I am not a 100% sure what we are supposed to blog about but I will tell about the best thing that I did so far this week. I went to the comprehensive arthritis program (CAP) clinic where orthopedic surgeons and rheumatologists discuss an interesting case. The case is described in detail and then a patient is actually brought out on stage and examined. Afterwards treatment options and complications are discussed extensively and after debate a consensus is reached for the best treatment, whether it be surgical intervention, medication, or a combination. I found it interesting to hear how the concerns of the doctors varied significantly depending on what their backgrounds were in.
Not much happened for me this week but I was able to shadow some rheumatologists with Jason. I was also able to attend the comprehensive arthritis program (CAP) clinic as well, where they examined a patient and as a group discussed what they thought was the best course of action for him.
I would say that my favorite part of the week was the CAP clinic. I found it very cool how the doctors assessed the patient and there was some very good discussion points that they all addressed. It was nice to see how they thought through the process and came to a consensus about the patient. The more experienced doctors were able to coax the fellows in the right direction if they thought a course of action was not as good as it could have been.
I also liked seeing patients in the exam rooms as well as visiting patients in their hospital beds. The exams that the doctors gave were very thorough because a lot of patients exhibit many symptoms from several conditions, which made it more difficult to discern what was actually going on. It seems like the default solution to everything in rheumatology is to apply some sort of steroids to calm down the inflammation in the joints or in other areas, and the long term solution depends on how they respond to the initial steroid treatments. I look forward to being in the OR next week, as well as exploring some other areas of medicine.
Im also not sure what we are supposed to blog about or where, so I guess here in the comments works. I have shadowed no one on rounds, seen no surgeries, gone to no grand rounds, or seen any patients. Instead, I spent the majority of my time in my mentor's office working on my research project broken up with short periods of watching him measure heart valve dimensions on an MRI. I was very bored and frustrated this first week. Luckily, I had to return to Ithaca Thursday-Friday to pick up a heart valve from a collaborator. When I retrieve human valves from the collaborator its during the valve replacement surgery so I get to scrub into an open heart surgery. I got infinitely more clinical action doing my regular Ithaca research than I have in this clinical immersion term so far.
I should note that open heart surgeries blow my mind every time I see them. It is so incredible to watch doctors slow the heart down by literally putting ice on it, medically stop someones heart, bypass their heart and lungs with a heart-lung machine, and then rewarm the patient and have them make a full recovery. Seeing a patients beating heart right in front of me only to watch it stop then start up again house later is probably the coolest clinical experience Ive ever had. Also, the way bioproesthetic heart valves are places is really neat- they stitch in a draw string like tie all around the cusp of the prosthetic and the ventricular wall where the valve was and then just yank down. I did talk to the surgeon about a certain type of bioprosthetic valve that surgeons absolutely hate using as the cusp on the valve used to stitch into is too wide and cumbersome to easily stitch in and pull down. As a result of this device's poor design almost no one uses it. Made me think of the importance of seeing clinical practice in device and method design so that instances like that dont happen.
My mentor does not really see patients as he is an imaging guy and mostly does MRI reads or works on his research. I've been pretty dissapointed with the whole experience so far. I requested to my mentor to see some more clinical practice and was dropped off at cardio cath lab so I got to see a cardiac catheterization for about an hour and a half. My mentor seems to want my research to be my priority and did not seem comfortable with me spending mornings shadowing other doctors to see clinical practice and has redirected me back to his office to keep working on the project several times. At this point, I would like to continue the research project with my mentor as its highly relevant to my actual research and a collaboration I wish to continue, but I want to find another clinician to shadow so I can actually see clinical care.
During my first week at the Hospital for Special Surgery, I was able to shadow two surgeons in the clinic. First was my mentor, Dr. Michael Cross, a hip and knee surgeon, and second was Dr. Anil Ranawat, a sports medicine surgeon. With Dr. Cross, I was able to observe a variety of patients, some of whom were first seeking advice from Dr. Cross due to joint pain, and others who had recently received hip or knee replacements. With Dr. Ranawat, I got an idea of the breadth of traumatic injuries that can occur from intense physical activity, ranging from ACL tears to severely inflamed or arthritic joints. Next week, I plan to join these surgeons to observe arthoplasty and ACL reconstruction in the operating room.
In addition to the clinic, I have begun two research projects. The first is my clinical project with Dr. Cross - I'll be looking at the effects of malnutrition on the probability of infection after a total joint replacement. The second is the continuation of my research in Ithaca - I'll be learning and performing qRT-PCR in collaboration with Goldring lab at HSS. I look forward to more clinical experiences in the near future.
During my first week, I had multiple meetings with my mentor and Sleep Medicine Specialist, Dr. Ebben, who has a background in Psychology and a Ph.D. in Neurology. How does one develop a sleep disorder in the city that never sleeps you ask? I spent all day Thursday pondering that question by shadowing Dr. Ebben and meeting with a slew of patients throughout the day. His interview process is fascinating because you really get to know a patient quickly.Sleep habits are very personal and often correlate with stress/anxiety, emotional health, lifestyle, etc. I met patients with everything from REM-behavior disorder (where the patient acted out dreams-- would stand on the bed and box and occassionally think it was a diving board and jump off) to common sleep apnea.
Dr. Ebben specializes in sleep apnea of which there are two types: obstructive (blocked airway due to obesity or anantomical obstruction) and central (more neurological and complicated). Basically, to have sleep apnea you have to stop breathing (for more than 10 seconds), multiple times throughout the night. This can go undiagnosed for years, putting serious strain on the heart and causing seriously-fatigued people. While there is no sure-shot cure, treatment methods exist such as CPAP: continuous positive airway pressure therapy and BiPAP: bilevel positive airway pressure therapy, which can reduce apnea episodes from over 100 times per hour down to below 5. My project for the summer will be to create a novel actigraph device to meaure sleep/wake in sleep apnea patients. This week I began putting a parts list together and designing the wearable device.
Other random fun facts I learned:
- Lots of sunlight exposure in the morning will cause someone to go to be earlier. 10,000 lux of light is optimal and the light/dark cycles are most sensitie to light in the blue range of the spectrum. - Melatonin is like the anti-sunlight. - Slow phase sleep is therapeutically extended by beta hydroxyl butyric acid (aka the date rape drug). Body builders will slip this in with their protein shakes because it jacks up their HGH levels.
I look forward to getting into the OR next week. Somebody hook me up!
I am not a 100% sure what we are supposed to blog about but I will tell about the best thing that I did so far this week. I went to the comprehensive arthritis program (CAP) clinic where orthopedic surgeons and rheumatologists discuss an interesting case. The case is described in detail and then a patient is actually brought out on stage and examined. Afterwards treatment options and complications are discussed extensively and after debate a consensus is reached for the best treatment, whether it be surgical intervention, medication, or a combination. I found it interesting to hear how the concerns of the doctors varied significantly depending on what their backgrounds were in.
ReplyDeleteNot much happened for me this week but I was able to shadow some rheumatologists with Jason. I was also able to attend the comprehensive arthritis program (CAP) clinic as well, where they examined a patient and as a group discussed what they thought was the best course of action for him.
ReplyDeleteI would say that my favorite part of the week was the CAP clinic. I found it very cool how the doctors assessed the patient and there was some very good discussion points that they all addressed. It was nice to see how they thought through the process and came to a consensus about the patient. The more experienced doctors were able to coax the fellows in the right direction if they thought a course of action was not as good as it could have been.
I also liked seeing patients in the exam rooms as well as visiting patients in their hospital beds. The exams that the doctors gave were very thorough because a lot of patients exhibit many symptoms from several conditions, which made it more difficult to discern what was actually going on. It seems like the default solution to everything in rheumatology is to apply some sort of steroids to calm down the inflammation in the joints or in other areas, and the long term solution depends on how they respond to the initial steroid treatments. I look forward to being in the OR next week, as well as exploring some other areas of medicine.
Im also not sure what we are supposed to blog about or where, so I guess here in the comments works. I have shadowed no one on rounds, seen no surgeries, gone to no grand rounds, or seen any patients. Instead, I spent the majority of my time in my mentor's office working on my research project broken up with short periods of watching him measure heart valve dimensions on an MRI. I was very bored and frustrated this first week. Luckily, I had to return to Ithaca Thursday-Friday to pick up a heart valve from a collaborator. When I retrieve human valves from the collaborator its during the valve replacement surgery so I get to scrub into an open heart surgery. I got infinitely more clinical action doing my regular Ithaca research than I have in this clinical immersion term so far.
ReplyDeleteI should note that open heart surgeries blow my mind every time I see them. It is so incredible to watch doctors slow the heart down by literally putting ice on it, medically stop someones heart, bypass their heart and lungs with a heart-lung machine, and then rewarm the patient and have them make a full recovery. Seeing a patients beating heart right in front of me only to watch it stop then start up again house later is probably the coolest clinical experience Ive ever had. Also, the way bioproesthetic heart valves are places is really neat- they stitch in a draw string like tie all around the cusp of the prosthetic and the ventricular wall where the valve was and then just yank down. I did talk to the surgeon about a certain type of bioprosthetic valve that surgeons absolutely hate using as the cusp on the valve used to stitch into is too wide and cumbersome to easily stitch in and pull down. As a result of this device's poor design almost no one uses it. Made me think of the importance of seeing clinical practice in device and method design so that instances like that dont happen.
My mentor does not really see patients as he is an imaging guy and mostly does MRI reads or works on his research. I've been pretty dissapointed with the whole experience so far. I requested to my mentor to see some more clinical practice and was dropped off at cardio cath lab so I got to see a cardiac catheterization for about an hour and a half. My mentor seems to want my research to be my priority and did not seem comfortable with me spending mornings shadowing other doctors to see clinical practice and has redirected me back to his office to keep working on the project several times. At this point, I would like to continue the research project with my mentor as its highly relevant to my actual research and a collaboration I wish to continue, but I want to find another clinician to shadow so I can actually see clinical care.
During my first week at the Hospital for Special Surgery, I was able to shadow two surgeons in the clinic. First was my mentor, Dr. Michael Cross, a hip and knee surgeon, and second was Dr. Anil Ranawat, a sports medicine surgeon. With Dr. Cross, I was able to observe a variety of patients, some of whom were first seeking advice from Dr. Cross due to joint pain, and others who had recently received hip or knee replacements. With Dr. Ranawat, I got an idea of the breadth of traumatic injuries that can occur from intense physical activity, ranging from ACL tears to severely inflamed or arthritic joints. Next week, I plan to join these surgeons to observe arthoplasty and ACL reconstruction in the operating room.
ReplyDeleteIn addition to the clinic, I have begun two research projects. The first is my clinical project with Dr. Cross - I'll be looking at the effects of malnutrition on the probability of infection after a total joint replacement. The second is the continuation of my research in Ithaca - I'll be learning and performing qRT-PCR in collaboration with Goldring lab at HSS. I look forward to more clinical experiences in the near future.
During my first week, I had multiple meetings with my mentor and Sleep Medicine Specialist, Dr. Ebben, who has a background in Psychology and a Ph.D. in Neurology. How does one develop a sleep disorder in the city that never sleeps you ask? I spent all day Thursday pondering that question by shadowing Dr. Ebben and meeting with a slew of patients throughout the day. His interview process is fascinating because you really get to know a patient quickly.Sleep habits are very personal and often correlate with stress/anxiety, emotional health, lifestyle, etc. I met patients with everything from REM-behavior disorder (where the patient acted out dreams-- would stand on the bed and box and occassionally think it was a diving board and jump off) to common sleep apnea.
ReplyDeleteDr. Ebben specializes in sleep apnea of which there are two types: obstructive (blocked airway due to obesity or anantomical obstruction) and central (more neurological and complicated). Basically, to have sleep apnea you have to stop breathing (for more than 10 seconds), multiple times throughout the night. This can go undiagnosed for years, putting serious strain on the heart and causing seriously-fatigued people. While there is no sure-shot cure, treatment methods exist such as CPAP: continuous positive airway pressure therapy and BiPAP: bilevel positive airway pressure therapy, which can reduce apnea episodes from over 100 times per hour down to below 5. My project for the summer will be to create a novel actigraph device to meaure sleep/wake in sleep apnea patients. This week I began putting a parts list together and designing the wearable device.
Other random fun facts I learned:
- Lots of sunlight exposure in the morning will cause someone to go to be earlier. 10,000 lux of light is optimal and the light/dark cycles are most sensitie to light in the blue range of the spectrum.
- Melatonin is like the anti-sunlight.
- Slow phase sleep is therapeutically extended by beta hydroxyl butyric acid (aka the date rape drug). Body builders will slip this in with their protein shakes because it jacks up their HGH levels.
I look forward to getting into the OR next week. Somebody hook me up!