James Week 3

6/27/2011 –

I went to the med school’s café this morning for breakfast which put an end to the rest of my day. After eating I went down for rounds but was not feeling well, and then I became nauseous and ended up in bed for the rest of the day… (will not be going to this café again)

6/28/2011 –

I joined the vascular neurology team for rounds and found that the attending changed again! Rounds are now being conducted by Dr. Segal, he runs rounds differently than the other attendings I have been with. In the morning instead of discussing each patient he starts with patient rounds and each case is discussed in the hallway before we meet the patient. Rounds were normal, no abnormal cases, although we do have many patients that need to be strapped to the bed to prevent them from pulling things off, hitting people, or self mutilation. There was one interesting case during morning report. A patient was admitted to the ICU for hypertension emergency and his blood pressure was able to be moderately controlled with a bit of fluctuation. The patient developed hemiplegia (paralysis) later that day (I believe). The MRI was taken and checked and it was shown that his thalamus was shot and the cerebellum was wiped out. Instead of taking the MRI the doctor could have tried a miracle surgery, but from what the Doctors were saying there have been no known cases of someone coming back after hemiplegia. The patient did die but there was controversy whether the doctor in charge should have submitted for a surgery or taken the MRI. On a side note I learned that to check is someone has acute sever hypertension the two most affected areas are the kidneys and retina. Radiology rounds went well and after I had a meeting with Dr. Leifer. I wanted to open up collaborations with Dr. Leifer and my lab from Ithaca. I found that although it is possible, it will not be easy AT ALL. I have to file IRB protocols, and tens of other forms to work with patients. So, I will not be working with him any time soon. I had many questions I still wanted to ask Dr. Leifer, however he is an extremely busy man so it will have to wait for another time. The last part of the day I joined him in clinical. I did get to see a patient that was part of a clinical research project, so I got to see all the new questions that had to be asked.

6/29/2011 –

I went to vascular neurology rounds this morning and at then made my way to Grand Rounds. Grand Rounds was on spina bifida and targeted therapy using Lrp6 and Folate. It has been shown that folate rescues NTD (neural tube defects) in Lrp6 null mice. All of the study was done in mice, but they have started going through a gene sequence of 2000 patients with spina bifida. After Grand Rounds I went to radiology to finish normal rounds. After rounds instead of going to clinical I decided to try and set up the database for my research project on Aspirin vs Plavix resistance. Also, I went through the many forms that would be needed to open up collaboration with Dr. Leifer and my Ithaca lab.

6/30/2011 –

During today’s rounds I witnessed a patient with acute global aphasia. When the patient came to the hospital the patient had some word finding difficulties and was extremely nervous to the point of tremors. The patient had a stroke scale of 5, which was odd because they counted 3 points to her being blind even though her blindness was brought on by diabetes and not by stroke, so effectively the patient only had a stroke scale of two. Her MRI and CT scans were pretty normal and they could not place the reason for the aphasia. Later the same day when I went to see the patient the patient could was in extreme aphasia, the patient could not form sentences or find proper words. For instance the patient would say her pointer was her thumb and most cognitive functions were unable to be completed, such as being able to do any math, or say farm animals. It was odd because the patient was very chipper and didn’t appear disabled, however when you talk to her the patient would think about every word and either say a different word or just stay there thinking for a while. The rest of rounds were uneventful.

7/1/2011 –

Today during rounds we went to check on the aphasia patient again and the patient was almost back to base line, it was a very acute event and seemingly disappeared, no one has an answer for it, but the patient was sent home today. One patient was presented at morning report with odd behavior such as wondering the streets. The patient was admitted and an MRI was done, turned out the patient has a large 3.2 mm frontal parietal meningioma. The meningioma was completely vascularized so no surgery could be done. Dr. Leifer did not hold clinical today so I came back and worked a little more on the database.