James Week 4

7/4/2011 –

4^th of July Holiday

7/5/2011 –

Was not back to NYC today, needed to renew driver’s license.

7/6/2011 –

I started with consult rounds today. Rounds were really helpful; there were two medical MD-PhD students that just started, so the attending explained most of the patience. This morning’s grand rounds were on DBS for dystonia. Dystonia is a movement disorder that affects 3000 people a year. Electrodes are placed on the GPI and are stimulated with varying current, amplitude and frequency. The range of improvement is 50 to 90%!! It was very interesting to watch all the live footage of patience before and after the DBS. It is not an immediate recovery usually taking from 3 months to a year for almost complete recovery. After grand rounds I learned how to write a consult note and how to give and understand a mental and physical neurological test. I then joined my clinician for clinical.

7/7/2011 –

I joined consult rounds again today and went to morning report. During morning report I learned about a patient that had lung cancer which metastasized to the brain (left posterior). Surgery was performed to remove the tumor but the patient became very delusional and could not take care of oneself. Nothing could be done about these problems and it was decided for to at least make the patient comfortable and to go to hospice. After morning report I resumed rounds and met a patient from yesterday that suffered a serious ammonium attack. Yesterday the patient was alert but not cognitively sound, mixing up words, not understanding questions, no short term memory, etc… Today the patient became much worse, falling asleep and non-cooperative. The neurology team does not believe she had any neurological issues on metabolic which is effecting her globally. During the noon meeting we had a lesson on the brain and the many parts of it, what their function is and what diseases arise from each. I did learn the difference between dysarthria (motor problem that garbles speech) and afasia (cognitive problem that mixes up words or word finding problems).

7/8/2011-

Started the day with consult rounds and then went to morning report. One interesting case was presented during morning report; a patient came in with blurry vision and dizziness. Found 2 small lesions on the MRI, however they are placed right next to the brain-stem. This is a critical case because although the patient looks fine and there are only 2 small lesions the slightest movement of the lesions will make the patient stop breathing and potentially kill the patient at any time. Afterwards we went to neuroradiology to look more closely at some patients MRI’s. Some of the residents and I learned a really neat technique by the attending on one patient that had vertigo every time he stood up. The attending told us after the patient fell the notiliscs that are located in the gravity portion of the ear must have been knocked into the circular motion canal which is filled with fluid to sense motion. So, he actually made the patient lie on his back and through some head positioning and rolling on the bed he attempted to reposition the notilisc out of the motion canal and back into the gravity portion. It was really interesting. Although, the patient was very nauseous and could only complete one side while I was there.