Week 1 06/21/2021

  

Week 1 06/21/2021

 

This week I have been shadowing clinicians in the Interventional Radiology (IR) department. My clinical mentor, Dr. Bradley Pua, was on the leave this week, but he has assigned me to work with other clinicians in the department, including Dr. Malhotra, Dr. McClure, Dr. Scherer, and Dr. Browne. I was able to shadow them for both patient visits and outpatient procedures. The procedures I observed this week include balloon angioplasty, tumour ablation, embolization, and biopsy, which are all minimally invasive interventions which utilizes various imaging techniques, e.g. CT scan, MRI, to guide the insertion of small, intravenous catheters.

 

One of the medical conditions the IR department treats is deep vein thrombosis (DVT). DVT is essentially a blood clot, or thrombus, found in the deep veins in the body. Most DVTs are found in the lower limbs. Sometimes the blood clot and break loose and travel to the lungs, causing what is known as pulmonary embolism (PE). Treatments for DVT usually involves the use of blood thinners and compression stocks. A significant portion of DVT patients goes on to develop post-thrombotic syndrome (PTS), also known as chronic DVT, which is caused by scar tissue formation near the damaged vein where the blood clot was previously at. Blood flow across the damaged veins are obstructed, leading to pressure build-up and symptoms of swelling, muscle cramping, itching, and more severely, skin ulcers. Blood thinners and compression stocks can continue to help manage the condition, but the scarred tissue can never reverse.

 

For DVT patients who show severe symptoms, an intervention called angioplasty can be helpful. Angioplasty is a percutaneous procedure to restore blood flow in the damaged veins. To do so, the surgeon would insert a wire through a small incision made along the proximal vein, e.g. at the ankle, and manoeuvre the wire up towards the scarred tissue with the assistance of an X-ray machine. Once the wire is in place, a tube with a balloon attached at the tip is threaded through the guiding wire. Again, with the X-ray machine, the surgeon can inflate the balloon at the desired location to open up the occluded vein. Several balloon inflations can be performed along the area of occlusion. The blood flow before and after the procedure can be assessed under X-ray with the help of an injectable contrast agent. Usually, the patient would regain a certain amount of blood flow in the treated area and symptoms of swelling, cramping, etc. should reduce. 

 

For next week, I will be meeting with Dr. Bradley Pua and observe his duties in the hospital.

 

Comments

Post a Comment

Popular posts from this blog

Week 1

For my first week of immersion I attended the OR's of a few different physicians as my clinical mentor Dr. Jason Spector of plastic surgery and reconstruction was on vacation this week. I was able to see three different hernia repairs, and one double mastectomy and bilateral DIEP flap.  I think my favorite thing I saw was the double mastectomy and bilateral DIEP flap. From what I understand, this is a procedure in which both breasts were removed and fat from the stomach is used to reconstruct the breasts. The novelty of the DIEP flap is that it does not require the removal of muscle which allows patients to recover quicker. Additionally, blood vessels from the fat in the stomach are left in tact and "hooked up" to corresponding vessels in the breast. All in all, the procedure essentially amounted to a breast reconstruction and tummy tuck. It was a 10 hour surgery that required multiple doctors and departments, as this was not just a purely cosmetic procedure- the patient ...
Read more

Week 1

Image
  During my first week of Immersion at Weill Cornell Medicine, my clinical mentor, Dr. Jason Spector, was out of town. As a result, I spent my time shadowing other clinicians, familiarizing myself with the layout of the hospital, and introducing myself to his lab.  I witnessed four major types of surgery: gastric bypass, breast reconstruction, hernia repair, and craniectomy. Gastric bypass surgeries reduce the working size of the stomach with the intention of helping the patient lose weight by reducing appetite. This is accomplished by creating a small pouch from the stomach and passing over the first section of the small intestine.  The first breast reconstruction surgery was for a patient who was undergoing radiotherapy for breast cancer. Temporary inflatable implants were surgically inserted as placeholders while she undergoes therapy. After her treatment is complete, she will return for polymeric-based implants. This case was interesting to witness since...
Read more

Week 1 - Robert Hawkins

Research - My project for this summer is going to focus on using a large national database that contains blood/plasma biomarker data, cognitive scores, and image data on ~6000 subjects that are either healthy, have mild cognitive impairment, or have Alzheimer's disease. Specifically, I will be looking for associations between neutrophil activation and reductions in cerebral blood flow, which is what my (Schaffer-Nishimura) lab in Ithaca is also investigating. I like this project because in the Schaffer-Nishimura Lab we only work with mice, and so it nice to now be able translate that work and to analyze some of the same measurements in human subjects. I am also learning how to use the statistical program 'R' for this project, which I think is a good skill to develop. Much of my week has been spent looking at this Alzheimer database and trying to find/extract the data that I need. I've already run into a few problems with this dataset in that there are not many patients ...
Read more