Week 3 - Sara

This week was another eventful week of surgeries and clinic.

I got to know the nurses, surgeons and residents much better, so surgeries are more interesting as I can get more explanation and details. Of note, I saw a hydroceles surgery in which the surgeon removed pockets of fluids that were attached to the testicles. I also saw different endoscopy procedures. One of them was a surveillance to see if a patient had any recurrence of tumor. Luckily, he didn't so the procedure was quick. I also saw a cytoscopy procedure to extract specimen for biopsy of a bladder tumor. It was interesting to observe the tumor under magnification. Personally, I could not distinguish the tumor from the rest of the bladder, except from where the tumor bulges out; however, Dr. Scherr, who's an expert, quickly identified the tumor and obtained multiple specimen. In our meeting, according to Dr. Frayer, the tumor may be beneath the bladder tissue causing a bulging, and that's why the tissue looks identical.

I also observed a surgery to remove a neobladder, abdominal mass, and small and big bowel. The patient had bladder cancer previously, and the bladder was removed. A neobladder was constructed out of the intestine. Unfortunately, the patient has recurrence of cancer, in which cancer was growing into the bladder and invading out of it. The mass was enormous ( 9x13cm) and has invaded into other intestines, and was stuck onto the pancreas. The neobladder was removed (a very big mass, I must say!) and part of the big intestine was also removed. It was very interesting to see how they resect the big intestine and then seal/staple the two ends back together. Due to the lack of bladder, the patient can must use a urine bag for the rest of his life. At least with the surgery, he will no longer experience the pain in his stomach, which he was complaining about.

Many interesting cases also emerged in clinic. Of note is a patient suffering from kidney cancer came in complaining about weakness in his right leg. Dr. Nanus examined him and ordered an xray for him immediately. Results came back near the end of the day indicating a pathological fracture, which means that the patient now has bone metastases. It is interesting to see how different symptoms can lead to specific diagnosis with knowledge and experience of a specific disease (kidney cancer is known to lead to lytic disease). Another interesting case is a patient who was undergoing chemotherapy, but her platelet counts drop substantially afterwards (due to toxicity effects). She cannot obtain blood transfusion however due to a complete IgA deficiency. It is suspected that she has metabolic deficiency so the drug is retained in the system for longer leading to long-term toxicity effects. Unfortunately, all Dr. Nanus can do is to decrease the dose when the platelet count is up again.

There were also several new patients in clinic this week. It is interesting to listen to their stories - their symptoms, their treatment, and their diagnosis. It is still very difficult for me to listen to Dr. Nanus to break the news to them and explain to them their options and the prognosis.

As for project, I have gained access to a flow cytometer for my project. The antibodies and cells are also arriving in the lab. I am hoping to start my experiments next week, and hopefully they will run well.