I have never blogged before. So I want to apologize in this first post for being long winded, rambling, or any other trait my writing tends to have. That being said I will do my best to give a brief recap of this first whirl-wind week being immersed in Weill Medical College. Also before I start, I am working with an orthopedic surgeon so I may be describing graphic and seemingly brutal surgeries. This blog will not be for the faint of heart because I believe that the truly interesting parts of surgery are the controlled chaos that ends with a patient walking out better than they rolled in. (This post is safe since my surgeries will start next week.)
In order to completely follow HIPPA guidelines and fully explain everything I have seen, I will change the names, ages and possibly sexes of everyone involved in a random manner. It is my sincere hope that this doesn’t take away from the experience but enhances it by giving a face to those who must remain faceless.
DAY 1: Meeting the troops and learning the game plan
This day will mark for the rest of my life as the first time I ever willingly stepped into a hospital. As I sat in that first meeting with Dr. Wang, Mitch and the multitudes of my classmates, I felt my heart racing with excitement to finally see the fruits of biomedical engineering research. As we learned what was expected from us, I felt my expectations rise even further. Could it be possible that in only seven weeks we would be exposed to so much? Will I even be the same person when I return? How can my head possibly not explode from gaining so much experience in so little time? I was chomping at the bit to say the least, luckily my tie kept my enthusiasm in check.
Unfortunately, I my mentor was not in this day so I wasn’t able to start my journey and instead shopped and checked out the gym in the basement of Olin Hall. The shops were located not that far away and I was satisfied with the weights and the amazingly empty basketball court. Later I would learn that this court is occasionally used for such past-times as badminton and soccer which would disapprove of. But I appear to be digressing, overall the day left me excited and ready to start early the next day.
DAY2: Complementing the inhibitor
This day was filled with me first meeting my mentor then going to a super interesting meeting where I learned what complement is and how it affects the regulation of the synovium.
At our meeting, we went over the minute details of his research and his work. We went over where I will fit in this summer both in his surgical routine and research. The first part of the project that I will be working on is some image analysis where I will be correlating DAPI and TUNNEL staining images to determine the number of dead cells in specific regions. This will be an important albeit minor portion of his current research, however, once I get back to good ole Ithaca there seems to be a chance of collaboration. The use of his research regarding a method for injection that will fuse vertebrae together and my experience working with the rat tail model and creating FEA models from micro-ct images will complement each other into a great union.
I will give a brief discussion of the meeting I attended that was titled “Complement Inhibitor Expression and Regulation of the Synovium”. In the interest of brevity I have only included the bullet summary I took during the meeting:
- Intima thin (fibroblasts +macrophages_
o In OA gets thicker
o C1q>clears apoptotic cells
o Small amount published about complement activation in OA
- More deposits of complement in OA patients
- Compare Synovial tissue/fluid from
o Normal, anterior cruiciate ligament reconstruction, early osteoarthritis, advanced osteoarthritis, rheumatoid arthritis
o Complement can harm cells
o CD46 expression in majority of cells
o CD56 expression in endothelial cells
o CD46 cofactor for CFI mediated C3b and C4b cleavage
o CD55 accelerates disassembly of the c3bBb complex
o Grow cells in saline free low serum media
o OD C5b,6 and C7 then C6 and C8 is C56-9 deposition in tissue associated with local increases in pro-inflammatoryu cytokines and matrix-degrading enzymes
Thus ended day three.
DAY3: Talking to the masses
During this day, my mentor took me along on his outpatient visits where we saw 10 patients between the hours of 9:30 and 6. The patients interestingly were about 80% female and fell into two main age groups. The first group which was larger was 60 and up while the second group which was smaller was 15 and down.
I learned a large number of small facts during these visits and I will share them as follows:
- You can pinch your sciatic nerve with sitting (i.e. going to the bathroom too long)
- When patients are injured they tend to do their own research on the issues and collect data no matter how scientific or relevant to bring to the doctor
- You can bike with a herniated disk
- From images of the cages/supports/spine you can determine scoliosis by measuring from outer line to a line drawn down edge of vertebrae
- Young girl with a back brace having Sherman’s kyposis can have the back brace ride up
o It should be worn 23 hours a day and you should be able to fit a finger between the patient and the brace at all points of the edges
- You can add upwards of 4 inches to a patients through corrective surgery if they have a severe scoliosis
- Pain and weakness are commonly signs of spine injury
- Strengthening is better than stretching
- Normal people have a 30% angle in their thoracic spine
The most interesting patient I saw was the one who gained approximately 4.5 inches to their height after the surgery. In the x-ray, her spine was bent in 90 degrees in two directions which was very interesting to see. Overall, it was an exhausting and educational day where I learned more about spine surgery and disc replacement than I have previously learned about any other subject ever.
DAY4: Ethics images and discussion
This day was originally going to be fully dedicated to me following my surgeon around seeing patients again and possibly seeing a surgery, however, due to the conflict of having an ethics meeting that lasted from 10:30-12:30 and another meeting from 4:30-6:30 I was unable to meet with my mentor. Although I was upset about missing those integral parts of my experience, we had an enthralling discussion on the topic of ethics where I learned many new theories on the subject of Ethics.
Out of the discussions on stealing indigenous people’s blood for curing cancer and the number of people you are justified in killing to protect your life, one concept really stuck with me which I will from here on forward call the life boat dilemma. The dilemma stems from the justified killing concept and can be explained simply by thinking of 4 people on a life boat with enough food to feed 3 people. Are the three people justified in killing the fourth person to save their lives? This concept can be expanded to include the entire planet as a life boat. If you are interested in further understanding this concept the Wikipedia page for Thomas Robert Malthus which can be found at (http://en.wikipedia.org/wiki/Thomas_Robert_Malthus).
DAY5: Yesterday was thursday
As the week drew to a close, I found many threads were starting to arise that I could hopefully follow to a productive end. During this day I saw two experiments that were running in the same lab area as my mentor.
One experiment was designing a fully automated method for performing ACL surgery rehabilitation where they were experimenting first on rats. They were currently working with cadavers and I should have pictures next week to show how this experiment was run.
Another experiment followed the effects of holding a strand of rat tail tendon under constant strain and how well collagenase could denature the protein. It seems that as a tendon is held under constant strain, it is more difficult to denature the protein but the exact mechanism has yet to be understood.
I made significant head way in my project as well on this last day of the week. Using my own code that I wrote in matlab, along with some instructional code written by another person in the lab about what to look for in the images, I was able to count the number of dead cells in each slide. I believe there might be a couple more days worth of work left in correcting the code, however, I feel confident that this part of the project might have already come to a climax. I will have helped the lab analyze a larger number of images, but more importantly left them with an easily understood tool for future analysis. From what I can understand about the nature of this project, the fully automated tool should take what currently takes days and convert it into a several minute long analysis that the person doesn’t even need to watch. I know all the people following this blog would like me to go into full detail about each slide and the nuances that the code is able to decipher, but I will wait till I have fully working for that.
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