On Saturday we took the very comfortable and luxurious coach bus from Ithaca to NYC. Stephanie, Sara, Jose, and I sat around a table in our comfy leather chairs and there were plenty of free snacks and outlets for your electronics. On our drive in, we passed Time Square, which was amazing to look at all the lights and people around. I definitely want to go back there before I leave. When we arrived to the med. student dorm, we got our keys and moved all our stuff into our rooms and called it a night. Everything in here reminds me of freshman year of undergrad all over again except that I’m far less equipped, but I'm sure I'll feel more at home the longer we're here.
I was supposed to meet with Dr. John Boockvar in his lab on Monday morning before our summer immersion orientation meeting but he never showed up. So I left and went to the meeting where we met with Dr. Yi Wang and Mitch Cooper. Following our meeting we went over to the administration building to get our hospital IDs. Since Dr. Boockvar was in surgery for the rest of the day, I went out to lunch with friends and got to know my way around the surrounding area better.
I eagerly got up early on Tuesday morning to go find Dr. Boockvar and begin shadowing him because I'm really excited to interact with patients and learn about the life of a neurosurgeon. I managed to catch up with him in his clinical office sit in on his clinical consultations for several interesting cases. One patient was complaining of debilitating, sharp pain radiating down his legs, with the right leg being the worst of the two. After looking at his MRIs, Dr. Boockvar showed me that he had inflammation of several vertebral discs and recommended to the patient that he have surgery to remove the bulges from the discs, alleviating the pressure on his spin and his pain in his legs. A few patients were pre-operative brain tumor cases, which focused on the potential treatment options (all included tumor resection surgery followed by chemotherapy, radiotherapy, and/or hormone therapy depending on tumor location and prognosis) and coping with the diagnosis and living with the disease. These clinical appointments were very morbid and disheartening and gave me a new perspective and glimpse of what patients with cancer experience. Most of the other patients were post-operative checkups for spinal cord tumor or brain tumor resection surgeries. One female patient who had an atypical meningioma removed from her brain came in to discuss her fear of receiving chemotherapy due to the side effects. Typically, chemotherapy for brain cancer is delivered intravenously, which cycles the drug around the body and thus produces the undesirable side effects. Dr. Boockvar proposed delivering chemotherapy intraarterially, which would deliver a higher dose of the chemo. directly to the tumor resection site and far less would circulate around the body, thereby diminishing the chance of side effects. Additionally, Dr. Boockvar asked me to research the administration of tamoxifen, a hormone therapy antagonist of the estrogen receptor, in atypical meningioma cases. Since tamoxifen is typically used for breast cancer patients, I could not find many journals documenting use of tamoxifen for brain cancer. What I could find though was that there has been one study of tamoxifen administration for meningioma where there was a less than 5% rate of “partial success.” Additionally, there have been a few more cases where tamoxifen was administered to benign meningioma patients, but this information is not beneficial for the patient’s case. Following clinical shadowing, we went over to the “Multidisciplinary Brain Tumor Conference,” where the hospitals neurosurgeons and their fellows, residents, and interns sit down to discuss their cases and treatment direction. Overall, today was a very long and busy day but I loved every minute of it and I'm totally looking forward to what's to come this summer.
On Wednesday, I went into the operating room wing to shadow Dr. Boockvar during his surgeries. Once I got my green surgeon scrubs, I went to room 6, where Dr. Boockvar and a plastic surgeon, Dr. Spinelli, were preparing for an occipital craniotomy on the right side and resection of a meningioma. Watching the surgeons cut and peel back the scalp, drill/saw off a piece of the skull, remove a marble-sized tumor, and then put everything back together again was very intense and I particularly liked the bioengineered metal brackets that the surgeons used to reattach and secure the piece of the skull that they had removed. I saw Stephanie come into the room while the surgeons were finishing up and then I left to see another surgery in a different room. In this new room, where I met up with Joseph, Dr. Schwartz was performing an endoscopic pituitary microangioma resection. The surgeons went in through the patient's nose and drilled through the skull to access the pituitary gland, then a 3D endoscope was inserted into the surgical site and everyone in the OR put on 3D glasses to watch the surgical removal of the tumor on the 3D flatscreen monitor, which was an awesome experience! Once all of the tumor was removed (a total of half the pituitary), Dr. Schwartz sutured everything back up and his fellows and residents finished closing up the patient.
Thursday was a pretty boring day compared to the rest of the week that I've had. We had an ethics seminar and our weekly update meeting with Dr. Wang and Dr. Frayes. Over New York style pizza (I'm from Chicago and still think Chicago style is best!), we all went around the conference room and shared our experiences so far and what our project ideas are. So far Dr. Boockvar and I have not had much time to discuss project ideas, so I didn’t have much to say about that but I did have more to say as far as experiences go than a lot of the other students. It was very interesting to hear about what everyone else has been up to and also to hear from Dr. Frayer that we’re going to be able to attend a cardiac bypass surgery and take an MRI of each other.
Since Dr. Boockvar took Friday off to attend his daughter’s graduation, I decided to go to the OR and see what interesting neurosurgeries might be going on and if I could observe them. Of the few neuro-related cases this morning, I decided that Dr. Hartl’s operation seemed the most interesting where he was to perform an occipital cervical spine fusion to correct an invagination of the base of the skull, or in other words, his vertebrae in his neck were going up into the base of his skull and therefore needed to be pulled back and kept out. Dr. Hartl had an x-ray machine in the OR to image the patient’s spine during the surgery and therefore we all had to wear lead shirts, skirts, and throat protectors, which weighed about 15 pounds total and made standing for the surgery for 7 hours pretty tiring but the surgery was great otherwise and I'm really looking forward to what's in store for next week.
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