leukocytes

Wet or sticky? What your discharge is telling you

Tracking your cervical fluid can give you clues about what hormonal changes and events are happening in your body right now. Understanding your own patterns can help you to know when ovulation has occurred, and when you might be able to skip the lube. Getting to know your fluid can also allow you to recognize when something may be off — from an infection or hormonal issue, for example.

The ebbs and flows of cervical fluid

The cervix is the passageway between your lower and upper reproductive tract. It has glands in and around it which produce fluid. The quality, consistency, and volume of this fluid changes along with your cycle. The pattern and experience of these changes is different for everyone but cervical fluid tends to follow a consistent cyclical pattern. It changes in quality, quantity and function. This happens in response to your changing hormones. At different times, cervical fluid acts to facilitate or prevent sperm from moving past your cervix (1). It also contains antibodies, and helps to keep out unhealthy bacteria and viruses (2).

A fluid timeline

1. Menstruation: Start of cycle

On day one of the cycle, both estrogen and progesterone are low. The cervix is not likely producing much fluid, but you won’t be able to tell, as it’s mixed in with blood, endometrial tissue and dissolved remnants of a disintegrated egg.

2. Dry/Sticky: Early-to-mid follicular phase

In the early follicular phase, estrogen starts to rise (it’s produced by your follicles as they grow). This rising estrogen leads to increased production of fluid. You probably won’t notice much of it in the days after your period — these are “dry” fluid days for many people — some might notice “sticky” fluid. Typically, cervical fluid first becomes noticeable around the middle of the follicular phase (day ~7 in a 28 day cycle) (3).

3. Creamy: Mid-to-late follicular phase

It may start sticky, but as estrogen and water content rises fluid tends to become ‘creamy,’ cloudy (not clear) and whitish or yellowish. Research has shown sperm can start to swim through cervical fluid on about day ~9 of a 28 day cycle (1).

4. Egg White/Wet: Late follicular phase/mid-cycle

As ovulation approaches, more cervical fluid is produced. Fluid becomes stretchier, clearer and more wet and slippery — like an raw egg white. This fluid tends to “peak” about 1–2 days before ovulation, when estrogen is highest (3). Around that time fluid can often be stretched several inches between your finger and thumb. For others it may be more watery. The amount of peak fluid the body produces is different for everyone, but it can be up to 20x more in some cases (4). This fluid is about 95% water in weight, and 5% solids (electrolytes, organic compounds and soluble proteins)(2). If you’re having sex and using lube, you may notice you need less around this time. *Note that the presence of fertile-type cervical fluid alone cannot confirm ovulation — it’s not accurate enough on its own to use for a FAM method or pregnancy prevention.

5. Dry/Sticky: Luteal phase

As soon as ovulation is over, fluid changes — even before you notice a visual change, it will already have become more fibrous and less penetrable for sperm (1). In the day or two after ovulation (the first days of the luteal phase), cervical fluid lessens and becomes much thicker. Progesterone, the dominant hormone in this phase, acts to inhibit the secretion of fluid from the epithelial cells (1). You may notice little fluid, or it may be sticky (or something else unique to you).

Note that every body is unique — these changes may show up differently for you, or you may experience or interpret them in a different way.

To swim or stick — the changing role of fluid

Keep reading

Quick Sheet: Hormones Produced in the endocrine system

Gland

    • Hormone(s) Produced
      • Primary Function(s)

Hypothalamus

    • Regulatory hormones
      • Control release of hormones from anterior pituitary

Hypothalamus (released from posterior pituitary)

  • Antidiuretic hormone (ADH)
    • Stimulates both the kidneys to decrease urine output and thirst center to increase fluid intake when the body is dehydrated; in high doses, ADH is a vasoconstrictor (thus, it is also called vasopressin)
  • Oxytocin
    • Contraction of smooth muscle of uterus; ejection of milk; increases feelings of emotional bonding between individuals

Pituitary gland (anterior)

  • Thyroid-stimulating hormone
      • Stimulates thyroid gland to release thyroid hormone
  • Prolactin (PRL)
      • Regulates mammary gland growth and breast milk production in females; may increase secretion of testosterone in males
  • Follicle-stimulating hormone (FSH)
      • Controls development of both oocyte and ovarian follicle (spherical structure that houses an oocyte) within ovaries; controls development of sperm within testes
  • Luteinizing hormone (LH)
      • Induces ovulation of secondary oocyte from the ovarian follicle
      • Controls testosterone synthesis within testes
  • Adrenocorticotropic hormone (ACTH)
      • Stimulates adrenal cortex to release corticosteroids (e.g., cortisol)
  • Growth hormone (GH)
    • Release of insulin-like growth factors (IGFs) from liver; GH and IGFs function synergistically to induce growth

Pineal gland

  • Melatonin
    • Helps regulate the body’s circadian rhythms (biological clock); functions in sexual maturation

Thyroid gland

  • Thyroid hormones:
  • T3 (triiodothyronine) and
  • T4 (tetraiodothyronine or thyroxine)
    • Increase metabolic rate of all cells; increase heat production (calorigenic effect)
  • Calcitonin
    • Decreases blood calcium levels; most significant in children

Parathyroid glands

  • Parathyroid hormone (PTH)
    • Increases blood calcium levels by stimulating both release of calcium from bone tissue and decrease loss of calcium in urine; causes formation of calcitriol hormone (a hormone that increases calcium absorption from small intestine)

Thymus

  • Thymosin, thymulin, thymopoietin
    • Maturation of T-lymphocytes (a type of white blood cell or leukocyte)

Adrenal cortex

  • Mineralocorticoids (e.g., aldosterone)
    • Regulate blood Na+ and K+ levels by decreasing the Na+ and increasing the K+ excreted in urine
  • Glucocorticoids (e.g., cortisol)
    • Participate in the stress response; increase nutrients (e.g., glucose) that are available in the blood
  • Gonadocorticoids (e.g., dehydroepiandrosterone [DHEA])
    • Stimulate maturation and functioning of reproductive system

Adrenal medulla

  • Epinephrine (EPI) and norepinephrine (NE)
    • Prolong effects of the sympathetic division of the autonomic nervous system

Pancreas

  • Insulin
    • Decreases blood glucose levels
  • Glucagon
    • Increases blood glucose levels

Testes (gonads)

  • Testosterone
    • Stimulates maturation and function of male reproductive system
  • Inhibin
    • Inhibits release of follicle-stimulating hormone (FSH) from anterior pituitary

Ovaries (gonads)

  • Estrogen and progesterone
    • Stimulates maturation and function of female reproductive system
  • Inhibin
    • Inhibits release of follicle-stimulating hormone (FSH) from anterior pituitary

Heart

  • Atrial natriuretic peptide (ANP)
    • Functions primarily to decrease blood pressure by stimulating both the kidneys to increase urine output and the blood vessels to dilate

Kidneys

  • Erythropoietin (EPO)
    • Increases production of red blood cells (erythrocytes)

Liver

  • Angiotensinogen
    • Converted by enzymes released from the kidney and within the inner lining of blood vessels to angiotensin II; increases blood pressure by causing vasoconstriction and decreasing urine output; stimulates thirst center
  • Insulin-like growth factors (IGFs)
    • Functions synergistically with growth hormone to regulate growth
  • Erythropoietin (EPO)
    • Increases production of red blood cells (erythrocytes); note that kidneys are the major producers of EPO

Stomach

  • Gastrin
    • Facilitates digestion within stomach

Small intestine

  • Secretin
    • Regulates digestion within small intestine by helping to maintain normal pH within small intestine
  • Cholecystokinin (CCK)
    • Regulates digestion within small intestine by facilitating digestion of nutrients within small intestine

Skin

  • Vitamin D3
    • Converted by enzymes of liver and kidney to calcitriol; functions synergistically with PTH and increases calcium absorption from small intestine

Adipose connective tissue

  • Leptin
    • Helps regulate food intake

Placenta

  • Estrogen and progesterone
    • Stimulates development of fetus; stimulates physical changes within mother associated with pregnancy including those in the uterus and mammary glands
youtube
  • blood 血液 けつえき or 
  • blood transfusion 輸血 ゆけつ
  • blood donation 献血 けんけつ
  • whole blood 全血 ぜんけつ
  • red cell or erythrocyte 赤血球 せっけっきゅう
  • platelet 血小板 けっしょうばん
  • plasma 血漿 けっしょう or プラズマ
  • cryoprecipitate 寒冷沈降物 かんれいちんこうぶつ or クリオプレシピテート
  • centrifuge (noun) 遠心機 えんしんき
  • centrifuge (verb) 遠心する えんしんする
  • white cell or leukocyte 白血球 はっけっきゅう
  • electrolyte 電解質 でんかいしつ
  • plasma protein 血漿タンパク質 けっしょうたんぱくしつ
  • albumin アルブミン
  • alpha globulin αグロブリン あるふぁぐろぶりん
  • beta globulin βグロブリン べーたぐろぶりん
  • osmotic pressure 浸透圧 しんとうあつ
  • gamma globulin γグロブリン がんまぐろぶりん
  • fibrinogen フィブリノーゲン or フィブリノゲン or 線維素原 せんいそげん
  • haemostasis 止血 しけつ or うっ血 うっけつ
  • collagen fibre コラーゲン線維 こらーげんせんい or 膠原線維 こうげんせんい
  • clot 血餅 けっぺい
  • coagulation 凝固 ぎょうこ
  • fibrin フィブリン or 線維素 せんいそ
  • haemophilia 血友病
  • blood type 血液型 けつえきがた
  • glycoprotein 糖タンパク質 とうたんぱくしつ or グリコプロテイン
  • antigen 抗原 こうげん
  • agglutinogen 凝集原 ぎょうしゅうげん
  • universal recipient 万能受血者  ばんのうじゅけつしゃ
  • universal donor 万能ドナー ばんのうどなー or 万能給血者 ばんのうきゅうけつしゃ
  • Rhesus blood group Rh式血液型 あーるえっちしきけつえきがた
  • Rh positive Rh抗体陽性 あーるえっちこうたいようせい or Rh陽性 あーるえっちようせい or Rhプラス 
  • Rh negative Rh抗体陰性 あーるえっちこうたいいんせい or Rh陰性 あーるえっちいんせい or Rhマイナス
Remedy pt.2

Tags: @the-shewxlf, @megant22, @sexywolfsfordays, @houseofrahl, @sterek-basically, @kittycatgirlmaddie, @misshinehou, @unbreakablevoices, @champagneblues, @dallysgreasergirl, @juliaspnlover, @cineyou, @lipstickstainsandwerewolfchains, @fallenangel-13x, @urwarriorangel, @bless-my-demons, @lunaskyhunter, @arkhamirwin, @fangirlnerd101, @m-a-t-91​, @meanwhilesmiley​, @edithambroreigns​, @totallovelesson@kxttykatmichael

Word count: 3605

Author’s note: I’m shamelessly taking advantage of the fact that I can now insert some good ol’ House gifs in my posts. Also, authentically depicting House’s character is way harder than I initially thought, but hey – it’s my first time with him and I’m trying :) Aaaand prepare for some (a lot of) feels! Enjoy!

Betas: @i-am-a-misguided-misfit, @lipstickstainsandwerewolfchains, @mixed-up-fangirl, @kittycatgirlmaddie, @fallenangel-13x, @the-shewxlf, @b-chocolatelover, @from2016, @safiac, @random-fandom-fangirl2112

Masterpost

Your name: submit What is this?


“A shot man blacked out? You called me back to the hospital for this, idiot? There is no mystery,” House points out to me in a harsh, chiding tone. Clearly he’s moody because he’s back to work, and as such, he doesn’t fail to humiliate me in front of the entire Team for God knows how many time. But it’s fine; I’m getting used to it, and I’m usually not the only victim to his stinging snark.

“He doesn’t remember how it happened. After leaving the message I asked him further questions and it turned out that he hardly ever gets shot,” I say. House frowns at me, while his hand is rubbing his right leg instinctively, apparently without his conscious consent to it. A few seconds later, he averts his mesmerising blue eyes from me only to dart it at the dark grey rug, deep in thought.

“That doesn’t prove anything,” he states firmly, but the heat has now subsided from his tone. “Every cop gets shot from time to time.”

“Would it have been the better choice to leave him there just like that?” I snap. “I thought our priority was healing and making sure no one has further latent sicknesses by investigating until we’re convinced with one out of the many choices,” I retort, crossing my arms over my chest and giving House a meaningful look. When he glances at me, I hold gazes with him for a while before giving in to the temptation to lift an eyebrow at him. House is moving his lips and making faces in the process, while thinking through the options he has. No one speaks; we are all waiting for the boss’ decision.

“Alright. What’s your theory?”

My face lights up at his question—this means he officially accepted to take the officer’s case. I try to stifle my giddiness as I launch into my explanation, “It obviously has something to do with his brain. Most likely it was caused by Multiple Sclerosis or a tumor in his brain. I was planning to give him a CT and lumbar puncture.” House nods okay, and motions in the general direction of the glass door with his cane.

“Nice. Good for us, not good for the patient. Go ahead,” he says. I’m standing before he could even finish his sentence, and after closing the officer’s file on the table and picking it up, I head to the door with the folder clutched to my chest. However, before I’d leave the office, House warns, “If you’re wrong, you’re fired.”

The travel in the elevator seems suffocating after House’s threat. Cuddy has told him he’s not in the position to decide whether I stay or go, but I know him, and I’m definitely convinced that if he doesn’t want me to work on a case, he can sabotage my attempts to take part in it in any way.

Just to make sure, I quickly check the officer’s name once more when I arrive to the floor he’s housed on, then walk to his room, weaving my way through the few visitors and haphazard doctors. Upon entering, the man looks at me, and I give him a small smile in return, hoping he isn’t so worked up like he was yesterday.

“Derek Hale?” I ask politely, approaching the bed he’s laying on, now dressed in just a flimsy pale green outfit that the hospital’s patients are given. My eyes take a momentary glance at the monitor to see his ECG diagram.

“That’s me,” he answers. His voice conveys no distress, no anger, just resignation, like he’s surrendered to medicine. His eyes slip down to my ID then, tilting his head just the tiniest bit to align it with the angle of the card, eyes squinting to try and read my name.

“y/n Lockwood,” I introduce myself, for some reason feeling tempted to stick my hand out for him to shake. This is how it’s appropriate, right? He takes my hand in his—I’ve always known my hands are small, but the way his broad palm and long fingers wrap around it, makes it look even more insignificant in size. He gives me a firm squeeze, which I return, then we let go of each other. “I need to do a few tests on you,” I announce then, picking up his chart from the end of the bed, and pulling the pen out of the pocket over my chest, clicking it and writing on his paper the tests that are going to be done on him.

“What tests?” he asks curtly, crossing his impressively muscled arms in subconscious defence. I hang the chart back on the bed before walking back to stand next to him. “Just a CT and a lumbar puncture,” I answer. “No worries, the latter sounds worse than it actually is.”

“I’m not a vulnerable eggshell, you know,” Derek comments. For a second, I think he was offended by my statement, think that he took it personally, but the way his eyes twinkle slyly, I realise he’s just asserting his masculinity a little sarcastically. Once more, I reach out for him to help him move, but he dismisses it with a shake of his head. Throwing the blanket to the side, and turning to let his legs hang from the side of the bed, he adds, “I was just shot. I can walk by myself.”

I nod slowly, suddenly feeling embarrassed for some reason. My voice is a near squeak when I say, “Right. Follow me then, please.”

I wait while he puts his robe on to cover more of his body—the green outfit is short, like the patient is merely wearing an oversized T-shirt, and the V-neck of it leaves nothing to my imagination regarding Derek’s pectorals, collar bones and strong shoulders. He slips into his slippers, then we take off to the CT machine first.

. o O o .

“There is no tumor in his brain,” I inform the Team about the results of the CT. House gives me a look and narrows his eyes at me suspiciously. The only reason this makes me feel worse than usual is because this time he isn’t the only one standing in front of the rest of the Team—I’m there beside him, too. To relieve the tension a bit, I hold on to the folder in my hands for dear life, fingers gripping it just a touch stronger than a moment ago.

“You’re too calm,” he assesses. “Too calm for someone who was told could be fired if not everything goes smoothly. So I assume there’s more to it.”

I do my best to tamper down the smugness that’s bubbling up in my throat as I hand him over the paper with the results of the lumbar puncture. “As you can see, the amount of his proteins and leukocytes are increased.”

Chase’s head perks up from where he was playing with his pen until now, “That means encephalitis.”

“Told you it was something,” I say pointedly to House, who just looks at me in return. I suppose the knowing smirk on my face wasn’t overlooked by his insightful blue eyes, because he quips, “Come on, don’t be so happy about someone having an encephalitis. What kind of doctor are you? Sociopathic?”

I’m fast to react. “What if I told you I was?” I ask challengingly.

“The million dollar question is, what would you do upon hearing my answer, in case you’re actually a sociopath.”

“How about letting me know your answer and see where it goes?” I offer. The lightest, vaguest hint of a smile on his thin lips lights up House’s worn-out features. He tells me, “Go and give him antivirals. Also, make a test to find out if he has syphilis and check his body for potential marks of a sting from a tick.”

I don’t have to be told twice. I’m already worried about our cop just fine—I’m aware this is going against House’s number two rule here, the ‘don’t get attached to the patient’ rule. The uttermost policy is ‘everybody lies’.

I don’t find Derek in his room, so I have to go look for him. There was a case a couple months ago where we had to play hide and seek with the patient, and it was no fun for us; House was so livid, the Team was nearly snagged for someone getting fired. As for now, I couldn’t tell if my current frustration or my general worry for him is stronger at the moment—I know that if another blackout occurs, I would have to be there immediately. Besides, anything could happen to him while the time’s ticking by with me just searching for him everywhere frantically, even without him fainting.

Thankfully, it doesn’t take me more than a few minutes to find him—sitting on a couch next to the artificial waterfall, a woman on his side, the two of them holding hands. She’s wearing a black skirt suit with matching high-heels, her dark hair put in a neat ballerina bun, giving her a professional appearance. For some reason, it makes me feel utterly small, like she reminds me of the fact that I could never be like her; so strong, so attractive, so stylish. No, I’m just here in my jeans, my flat shoes and a casual shirt, all this adorned by my white labcoat and the ponytail I put my hair in this morning. I guess the clichéd roles—the queen bee and the nerd—will stick to the people for their entire lives. Inhaling deeply, I force a smile on my face before taking off towards them, but a part of Derek’s sentence is enough to stop me in my tracks.

“I’m afraid I’ll lose my job,” comes his quiet voice. The woman strokes his upper arm soothingly, then settles her hand on his shoulder and gives it an encouraging squeeze. Her other hand is still resting in her lap, palm facing up, welcoming Derek’s in it to provide him silent comfort.

“I’m sure it’s nothing serious,” she assures softly. Contrary to what it does to Derek—calming him down and giving him hope—it unsettles me to no end. I’m just about to inform him about the very serious illness that could explain his condition, and now this burden feels even more unbearable than before. “You’ll be just fine. I’m sure in two days you’re going to be chasing criminals again.” No one should be punished with having to tell someone their life is in jeopardy, or how long they have before their disease takes over. No one signs up for shattering dreams, but for healing and saving lives—saving their dreams. My body feels like a cage to me, from which I can’t escape before I’m done with my duty. With the lump huger in my throat, I force my legs to take me to where they are sitting.

“Mr. Hale,” I greet him. My voice comes out as a squeak, despite how hard I’m trying to prevent that. But seeing how his face lights up with the hope the woman gave him? It makes me want to cry, because I know I can’t live up to those expectations.

“Dr. Lockwood,” he nods to me, then motions towards the elegant woman on his side. “This is my elder sister, Laura.” I shake hands with her, but the smile I give her is tight, and I’m sure she noticed it, because her brow twitches shallowly. The grip Laura gives is firm, giving it away to me that she’s a determined person who knows what she wants, and isn’t afraid to go for it.

“Did you figure out anything?” she asks, taking her hand back. I’m taken aback by that question—usually, people start with something like, ‘he’s alright, right?’. Clearly she craves effectiveness and results, not beating around the bush. I have to swallow against the dryness in my mouth before I could speak.

“Yes,” I answer. The siblings’ attention is availably doubled at that, and my heart twists painfully in my chest, knowing that what I’m about to say is not what they are expecting to be told. This is why, I give them a meek warning beforehand, “But you won’t be happy with the results.” My voice is ginger, but tight. Even without my eyes dropping lower than their eyes, I can clearly catch the way Laura’s hand closes tighter around Derek’s. I struggle to go on, “According to the lumbar puncture, Mr. Hale’s leukocyte and protein number is higher than normal.”

“What does that mean?” Laura asks instead of Derek, tone calm and measured, but I can sense the underlying vibrating anxiousness. As soon as the words left my mouth, Derek tilted his head forward to look at the ground instead of me, like he can’t bear seeing me. It feels like a punch to the gut. I close my eyes apologetically for a moment, then explain hoarsely, “It means that Mr. Hale has encephalitis.”

This is the point where Laura loses her perfect mask of the sophisticated woman she normally shows to the world—it perishes silently, in the form of a fat teardrop escaping from her eye and rolling down her cheek. On the other hand, Derek handles it exactly how a strong man would do; he even has the capacity to wrap an arm around Laura and pull her close to him to comfort her, even though it should be the other way around. Laura, though, refuses it for being too proud, already wiping away the stray drop from her face, like it’s never made it there. Derek’s face is expressionless, and the fact he isn’t looking at me anymore stabs me in the chest. His green gaze is fixed on Laura, and nothing else.

I decide to leave them, assuming it’s the best thing I could do, but only after muttering an apology, despite I know this isn’t my fault. I shouldn’t let it get to me, and lately I’ve been getting better at it, but this single occasion ruined all my past successes. I go for the medicine I have to give Derek, then to his room to find a nurse undoing the covers on Derek’s bed.

“Erica, what are you doing?” I ask, putting the antiviral on the nightstand beside the bed. She turns to look at me with a smile.

“Changing his covers, if it wasn’t obvious already,” she quips. I can’t force a grin even for a second after what happened between me and the Hale siblings. Erica doesn’t fail to notice my unease, and she inquires, brows furrowing, “Is something wrong?” Setting down the blanket that’s halfway to being freed, she comes up to me, touching my upper arm gently.

“No, nothing,” I lie, asking the first thing that comes to my mind just to change the subject as soon as possible. “Why are you changing those?” I nod in the general direction of the mess Erica has made. She sighs and goes back to resume her work.

“He’s been going a lot to the toilet. Last time he couldn’t make it there, though, so his vomit ended up on the bed,” she replies, grimacing at the story she shared with me. Clearly the stink is bothering her.

I acknowledge her answer with a nod, then I sit down at the bed, now lacking the sheets, to wait for Derek to return, regardless of the aversion I have for that.

. o O o .

In the end, it takes Derek almost an hour to migrate back and to take his place at his now clear, freshly covered bed. He halts at the door upon noticing me, and just watches me with an expressionless stare. The stretching silence is deafening me, especially with the glass walls shutting out every noise, but this time I can’t bring myself to break it. Instead, I opt to do my job to give myself something else to focus on; I place the plastic pocket of antiviral on the hook above the bed and, after Derek laid down, I inject the other end in his vein. To my surprise and relief, he speaks up.

“How bad is my sickness?” I look at him. Derek’s gaze is darted firmly at the ceiling, not at me, making it clear to me he’s still uncomfortable with seeing me. It stings, but at least he’s now talking—I should appreciate all the small victories. His face is still devoid of emotions.

“We’ll have to figure that out with an MRI later, but right now, the priority is to find out what caused the illness in the first place.”

Derek acknowledges my answer with a nod, then closes his eyes—I get the message loud and clear; he’s telling me without words to leave him alone now. I don’t have a reason to protest, so I consent.

. o O o .

I arrive to the restaurant twenty minutes late. Rushing in, I scan the place, searching for my dinner partners. I spot them in one of the hidden corners, at a dimply lit box with a table and four chairs around it. I stride over to them with a wide grin, greeting them and taking my coat off to lay it on the back of the chair.

“Hey, y/n, long time no see.”

“Scott,” I nod, hugging him briefly before wrapping Allison up in my embrace, too. “Sorry for being late,” I say genuinely, sitting down. “My boss likes to give his Team all the work.”

“We know; everyone knows House’s reputation,” Scott waves it off with a hand.

“How are you?” I ask then, turning to Allison. She beams at me with a shining smile.

“The baby’s due on 14th February,” she announces giddily. “I’m perfectly fine, and so is my baby boy. Only two more months to go,” she drops her eyes at her extended belly, reaching up to rub it fondly, delicately. I chuckle.

“So he’s going to be a Valentine’s boy, huh. How do you know if the baby’s going to be a boy, though? You had it checked?” I ask.

“We don’t exactly know. Allison doesn’t want to check it, wants to wait until he’s born, but she’s convinced he’s a boy,” Scott explains.

“That’s cute,” I coo. A waiter comes to me to take my order, and after the brief chat I have with him, I devote my attention to my friends again.

“And how’s your internship at Princeton?” Allison asks. I shrug; honestly I really don’t wish to talk about that right now—I’d just ruin the mood with it, and that’s the last thing I want. I give them a subtle hint, “I don’t think that’s a fitting subject at the moment.” Scott winces and gives me a worried look.

“Did something happen?” I shake my head no, and pick up my napkin to busy myself with something—also to give myself an excuse not to have to look into either of their eyes.

“No,” I respond a little too late for the other two to believe it. Not that the timing would have mattered anyway; they know me all too well since high school.

“Tell us about it,” Allison urges.

“I really don’t think this is the appropriate time to –”

“y/n, don’t expect me to leave my other best friend tonight without talking this over with her,” Scott demands, a serious gleam in his deep, chestnut brown eyes. “Your face gives you away easily, you know, and I can see it’s something that deeply affected you.”

“Oh yeah, how Stiles and Lydia are doing?” I ask, desperately trying to lead the conversation in another direction, shamelessly taking the chance to talk about the other best friend Scott has without a second thought. While Scott is already opening his mouth to tell me about the other couple, Allison cuts in with a sharp, “y/n”.

“Okay, okay, got it,” I cry out, throwing my hands up in surrender. “So we have a new case since yesterday, and after testing the patient, it turned out he has encephalitis. And he’s a cop.” I take a deep breath before going on, “I had to tell him while his elder sister was there, too.”

“Poor baby,” Allison coos, reaching over the table to stroke my hand soothingly. I’m not surprised by her being so touchy-feely, nor the nickname she addressed me by—I blame it on the raging hormones in her body; thanks to them, she’s way more sensitive to emotional distress than an ordinary person, who isn’t carrying a blooming life under their heart. I manage to smile at her, albeit it doesn’t quite reach my eyes.

“We’re staying here in New Jersey until the baby’s born,” Scott chimes in to whisk the tension away, and the news don’t fail to light up my face.

“Seriously?” I ask, eyes excitedly commuting between the future parents, who just nod at the same time to me with a smile on their faces.

“Yes. And I’m going to attend controls at Princeton-Plainsboro,” Allison says proudly.

“Oh my God,” I chuckle, leaning back on the chair to rest against the back of it. “Give me a call whenever you’re there.”

“Definitely,” she promises. Scott places his hand on her belly to stroke it affectionately. I have never seen such an expression on Scott’s face before—it’s a mixture of responsibility-consciousness, fatherly protection, undying love and slight possessiveness. But above all, it’s meek.

Scott is now officially a grown-up man.

anonymous asked:

What are your thoughts on Irish Setters? (Do you see many over there in Oz? I live in Ireland, so obviously they're pretty popular, I kinda wonder if they're as common elsewhere). As for the question tax, came for the vet posts, stayed for the dog breed analysis!

We don’t see very many Irish Setters down here in Australia, but they’re certainly worth talking about because although they’re uncommon they do have a few notable quirks.

But first, as usual, please note the disclaimer. These posts are about the breed from a veterinary viewpoint as seen in clinical practice, i.e. the problems we are faced with. It’s not the be-all and end-all of the breed and is not to make a judgement about whether the breed is right for you. If you are asking for an opinion about these animals in a veterinary setting, that is what you will get. It’s not going to be all sunshine and cupcakes, and is not intended as a personal insult against your favorite breed. This is general advice for what is common, often with a scientific consensus but sometimes based on personal experiences, and is not a guarantee of what your dog is going to encounter in their life. 

(Image Source  RX-Guru )

For all the noise that gets made about ‘grain-free’ diets, the Irish Setter is the only breed where it might really matter. Irish Setters are the only breed, to my knowledge, which have actually been diagnosed with Celiac Disease, or at least something very similar to it. The symptoms are not as severe as in humans (although admittedly these dogs don’t live as long as humans do, so are only exposed to gluten for 10-15 years instead of 20+), so sometimes it’s called Gluten-sensitive enteropathy. Either way, it’s responsive to dietary control.

Hip Dysplasia is present in the breed, and these dogs are actually on the large side, which is easy to forget looking at pictures. They also get Progressive Retinal Atrophy and breeding dogs should be screened for both.

In terms of congenital conditions, these dogs should have neat eyes, but they can suffer from Entropion which needs surgical correction.

The breed is also over-represented among dogs with Patent Ductus Ateriosis, which is a unfortunate congenital heart defect where the aorta and pulmonary artery connect. It can be treated with heart surgery on an implant, but us obviously not desirable.

These dogs are deep chested enough to get Gastric Dilatation Volvulus, where the stomach twists upon itself, cutting off blood supply and requiring either emergency surgery or death.

The breed has a reputation for various cancers, including Osteosarcoma, and therefore delayed desexing may be of benefit in this breed. I haven’t seen enough of them to say whether other particular types of cancers are more common than others.

The breed must have an interesting immune system, given they are prone to a few conditions which either definitely have an immune mediated component, or are thought to, including Hypothyroidism and Megaoesophagus.

Immune Mediated Haemolytic Anaemia obviously has an immune mediated component, but approximately 50% of IMHA cases have a cancer somewhere which has set it off.

And Canine Leukocyte Adhesion Deficiency is a genetic immune deficiency. There is a genetic test available for this now. 

Serious speculation on why the monster cells didn’t seem to work on Sonic, a round table by your fandom truly:

1) Sonic cooked the darn thing too much

2)  Sonic is monster cells intolerant

3) Monster cells that entered his body got immediately terminated by assassin ninja leukocytes 

4) Sonic was never human I mean do you really wanna make me believe you get as strong and fast as him doing Gambare Goemon ninja training

(credits to @ryukai-san and @marshmallowdonutsprinkles for some of these FEEL FREE TO ADD MORE SERIOUS RESEARCH LMAO)

Cardioversion vs Defibrillation

Cardioversion is a method to restore an abnormal heart rhythm back to normal. Defibrillation is a medical technique used to counter the onset of ventricular fibrillation, (VF) a common cause of cardiac arrest, and pulseless ventricular tachycardia, which sometimes precedes ventricular fibrillation but can be just as dangerous on its own.

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Difference of Cardioversion and Defibrillation

MONA: Immediate Treatment of MI

Remember that MONA does not represent order in which you should administer these treatments. It is a mnemonic to help you remember the components of MI treatment, not the prioritization of them.

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3 Areas of Damage After MI

A heart attack occurs when blood flow to a part of your heart is blocked for a long enough time that part of the heart muscle is damaged or dies. The medical term for this is myocardial infarction.

Blood Flow Through The Cardiac Valves

Blood flows through the Tricuspid valve, then to the Pulmonic Valve, down the Mitral valve then to the Aortic valve.

Cardiac Output

Cardiac output is equal to the heart rate (beats of the heart) multiplied by stroke volume (amount of blood pumped each heart beat).

Treating Congestive Heart Failure

Heart failure is a condition in which the heart is no longer able to pump out enough oxygen-rich blood. This causes symptoms to occur throughout the body.

Pulmonary Artery Catheter

A pulmonary artery catheter (PAC) is a long, thin tube with a balloon tip on the end that helps it to move smoothly through the blood vessels and into the right chamber of the heart.

Osteoporosis

Osteoporosis, which literally means porous bone, is a disease in which the density and quality of bone are reduced. As bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs silently and progressively. Often there are no symptoms until the first fracture occurs.

Hip Fracture

Hip fractures are cracks or breaks in the top of the thigh bone (femur) close to the hip joint.

Appendicitis

Appendicitis is a painful swelling of the appendix, a finger-like pouch connected to the large intestine.

Peritonitis

Peritonitis is an inflammation (irritation) of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs.

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead.

Type 2 Diabetes

Type 2 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes.

Hypoglycemia

Hypoglycemia is a condition that occurs when your blood sugar (glucose) is too low. Blood sugar below 70 mg/dL is considered low. Blood sugar at or below this level can harm you

Anaphylactic Reaction

Anaphylaxis is a severe, whole-body allergic reaction to a chemical that has become an allergen. After being exposed to a substance such as bee sting venom, the person’s immune system becomes sensitized to it.

Autonomic Dysreflexia

Autonomic hyperreflexia is a reaction of the involuntary (autonomic) nervous system to too much stimulation. This reaction may include: Change in heart rate Excessive sweating High blood pressure Muscle spasms Skin color changes (paleness, redness, blue-grey skin color)

Duchennes Muscular Dystrophy

Duchenne muscular dystrophy is an inherited disorder that involves muscle weakness, which quickly gets worse. Duchenne muscular dystrophy is caused by a defective gene for dystrophin (a protein in the muscles). However, it often occurs in people without a known family history of the condition.

Dumping Syndrome

Dumping syndrome occurs when the contents of the stomach empty too quickly into the small intestine. The partially digested food draws excess fluid into the small intestine causing nausea, cramping, diarrhea, sweating, faintness, and palpitations. Dumping usually occurs after the consumption of too much simple or refined sugar in people who have had surgery to modify or remove all or part of the stomach.

Guillain-Barre Syndrome 

Guillain-Barre syndrome is a serious health problem that occurs when the body’s defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness or paralysis and other symptoms.

Hemophilia

Hemophilia is a bleeding disorder that slows the blood clotting process. People with this condition experience prolonged bleeding or oozing following an injury, surgery, or having a tooth pulled. In severe cases of hemophilia, continuous bleeding occurs after minor trauma or even in the absence of injury (spontaneous bleeding). Serious complications can result from bleeding into the joints, muscles, brain, or other internal organs. Milder forms of hemophilia do not necessarily involve spontaneous bleeding, and the condition may not become apparent until abnormal bleeding occurs following surgery or a serious injury.

Sickle Cell Anemia Crisis

Sickle cell anemia is a disease passed down through families. The red blood cells which are normally shaped like a disc take on a sickle or crescent shape. Red blood cells carry oxygen to the body.

Symptoms of Leukemia

Leukemia is cancer of the white blood cells (leukocytes).

Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs. The underlying cause of autoimmune diseases is not fully known.

Acromegaly

Acromegaly is a long-term condition in which there is too much growth hormone and the body tissues get larger over time.

SIR Hernia

A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle. This layer is called the fascia.

I am grumpy because I have another uti and want to pee what feels like every ten minutes. So to distract myself, I decided to look up why blood shows up in urine with a uti (hematuria), and am going to share my knowledge.

OKAY. Urinary tract infections, as you might have guessed, involve the urinary system. The urinary system is your bladder, kidneys, uterers, and urethra. If the infection is in your upper urinary tract, it’s a kidney infection; if it’s in your lower urinary tract, it’s a bladder infection. Both have different symptoms and both are super fucking annoying.

Anyway. There are these things called mast cells and basophil. they are white blood cells and part of our immune systems, and their job is to keep an eye out for foreign bodies. So, in the case of a uti, you have mast cells and basophil just sort of chilling in the urinary system, when suddenly, E.COLI APPEARS! (with a uti, it’s usually e.coli. other bacteria or in some cases viruses or fungi can cause it, but usually you’re safe blaming e.coli. that asshole.)

anyway, mast cells and basophil see THE CALL IS COMING FROM INSIDE THE HOUSE. they basically go SHIT SHIT and enact that scene from Mulan where there’s that guard on the wall who knows he has to light the beacon fire. HOWEVER. mast cells and basophil do not have handy fire pits to light so instead, as far as I can understand, they rupture or implode. Most immune responses are basically “let’s set everything around us on fire and hope whatever foreign object is here also catches on fire, we’re pretty sure insurance will cover the incidental damage”. incidental damage is important in this explanation, because the result of the self-immolation of mast cells and basophil is to release histamine.

histamine does stuff for several systems in our bodies but the main thing we care about right now is that it increases the permeability of capillaries for white blood cells. or basically, the mast cells and basophil signaled for help and in blowing themselves up, made holes in the wall to make it easier for the immunological SWAT team white blood cells to swoop through and beat up invaders.

BUT. we all learned doors open both ways from the intro to the Avengers movie, and when the capillaries are more permeable, red blood cells and white blood cells will also accidentally leave the capillaries and wind up exiting the body via your urine. that is why urine tests don’t only check for bacteria, but also the presence of red blood cells and leukocytes. (Leukocytes is the fancy word for white blood cells).

AND NOW YOU KNOW.

Innate Immunity - intro
  • First line of defence + first to act
  • A primitive response (exists in animals and some plants)
  • Non-specialised and without ‘memory’

Consists of:

  • Physical barriers (eg skin and mucosa//tight junctions, airflow)
  • Chemical barriers (eg enzymes, lung surfactant, antimicrobals)
  • Soluble mediators of inflammation (eg cytokines)
  • Microbal defence (eg commensal competition, secreted antimicrobals)
  • Cells (eg phagocytes)
  • Receptors to recognise presence of pathogen/injury - results in inflammation

Soluble Mediators

Complement Proteins

  • liver-derived 
  • circulate in serum in inactive form
  • activated by pathogens during innate response
  • functions include lysis, chemotaxis and opsonisation

Auxiliary Cells

Mediate inflammation as part of the immune response. The main auxiliary cells involved in the immune response are Basophils, Mast cells and Platelets.

Basophils 

  • Leukocyte containing granules 
  • on degranulation release histamineplatelet activating factor
  • causing increased vascular permeability and smooth muscle contraction
  • also synthesise and secrete other mediators that control the development of immune system reactions

Mast Cells

  • Also contain granules 
  • However they are not circulating cells - found close to blood vessels in all types of tissue especially mucosal and epithelial tissues.
  • rapidly release inflammatory histamine but this is IgE dependant so not innate

Platelets 

  • normally function in blood clotting
  • also release inflammatory mediators

Cytokines and chemokines

Produced by many cells but especially mØ (macrophages), initiate inflammatory response and act on blood vessels 

  • interferons - antiviral protection
  • chemokines - recruit cells
  • interleukines - fever inducing, IL-6 induces acute phase proteins 
  • IL-1 - encourages leukocytes to migrate to infected/damaged tissue
  • as does tumour necrosis factor (TNFa)

Acute phase proteins

  • Liver derived proteins 
  • plasma concentrations increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation
  • called the acute-phase reaction 
  • triggered by inflammatory cytokines ( IL-1, IL-6, TNFα)
  • help mediate inflammation ( fever, leukocytosis, increased cortisol, decreased thyroxine, decreased serum iron, etc)
  • activate complement opsonisation 

Inflammation 

Cells

Cytotoxic Cells

  • Eosinophils/natural killer cells, cytotoxic T cells
  • kill target via release of toxic granules 
  • dendritic cell derived IL-12 helps activate NK cells

Phagocytes

  • mono-nuclear = long-lived; polynuclear = short-lived
  • engulf, internalize and destroy 
  • phagosome forms around microbe
  • enzyme filled with lysosomes fuses to form phagolysosome
  • organism is digested
  • fragments are either ‘presented’ or exocytosed

phagocytosis requires recognition of microbe via receptors for

  • PAMPs (pathogen associated molecular patterns - eg flagella or capsule) - recognised by toll-like receptors 
  • activated complement
  • antibody

The innate immune response primes for the adaptive 

  • B-cells are primed by activated complement
  • Th1 cell differentiation needs pro-inflammatory cytokines
Moony

The moon is in his blood.

It waxes and wanes, ebbs and flows, but it is always there; always there, battling for his attention, vying for dominance with the plasma and the leukocytes and all the other bits that make his blood, blood. Remus can almost not remember what its absence feels like, but every night, every night leading up to the full moon, he tortures himself with the memory…

He had been a boy–just a boy like any other at his young age. He’d been five and his greatest worries had included the devastating possibility that his parents would not take him along for sweets on the weekends. He’d scrape his knees on the sidewalk and call it a bad day, but his dad would wave his wand and his mum would kiss it better, ‘just for luck’, and everything would be made right.

He’d been so alive. So normal.

And then it happened, and his life became measured by the moon: its presence, its absence, and just how long into the gibbous he could push his luck and remain in polite society.

They’d moved more than they’d stayed put, and lied more than they’d spoken the truth, but somehow his parents had made it work for years, until he was sent to Hogwarts. And by then Remus had grown used to the lies, used to the feeble cover stories, to the constant remarks of, ‘are you all right? not tired, are you? you look a bit peaky…’, and most of all, used to the bone-crushing isolation of being bound to life by nothing but the moon, and all of the lies trapped in its orbit.

But the lies became too big for him, sucked him bodily into the never-ending spiral of deceit that, for too long, had been his reality. It had been easier, as a lad, because he’d never stayed in one place long enough to make friends.

At Hogwarts, he made friends.

And they were fantastic.

They were fantastic, brilliant, bright. They were perhaps too intelligent for their own good, and too arrogant besides; but they were brilliant, and they were his.

Best of all, they were his.

That was the problem, though; they cared about him. He’d never had peers before then that had treated him as though… as though his life had been framed by the sun, and the stars, and Quidditch and whatever else young boys used to tell the passing of time. They treated him as though he were normal, as though he were one of them, and even though he wasn’t–not really–he allowed himself to pretend. He allowed himself to pretend, even when he could feel nothing but the moon in his blood, reminding him with each additional setting of the sun that the illusion could never last.

It lasted until their second year.

“Remus,” James had said, “meet us by that portrait of the dancing hippogriffs on the sixth floor after dinner.”

Remus had been wary. “What have you done this time?”

“We haven’t done anything…yet,” Sirius had chimed in, all too innocently. 

And so, believing it to be the product of some prank, some new passageway they’d found, or some other such mischief (which Remus now believes had been their intention all along; to lull him into a sense of normalcy before going through with what they were actually about to do), Remus had done as asked and met them by the rather ridiculous painting on the sixth floor.

And then, they’d locked him in a classroom.

“What is this about? I–I have to visit my mother tonight–”

“We know.”

“Then… why are we just standing here?”

“No, Remus,” Sirius had said, uncharacteristically quietly.

“We mean, we know,” James had added.

And Remus had stared, and then it’d just clicked, and he’d thought, this is it– the illusion ends here–

But then the incredible happened–so incredible, he’d not even dared dream of it, because how could this happen? How could it be real?

But it was. At least, it had been.

“Why didn’t you just tell us?”

A pause, silence. Remus had been… he’d been…

Sometimes, when he needs to relay messages with the Order, and only a Patronus will do, this is the memory he uses. This is the one.

“We’re your mates.We can get through this, together.” 

“But–but you can’t–you’re not–”

“A werewolf?” Sirius’ bark of laughter had rang in Remus’ ears. “Who cares?”

And then they’d hugged him, and he’d cried–Remus gets choked up just thinking about it–cried into James and cried into Sirius, Peter patting his back all the while.

Somehow, it had made him feel less alone, even if he technically had been anything but. Somehow, it was enough.

But it hadn’t been enough for his friends, not by a long-shot, because three years later they finally found a way that they could get through it with him–together. As they had vowed to do.

And now… too many years, and too many memories later, now, all he can think is that he wishes to repay the favour. Whether he knows it or not, Harry is the closest thing he has to a son, the closest thing he has to a nephew, and he will not fail him.

Just like his father had never failed him.

“The trick, Harry, is to choose a happy memory–a really powerful one…”