Week 5

 

This week started with joining Mia to observe a cervical spinal fusion surgery by Dr. Riew and the fellow. The entry was done on the anterior side, and discectomy was done on 3 disks to replace with cages and allografts. I was quite intrigued by the choices of spacers – two were replaced by titanium cages and allografts, and one replaced with just bone allografts, shaped by Dr. Riew during the surgery to fit in the now-empty disc cavity. The progress took multiple test insertions and careful shaping for the bone allografts to fit in the space. The discs were removed with a rotary instrument, and final shaping of the cavity was done with a metal block / file tool that is the size of the titanium cage. Being observing in the infectious disease division for the past few weeks, I was surprised to see a generous dosage of topical antibiotics powder used before wound closure, compared to the more precise IV dosage for ID cases, perhaps due to the elevated risk of osteomyelitis.

After the spinal fusion surgery we went to see a craniotomy and brain abscess draining. Dr. Stieg kindly let us in the room where his fellow performed the drainage, reattachment of the bone piece and wound closure. Unfortunately we weren’t able to see the first part where the bone piece was taken off. The head stabilization instrument awfully reminded me of that of mouse craniotomies I watched during the rotations, where the patient’s skull is clamp down via several pins that are screwed into the head.

Later this week I was able to see patients with Dr. Vielemeyer at the clinic. The most memorable case was a patient who suffered from endocarditis caused by lactobacillus, which is known to be probiotic and a normal flora in GI tracts. As a result, he will be taking antibiotics for the rest of his life in pill form. Another case that was quite shocking was a patient with alcohol-related liver disease. He had a very large amount of abdominal liquid due to liver failure from alcohol abuse, and was on the list of liver transplant. Due to the amount he was highly susceptible to spontaneous bacterial peritonitis, a sudden outbreak of bacteria in the abdominal fluid. Dr. Vielemeyer's description of working in infectious disease was quite memorable: each new patient presents a different case, and it's up to the ID doctor to figure out what is happening inside the body, unlike other divisions which may have more similar cases and more standard workflows.

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