This is a slightly oblique anterior (front) view of my left shoulder/chest. Fracture callus means healing is working well!
Four surgical staples (bright white thingies on upper RH side of image): forever now a part of my anatomy.

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Sick feet, pig feet, boo hoo, in pain you are
Not well heeled; fate sealed, oh no, inflamed they are
And when your trotter’s on the floor
You’re nearly a good boar
Almost a porker

(corrupted from Pink Floyd’s “Pigs (Three Different Ones)” track #3 from the Animals concept album (1977). A song with quite a history- check out some more about it.)

It could happen...

It could happen…

Concept albums often weave back and forth between themes in a non-linear story, returning to refrains and leitmotifs to create their narrative weft and warp. This Freezermas, I’ve already woven in two legs and four legs, cats and other beasts, x-rays and more. Today, I tie in another thread, which extends throughout the blog, but especially into yesterday’s post. This post is about feet and health again. But it is also solely about pigs, which are cool animals whose biomechanics are surprisingly little studied.

It’s a shorter post (in contrast to the 11-17 minute Pink Floyd cousin song); a drum solo if you will; with just three images representing three big pigs and their funky feats of footedness, and the three days left in Freezermas. One image is about ongoing research; the other two about bizarre cases that kinda freak me out (enough to want to know more about them).

Stomach-Churning Rating: 4/10, not for gore but for surreality; things that should not be. Especially the 2nd picture.

pig gif

Above: X-ray GIF (may take a while to load) from our 3D XROMM analyses of foot biomechanics, here showing a pig studied by Dr. Olga Panagiotopoulou (also RVC Fellow Jeff Rankin; and Prof. Steve Gatesy at Brown University). With data like these, we not only can measure how the tiny bones move, but also get better estimates of the loads on the soft tissues within those feet. Those loads should relate to the risks of musculoskeletal injury or disease. This GIF is just a teaser for some fantastic 3D images we’re producing. The pig’s feet were normal. The odd little spheres on them are skin-adhered markers that let us compare how external estimates of skeletal motion compare to actual motion; normally this is a big source of error.

I know little about this case, posted on Reddit (link here), except that the overgrown, grossly deformed toes/hooves of this pig are like nothing I've seen before! This almost gave me nightmares. Poor chicken-footed pig!

I know little about this case (seems to trace back to an original Brazilian news story), posted on Reddit (link here), except that the overgrown, grossly deformed toes/hooves of this pig are like nothing I’ve seen before! This almost gave me nightmares. Poor chicken-footed pig. Foot deformities of this kind in pigs don’t seem to be as much of a problem as in cattle or horses; from the limited literature I’ve seen on this, they seem to have more problems with the soft tissues of their feet, such as  abscesses or inflammation of the digital cushion (padding) of the trotter.

Another crazy case; but this one I was able to track down more about after reading the Reddit post here. The Getty images page says: This photo dated November 24, 2011 shows a Chinese farmer showing off his prize swine, which he named 'Strong Pig', as the disabled animal keeps its 30kgs of body suspended in midair, in Mengcheng, east China's Anhui province. The pig has become an internet sensation around China due to its ability to walk around balancing on its two front legs. TOPSHOTS CHINA OUT AFP PHOTO (Photo credit should read STR/AFP/Getty Images)

Another crazy case; but this one I was able to track down more about after reading the Reddit post here. This news image page says:
“This photo dated November 24, 2011 shows a Chinese farmer showing off his prize swine, which he named ‘Strong Pig’, as the disabled animal keeps its 30kgs of body suspended in midair, in Mengcheng, east China’s Anhui province. The pig has become an internet sensation around China due to its ability to walk around balancing on its two front legs. TOPSHOTS CHINA OUT AFP PHOTO (Photo credit should read STR/AFP/Getty Images)”

Bipedal pigs– two legs good again? I guess so. Well done, Strong Pig. Well done.

Bipedal ability in injured/deformed/spooked quadrupeds is not so unusual- in addition to trained macaques and rats that have been scientifically studied, there are plenty of examples out there on the internet of videos/GIFs of bipedal cats, dogs, and so on… Post your favourites below. Hooray for the marvelous plasticity of the locomotor system! As Pink Floyd famously wrote, “Any fool knows a dog needs a home, a shelter from bipedal pigs.” (or something like that)

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Hey, a short post here to say go check this new blog out! I love it. The first main post-introductory post is a dissection of a snow leopard, documenting a real vet case attempting to figure out why it died. The “Veterinary Forensics blog” is going cool places, and it is a kindred spirit to this blog. You might, as I do sometimes when walking into a veterinary pathology/postmortem facility, see surprising and rare stuff– like in this photo of urban foxes:

troop of foxes

 

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Today, to help thaw you poor Americans out of that Arctic Vortex, we have a guest post bringing the heat, by my PhD student Sophie Regnault! This relates to some old posts about rhinos, which are a mainstay here at the WIJF blog- I’ve posted a lot about the rhino extinction crisisfeet, skin, big and bigger bones, and more, but this is our first rhinoceros-focused, actual published scientific paper! Take it away, Sophie! (We’re planning a few more “guest” blog posts from my team, so enjoy it, folks!)

Almost a year ago to the day, I submitted my first paper written with John Hutchinson and Renate Weller at the RVC and it has (finally!) just been published. To celebrate, I have been allowed to temporarily hijack ‘What’s in John’s Freezer?’ for my first foray into the world of blogging. I started the paper back as an undergraduate veterinary student. It was my first experience of proper research, and so enjoyable that I’m now doing a PhD, studying sesamoid bones like the patella!

We wanted to discover more about the types of bony disease rhinos get in their feet, of which there isn’t much known. Rhinos, of course, are big, potentially dangerous animals – difficult enough to examine and doubly difficult to x-ray clearly because of their thick skin. Unlike diseases which are fairly easy to spot (like abscesses or splitting of the nails and footpad), there is hardly anything out there in the scientific literature on bony diseases in rhino feet. It’s no small issue, either. When your feet each need to support over 900kg (typical for a large white rhino), even a relatively minor problem can be a major pain. Progressing unseen under their tough hide, lesions in the bone can eventually become so serious than the only solution is euthanasia, but even mild conditions can have negative consequences. For example, foot problems in other animals are known to have knock-on effects on fertility, which would be a big deal for programs trying to breed these species in captivity.

Hidden treasures abound!

Hidden treasures abound! (Photos can be clicked to embiggen)

Data gathering was a blast. I got to travel to Cambridge, Oxford, and London during one of England’s better summers, and these beautiful old museums were letting me snoop around their skeleton collections. I’d been there often as a visitor, but it was anatomy-nerd-heaven to go behind the scenes at the Natural History Museum, and to be left alone with drawers and drawers of fantastic old bones. Some of the specimens hadn’t been touched for decades – at Cambridge University Museum of Zoology, we opened an old biscuit tin filled with the smallest rhinoceros foot bones, only to realise they were wrapped in perfectly preserved 1940’s wartime Britain newspaper.

rhino-feet (2)

rhino-feet (4)

rhino-feet (3)

Osteomyelitis… (3 clickable pics above) the toe’s probably not meant to come off like that!

In addition to my museum studies, I had another fun opportunity to do hands-on research.  John (of course!) had freezers full of rhino legs (looking disconcertingly like doner kebabs, but maybe that’s just me!), which we CT scanned to see the bones. Although it is a pretty standard imaging technique, at this point I had only just started my clinical studies at the vet hospital, and being able to flick through CT scans felt super badass. Most vet students just get to see some horse feet or dog/cat scans, at best.

Another osteomyelitis fracture, visible in a CT scan.

Another osteomyelitis fracture, visible in a CT scan reconstruction.

We expected to find diseases like osteoarthritis (a degenerative joint disease) and osteomyelitis (bone infection and inflammation). Both had previously been reported in rhinoceroses, although it was interesting that we saw three cases of osteomyelitis in only 27 rhinos, perhaps making it a fairly common complication. It’s an ugly-looking disease, and in two of the cases led to the fat, fluffy bones fracturing apart.

We also had several unexpected findings, like flakes of fractured bone, mild dislocations, tons of enthesiophytes (bone depositions at tendon/ligament attachments) and lots of holes in the bones (usually small, occasionally massive). For me, writing up some of these findings was cool and freaky paranoid in equal measures. They hadn’t been much described before, and we were unsure of their significance. Was it normal, or pathological? Were we interpreting it correctly? Discussions with John and Renate (often involving cake) were reassuring, as was the realisation that in science (unlike vet school at the time, where every question seemed to have a concrete answer) you can never be 100% sure of things. Our study has a few important limitations, but has addressed a gap in the field and found some neat new things. Six months into my PhD, I’m enjoying research more than ever, and hoping that this paper will be the first of many (though I promise I won’t keep nicking John’s blog for my own shameless self-promotion if that happens!  EDIT BY JOHN: Please do!).

Nasty osteoarthritis wearing away the bone at the joint surface. Most cases occurred in the most distal joint.

Nasty osteoarthritis wearing away the bone at the joint surface. Most cases occurred in the most distal joint.

Deep holes in some of the bones: infection, injury?

Deep holes in some of the bones: infection, injury?

The paper:
Sophie Regnault, Robert Hermes, Thomas Hildebrandt, John Hutchinson, and Renate Weller (2013) OSTEOPATHOLOGY IN THE FEET OF RHINOCEROSES: LESION TYPE AND DISTRIBUTION. Journal of Zoo and Wildlife Medicine: December 2013, Vol. 44, No. 4, pp. 918-927.

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Greetings, freezerinos! WIJF has been on hiatus this summer because my life has been freaking insane! ICVM conference with 3 talks (See earlier post), then grant deadlines, camping trip, packing and moving house, hiring new staff and inducting them into my team, breathing, and other activities (ranging from essential to trivial and/or infuriating) in addition to Actually Doing Some Science have been to blame. But WIJF is coming back like a bad rash! It cannot be defeated by bureaucracy, by my current lack of home internet connection, or even by the end of the universe! I have grand plans, muhahaha… This is just a teaser to give me some blog-writing momentum so I can finish some of those bigger posts sooner or later.

Stomach-Churning Rating: 3/10 — unless you are the goldfish in question, whose stomach has already been duly churned.

So I mentioned house-moving above, and we’ve finished that over the previous week. I had two ponds at my old home, full of >200 fish and (during breeding season; tweeted under #FrogCount) >200 frogs and toads, among other critters, documented on occasion in my Flickr photostream/set. Our new abode just has one pond, but a decent one at that, and we inherited some new fish that I am getting to know. Here is a peculiar goldfish, whose unusual anatomy inspired me to catch it, take a photo, and blog about it. Consider this:

The fish in question.

The fish in question. Not your standard sleek, hydrodynamic specimen of Carassius auratus auratus!

I’ve done some Googling and confirmed my suspicions that this is not a pregnant goldfish but is some other condition that we could loosely term as pathological. It has been feeding reasonably well and seems not too perturbed– as much as a fish’s degree of perturbation can be read from its behaviour– by its rotund morphology. It has some problems controlling its inertia in rolling and pitching, which makes for some amusing viewing as well as easy capture.

But what’s up with this fish? It does not have dropsy, a nasty condition fish get that leaves the scales in a “pinecone” sort of extruded orientation. It may have a gut infection or other air sac problem. I’m certainly not a vet and don’t know and fishy vets. But I wanted to share the photo to stimulate discussion of fishy fish physiognomy. What’s your diagnosis, doctor internet?

Also, if this fish takes a turn for the worse, it very well may end up in my freezer and thence into an internal anatomy WIJF post (“What’s In John’s Goldfish?”). We shall see. But I’ve grown fond of this unnamed fish (soliciting suggestions for names below in the Comments), so I’ll see how long I can keep it out of that situation.

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