Monday 28 November 2016

Decaffeinated

It’s 11:22pm Melbourne time but I am still up and typing this post while having a cup of decaffeinated coffee (with, of course, some ‘biko’ that I cooked yesterday).  I had actually given up coffee for five days after suffering from intermittent vertigo attacks for almost a week.  Thankfully, caffeine abstinence is effective for me— I haven’t had that annoying dizziness for four days now!



But my cravings for this moreish drink never stopped; every morning or even after lunch, my desire for my favourite skinny flat white with ‘half’ sugar has just been getting more intense.  This must be part of the caffeine withdrawal symptoms, though I don’t have that characteristic headache that my late dad, who was an avid coffee drinker, was describing to me when he was experiencing coffee thirst.


WHILE WE WERE CHATTING on FB Messenger this evening, my friend Anna, who is also a coffee drinker, suggested that I might be able to get rid of this vertigo while at the same time enjoying coffee.  But there’s a catch— I have to drink decaffeinated coffee!  Oh boy, I haven’t thought about it, so at 10pm I found myself driving to Coles supermarket to get some coffee.

While at Coles, I noticed a few staff down the aisle who had just cleared an entire rack to give way to a display of a wide variety of Christmas decors!  I stopped to browse along the aisle hoping that I could get something for my unit.  There were different sizes and colours of reindeer, glistening metal balls, artificial pine needles made into wreath, mistletoes, Santa’s hat, socks, candy canes and the list goes on...  Sadly, I didn’t find what I was looking for—the nativity scene poster or figurines!  Not even an ornamental star! 

I just can’t believe that a supermarket giant has never considered or thought about selling (or even displaying) a nativity scene poster when in fact Christmas is all about celebrating the birth of Jesus Christ.  

As I drove home, what I had was only a pot of poinsettia to adorn my coffee table with, and a small jar of decaffeinated coffee in my shopping bag.  While navigating through the deserted, dimly lit streets of Bendigo, I was thinking that I may be able to manage vertigo attacks by drinking coffee without caffeine, but I definitely couldn’t celebrate Christmas without Christ, can I?      


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Saturday 5 November 2016

The Coughing Pig

So, what do you really do at work?”  This is the most common question my Facebook ‘friends’ ask me when I see them face-to-face.

Contrary to what they’d usually see on their FB newsfeed, I don’t just simply drive to the airport, hop on a plane and visit places for work.  There are actually more than a thousand things happening behind those photographs of beautiful destinations, delicious and great-looking dishes as well as drinks (well, I only order apple or orange juice most of the time).  

Actually, my FB friends just can’t believe that in between my FB and Instagram postings, I’ve also been seriously mastering the art of visiting a piggery, speaking with the farm owner, manager, staff or their consulting veterinarian, listening and counting the pig’s cough, checking the herd’s poo, collecting some blood samples, cutting dead pigs up, closely examining their internal organs and saving some thumb-size tissue samples if necessary—keeping these in small, transparent jars containing formalin solution and submitting these to the laboratory… Then when the test results come in, interpreting and coming up with a comprehensive case report.

Of all the activities I’d enumerate, listening to and counting the pig’s cough has been the most interesting and exciting thing for my friends, so far!  Some curious ones would innocently ask if I’d auscultate a pig’s chest using a stethoscope like what their GP would do to them while being asked to deeply inhale and exhale when they or their kids are examined for respiratory issues.  I’d politely reply that because my patients love to squeal when manually handled, and modern-day pig farming involves hundreds or thousands of pigs on one site, herd examination is more appropriate—thus attentively listening to the pigs’ cough—whether it’s dry or moist, long or short episode, and at the same time counting them are equally important.


IN THE PHILIPPINES, there’s this dish with Spanish origin called bopis which is made out of boiled pork lungs and heart—patiently cut into bits and pieces and sautéed in onion, tomatoes and chilies.  Unlike most of my friends, I, honestly, don’t like eating bopis and my repulsion from this Filipino-favourite pulutan (a dish that is slowly eaten while enjoying some bottles of beer or shots of spirits) started even before I became a veterinary student.  I just can’t handle chewing a spoonful of this smooth, soft and rubbery dish with those tiny, cartilaginous prickles from the pieces of offal tickling my tongue.

http://pulmonaryfibrosisresearch.org/nsip-2
Only when I enrolled in vet school and started studying veterinary anatomy did I learn that those rubbery portions that I felt when I chewed a spoonful of bopis were part of the functional tissues of the lungs that, when examined under the microscope, are actually tiny sacs made up or lined with flat and cuboidal cells.  These are called alveoli, which are perfectly known as air sacs because this is exactly where blood oxygen and carbon dioxide exchange occurs!

Oxygen, the life-supporting gas in animals, is actually taken in by the pig as it inhales air through its nostril.  The air will then pass through the left and right nasal passages—each of these contains lower and upper curled bones called turbinates.  Dr. Lumbao, my Veterinary Anatomy lecturer said they’re like turbines, while Muirhead and Alexander in their book Managing Pig Health described these turbinates as four hair curlers strategically placed inside the pig’s nose; these nasal ‘scrolls’ warm the inhaled air and at the same time creates air turbulence as the pig breathes.  As a result, larger particles (such as dust) are thrown out and attached to the mucous lining the airways.

https://www.pig333.com/pathology-atlas/rhinitis-and-turbinate-atrophy_94
Toxins produced by bacteria called Pasterurella multocida in synergy with the Bordetella bronchiseptica can lead to failure of the turbinate-bone growth and at the same time promoting its destruction—in the end the pigs’ snout will look distorted, affected pigs may be heard sneezing—a disease called atrophic rhinitis

The pigs’ airway, like other mammals, starts off as a series of 30 cartilaginous rings making up a windpipe or trachea.  This tube gradually branches down into three smaller tubes (bronchi)—actually unique for pigs because other domestic farm animals only have two.  These tubes continue to branch in right angles until it gets very tiny and microscopic pipes (bronchioles) that terminate into each of the air sacs.  These cartilaginous airways, I’ve learned, are the spikes that actually tickled my tongue the first and last time I had some bopis!

https://www.pig333.com/practical-experiences/evaluation-of-pneumonia-lesions-at-abattoir-with-lung-score-assessment_10946/

The airways are lined with mucous membrane where there are microscopic structures that resemble a pedantic display of 'goblets in a cupboard' thus aptly called ‘goblet cells’.  These cells produce mucous which, with the help of another microscopic feature of the airway—the hair-like projections (cilia) moving in a wavy manner, helps carry the nasty particles out from the lungs to the throat.  This is called 'mucociliary escalation'.

https://www.studyblue.com/notes/note/n/chapter-4-the-tissue-level-of-organization/deck/5452448


A PIG’S COUGH IS A DEFENSIVE REFLEX, considered protective as it aims to clear the lungs and the airways from irritants and foreign particles including harmful microbes that cause diseases.  Unfortunately however, coughing is also an excellent way of spreading pig respiratory diseases especially when the animals at risk and with varying status of immunity are sharing the same air space.    

photos from: www.carrsconsulting.com and http://www.merckvetmanual.com/

Viruses are too small; they can survive the mucociliary escalation and still reach and invade the pigs’ air sacs.  

Mycoplasma hyopneumoniae (Mhyo), a pig respiratory pathogen, loves to colonise and infect those tiny projections (cilia) lining the airways— so these will eventually stop moving, and start clumping together.  The first branch of the windpipe that's closest to the external environment the extra-bronchus that is unique in pigs supplies the right cranial lung lobe which is most commonly affected by this disease initially (photo above).
  
http://www.allwidewallpapers.com/swine-disease-prrs/
I knew what you're thinking, the pig’s immune system naturally secretes antibodies against Mhyo [Em-hayO] but these supposedly counteracting proteins can’t reach their ‘targets’ that are comfortably sitting on top of the clumped respiratory cilia.  So Mhyo will progressively multiply, white blood cells that serve as soldiers turn feeble and can’t keep up, and the mucosal lining will eventually peel off leaving the pigs’ airway devoid of goblet cells.  Loss of goblet cells simply means loss of mucous production resulting to a pig suffering from a dry, non-productive cough with very long episodes!      


SO WHENEVER OUR competent technical representatives and I are doing our job in the pig sheds or shelters, we’d wake the pigs up, continuously disturb them to stimulate them to cough.  With our tally counter and stop watches on, we’d then patiently listen to and count the coughing bouts within nine minutes.  Based on previous studies that checked the DNA of the microbes and the specific antibody level in a herd, a hundred pigs that cough twenty-four times or more in nine minutes would simply mean that a herd is unhealthy.

Sometimes it could get a bit complicated, as Mhyo is a primary invader—the damaged pig airways are now open to secondary respiratory pathogens!  Glasser’s disease, mostly occurring in weaners, is caused by a bug that damages the walls of the blood vessels in the lungs and other vital organs.  'Leaky' blood vessels result in a chest cavity containing fluids and appear like they're covered in feta cheese or spider web.  APP (Actinobacillus pleuropneumoniae) infection can also occur, mostly in grower or finisher pigs, and the toxins produced by this bug shatter the red blood cells, and create injury to the smooth covering (or pleura) that lines the chest cavity and the lungs.  The clinical signs could start as quick as 12 hrs after the disease agents have been inhaled by the pig... and with the characteristic feature of the condition where parts of the lungs are attached to the rib cage, this pleuropneumonia is obviously very painful— the pigs adopt a dog-sitting position while gasping for air and can only manage to cough once or twice per episode!  Microscopically, the air sacs will then be filled and densely packed with white blood cells; so to sum it all up these are basically the reasons why a pig's lungs are dark, firm and swollen, uncollapsed, attached to the rib cage, and most of the time the cut surface is oozing with blood upon examination!    

Yes, pig veterinarians, unlike companion animal and equine vets, or even unlike physicians, are highly privileged to be able to see the changes secondary to disease (or lesions) in their patients' internal organs by cutting up a representative pig—either dead or alive then euthanised—from a sick herd.  We can conveniently examine their 'plucks' while on the field or even in the abattoirs—just like what the vets and meat inspectors in the slaughter lines would routinely do as part of their post-mortem check to ensure that meat, including edible offal are fit for human consumption. 


BY VISITING THE herd, listening to their cough, looking at the lung lesions, and interpreting the lab test results, swine veterinarians can formulate solutions and give recommendations which, I believe, can provide assistance in promoting pig health and in producing more ‘pork’ for Australia and the world. 

…and when I say ‘pork’ it includes a healthy lung, as well.  That would mean more pork lungs for the bopis recipe of my friends, too!


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