James Week 5

7/11/2011 –

Today I started ICU rounds with attending Dr. Rosengart. The ICU was very quiet, I expected to see a lot of hustle and bustle, but there was none. So, I figured that it must just be a slow day and that there were not many patients. However, when rounds started, I realized the reason there was no noise, 95% of the patience in the ICU are in commas. We actually went through 16 patients, more than any other round I have been on thus far. The most common word used was transfer; most in the ICU are only there for 1 to 2 days and then get transferred to neurology, neurosurgery or cardiology. Dr. Rosengart reminds me of an attending on TV, he poses questions to the residents and they have to come up with answers, or he will leave medications/diagnosis to them. Overall, the ICU was more laid back than the other rounds, which seemed peculiar to me since it was a much more critical service. During patient rounds the tests were different from normal neurology, since most were in commas. They took a while to study the eyes, opening the lids and checking for dilation, reflex response, and drift. They also did several pain tests to check if the patient had any reflex to stimulation. Later I went to the neurology conference with the heads of the neurology department. It was a bit intimidating having the best of several departments in one room including the chiefs of neurology, neurosurgery, radiology and cardiology (I believe). The cases presented were complicated, a balance of whether they should do something from the cost/benefit on quality of life viewpoint. For example, a patient had severe stenosis of the right carotid artery, but very few symptoms. A stent could be placed but there is a kink in the artery that could have been further damaged and perhaps turned into a complete occlusion. Most of the cases were a bit hard to follow due to the amount of jargon thrown around. I then returned to making my database for my project.

7/12/2011 –

During morning report today I learned something new for me; I thought that white matter disease could be a precursor to Alzheimer’s, however, I found that you cannot detect Alzheimer’s at all with an MRI. I also learned that stenting is not used for intracranial atherosclerosis for two main reasons. First, the surgery is very invasive. Second, stents cause emboli or the “snow plow” effect. The snow plow effect is caused by pushing a stent against the plaque and it can actually be pushed up and completely occlude the vessel. After morning report I joined the neurovascular rounds to see patients. At noon there was the vascular conference which went through several cases, during which I learned how to properly read a brain perfusion scan. I then made my way to neuroradiology in hopes to be able to sit in and watch MR studies. I was lucky to find the attending for radiology and was able to watch a few of their cases. I think radiology is probably the best job, you don’t have to deal with people and you are respected for the amount of knowledge you have on the scans. I did not learn a great deal because I am not positive of all the structures of the brain and how they look in all the different MRI studies. So, I went back to the apartment and studied the brain and MR physiology so the next time I sit in I will know and learn things.

7/13/2011 –

I started the day in ICU rounds, again there was not much going on. I left rounds to go to grand rounds which was given by one of the nation’s best neurotoxicologists. I actually learned of many abstract poisons given by different types of fish (barracuda, red snapper, even tuna) and cone snails. He also went into normal everyday toxins to be aware of and insect venoms and there neurological effects. After grand rounds I joined up with consult rounds. I must say out of all the rounds I like consult the best because the attending will actually explain things. There were no “out of the ordinary” patients today. I then met up with Dr. Frayer who took me to see Dr. Agrawal: Director of the central laboratory and POCTS. This was an amazing opportunity for me since my PhD work is making a POCT device. I toured the labs and explained my thesis work. It seems that collaborations will be made between my lab and Dr. Agrawal! I am very excited to be able to test my experiments with actual stroke patient blood samples.

7/14/2011 –

Today I was running around trying to get access to patient charts for my project. In the morning I followed clinical rounds and then went to morning report. No significant cases to report. For most of the day I worked on my project and getting access to the charts.

7/15/2011 –

I spent today working on the project, completed the database, but still have no access to the charts.