Weeks 5-7 for Derek

Sooooooo, I apologize for the delay, but my last few weeks of the immersion term were quite hectic. I spent most of my time on research in collaboration with the famous Mary Goldring lab, but I also spent some more time observing surgeons in the clinic. So I'll break each week down one-by-one.

Week 5: During Week 5, my main goal was to become adept at RNA isolation, a process that involves a huge amount of micro-pipetting, something that I have not done much of in Ithaca. Miguel and Kirsty from the Goldring gave me a great protocol to follow. Briefly, I begin by harvesting articular cartilage from a mouse knee joint, which is not an easy task and requires a lot of skill with a scalpel. Then, the RNA isolation begins, which takes usually takes two full days. Finally, we measure the purity and quality of the RNA, and if it is good enough, we can perform qPCR to determine gene expression in the articular cartilage. I successfully isolated high-quality RNA with my six practice samples. In addition to research, I spent some time with Dr. Bostrom in the clinic visiting patients. Dr. Bostrom has been a hip and knee replacement surgeon for over 25 years, and he is one of the best at what he does. It's interesting how each surgeon has his/her own way of talking to patients and explaining to them what their options are. In the case of joint replacement surgeons, the options are actually quite simple: either deal with the arthritic pain, get a steroid shot, or have your joint replaced. But surgeons of course are very courteous to their patients, and explain things in a very comforting way. Dr. Bostrom was very good at ensuring his patients would get the best treatment.

Week 6: This was the week that my animals were finally of age to begin experimenting, so once again, I was in the lab a lot! I was also teaching an HHMI grantee how to use our tibial loading device, as he will be using it in the near future. It felt great to teach someone the methods that my lab has developed over the years. Besides experimenting, I continued my practice for qPCR, as the real thing was coming up next week. Again practice went very well. Besides my time in the lab, I attended a research meeting with my mentor, Dr. Cross, where I presented both my research from Cornell and from my clinical work I was doing in the city about malnutrition and infection post-total hip replacement. The rest of the research team was very interested in both of my projects. I also had some time to observe Dr. Cross in the OR to see more joint replacements.

Week 7: A very unfortunate last week resulted from my RNA isolation failing. As I mentioned earlier, my practice samples went extremely well, but when it came to the real thing, my RNA purity was terrible - I'm still not sure what I did wrong. But I did perform some more experiments, and Kirsty and Miguel are helping me out by performing RNA isolation themselves while I'm in Ithaca - they're two of the nicest and smartest people I know. So, hopefully my second batch turns out better than the first. I also spent a lot of time on my clinical project and managed to obtain data for sixty patients, so I'll have some solid preliminary data for my immersion term paper and poster. My final day in the city I spent with Dr. Bostrom on his sail boat in the Long Island Sound. IT WAS AWESOME. We did some swimming, some tubing, and he treated us to drinks and dinner. It was a great way to end a busy seven weeks in the city. Overall, the clinical immersion term was very helpful, and I have a huge amount of motivation to improve treatment for osteoarthritis. I know there is something else out there that can help treat/prevent the disease, and I will figure it out in the rest of my years as a PhD student at Cornell. Thanks for reading!

Week 1 Redo Post

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.

Derek's 4th Week in NYC

We're over halfway through the summer term in New York City, and this past weekend at home with my family and friends reminded why I love living in a rural area. Breathing in fresh, clean country air was an excellent feeling. But now I'm back in the city and the smell of garbage is back!

But, a certain experience this past week did make everything in the city totally worth it. I was observing my mentor in the operating room and we came across a very interesting case. A patient had a knee replacement back in 1999, and the entire medial half of the plastic implant was completely worn down and some of the metal implant even wore off. The result was a tremendous amount of necrotic tissue (completely black for those haven't seen necrotic tissue before). My mentor handled the situation by removing all of the dead tissue, removing the implant (which wasn't easy), and readjusting her knee by implanting a totally new knee replacement. As an engineer, I would like to figure out why exactly that first implant performed so poorly after fifteen years. Overall, this was the most exciting surgical experience I've had so far. 

Besides my time in the OR, I was hard at work this week learning new research techniques. Harvesting articular cartilage from mouse knee joints is not an easy task! But each time I'm getting a little better hopefully. Next week, I'll learn how to perform some qPCR and see how well I did harvesting the cartilage based on the quality of the RNA. Next week, my main focus is going to be research - both for my clinical project and PCR work. 

My third week in NYC

My main goal this week was to set up all the equipment for the experiments I'm running in collaboration with the Goldring lab. This required a significant amount of troubleshooting because the equipment hasn't been used in two years, but I was able to get everything up and working. Next week, I plan to begin my experiments and learn new skills with some cartilage experts in the Goldring lab. I also completed all of my microCT scans for analysis back up in Ithaca this week.

Besides my lab work, I experienced two new things in the hospital: cardiothoracic surgery and the pediatric intensive care unit (PICU). I observed an aortic valve replacement and the beginning of a mitral valve replacement. The fellow working the echocardiogram was very helpful and I learned a lot from him on how to diagnose heart problems. Seeing an open heart surgery for the first time was pretty intense, but overall, I enjoyed it a lot. In the PICU, I saw a bunch of different cases with patients varying from a few months old to their teens. A lot of the terminology the team used was very difficult for me to understand, but hearing them discuss what their plans were based on the patients' conditions and X-rays was awesome, as I learned how some doctors have to think like engineers on a regular basis.

Derek's second week at HSS

This week, I was able to join three different surgeons in the OR. Two of them were sports medicine specialists and the other was an arthroplasty surgeon. With the sports medicine surgeons, I saw how X-rays and MRI scans play such a key role in deciding on which surgeries to perform. Both of the sports medicine surgeons frequently used the arthroscope to make the surgery as minimally invasive as possible. With the arthroscopic camera, they are able to see inside a patient's joints, which allows them to remove diseased tissues, repair torn pieces of cartilage, etc. With the arthroplasty surgeon, I witnessed a total hip replacement. Simply put, it was awesome and I want to see more.

I have also been busy gaining access to everything I need for my research projects. My clinical project should be up and running by next week, and I have been collaborating with the Goldring lab to determine the next appropriate steps for my research in Ithaca.