Tuesday, January 5, 2021

UK Strain

     So I wasn't planning to write two days in a row but so much happened today I don't want to forget. Very interesting news in huddle. Turns out we are the only ones in the state that can detect the UK strain, as you know the one that is more transmissible, and so we are going to start tracking it for the Health Department. Here's how it works. There are three targets in the Covid PCR machine, the open reading frame and the N gene and the S gene. The S gene is the one responsible for the cute spiky things on the surface of the virus. The UK version has S gene dropout. It also has a lower threshold of detection, only 27 cycles, we do up to 36 cycles and native Covid 19 is higher. So we can look for the positives that are picked up at 27 cycles and don't have the S gene target light up only open reading frame or N gene or both and tell ADH. They can track our data on the UK strain and do - whatever they need to do with it. I'm not sure what it would mean clinically - higher precautions? More isolation? 

    I'm sure Mandy Novack would know I met her new PA yesterday we were singing the praises of Amy director of micro out loud. She was off last week like me and Monday morning one of the really good new techs Valerie I toured my department a couple of months ago (she aspires to be an M.D.) pointed out that all she did all week was put out fires Amy was not allowed to be off again. Mandy and new PA and I marveled over the fact that we are running out of pipettes (pipettes!!!) and since the company won't have them until June the new QC coordinator found them on LabDirect (which we laughed about sounds like Office Depot). Amy assured us she's a whiz at finding lab supplies in crazy places Mandy said did you try Amazon. Yup no dice. Amy told us she'd been working on the pipette issue since she walked in the door. It was 2:30 pm. 

    I had an hour after lunch in limbo so I decided to cut in the autopsy heart it had fixed for over a week. We looked for local invasion of cancer, which we did not grossly see but took tons of sections of the epicardium in a scarred looking place to make sure there was not microscopic infiltration. Then we opened the atria and ventricles and I marveled to Jessica about how the heart looked like a cave. The other thing we are looking for is myocarditis that can't be seen grossly only microscopically so she's going to take tons of sections of the ventricles. Jessica remarked that it did look like a cave and that made sense because caves are like the arteries of the Earth they transport life goods.

    I marveled internally at this astute observation and wasted about 20 minutes in my office googling and google imaging underwater caves. They were lifelines for prehistoric populations they provided fresh water and attracted flora and fauna that sustained the populations. The pictures mesmerized me.

    My bone spur surgery is February 12 I decided not to watch the scary movies until after I go under his knife. He was so humble when I mentioned his accomplishments I read about. He said Tribeca was cool. I will be in a surgery shoe for 3-4 weeks (this is better than a boot) but can walk and use an exercise bike if I want. And I'll have a pin in my bone! I've never had a pinned bone. 

    The highlight of my week so far was getting the first surgical case of the year S21-1. I've had the first cytology case but never the first surgical it was such a thrill I'd tell you the diagnosis but that's two identifiers I worry it's a HIPAA violation. I did have a really cool case today probably adenosquamous carcinoma of the pancreas diagnosed it on cell block it's so rare only like 3% of pancreatic cancers unfortunately super aggressive. When I was called to gross room this morning early for pancreas FNA Sven Hida marveled (GI interventionalist) I've only ever seen two of those. It requires surgical resection for definitive diagnosis bc you have to have 30% squame component to call it and you can't really do that on a handful of cells from FNA but it will still point them in the right direction.

    Happy Tuesday. I'm going to think about nachos and watch some TV and wind down. I've got a big time crazy thing happening this weekend that's a huge surprise I can't wait to blog about it when it's all over. Let's just say my friend Christie plans some amazing birthday parties. Much love, Elizabeth

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