The first week was a very hectic one; between moving in, seeing patients, viewing surgeries, researching potential projects, and exploring NYC, there was very little time for sleep (I can sleep when I get back to Ithaca...just don't tell my advisor that!). I will do my best to recap here; if you are curious as to why the following sections are color-coded, simply view my last blog entry (Mike Mitchell's Summer Immersion: Introduction) for a quick overview!
I will forever be known to the first year medical students as "the poor kid who moved in during a monsoon," as I moved in a day later than most of my colleagues during the middle of a torrential downpour. Luckily, they were all kind enough to help me move into Olin Hall, our residence for the summer. Housing expenses are zero for our time here, and most of us either share a dorm-sized room and living room with a roommate, or have a single room and share a bathroom with another individual. The rooms are already furnished as well; just make sure to become buddies with IT so you can get the internet up and running! A full basketball court, cardio and weight training machines, along with free weights are conveniently available within the residence.
Dr. Yi Wang introduced us to the program on our first day, and helped us get into contact with our clinicians. Mitch Cooper also helped us obtain IDs, an absolute staple when entering any building room within Weill Cornell and New York Presbyterian Hospital. I would also recommend using these first few days to become acquainted with New York Presbyterian and Weill Cornell. The hospital is absolutely massive and most of the buildings are interconnected; in order to attend meetings on time, it is essential to know your way around. Clinicians are extremely busy, and being late for one meeting could mean that you will not have another chance to meet with them for a few days or more!
Speaking of clinicians, I was able to meet with my own mentor for the summer: Dr. John Karwowski, Chief of Vascular Surgery. We barely had time to shake hands and introduce ourselves to one another, as surgery was about to begin.
The two main surgeries I viewed this week involved minimally invasive interventions for vascular disease. Vascular disease affects the blood vessels within your body, either in terms of hard plaques on the vessel walls (they are typically calcified; think of having an almost bone-like material on your vessel wall), blood clots (typically clumps of platelets called a thrombus that can stop your blood from flowing normally; the normal function of platelets are to heal wounds/tears on our blood vessels), and other blood flow abnormalities. Since blood flow is essential for nutrients and oxygen to be distributed through the body, not enough blood flow can make it very difficult for parts of the body to survive.
The two cases involved:
(1) A thrombus formation in the inferior vena cava (aka IVC, a large vein the provides blood to the right atrium of the heart);
(2) A patient with foot ulcers (wounds due to vascular complications; and absolute haven for infections), due to inadequate blood flow to his lower body (caused by plaques within the vessels).
Two different devices were used in these cases; for the first, an IVC filter (seen below, courtesy of Gunther Tulip Inc.) was used, and in the second a balloon catheter was utilized (see video from MIT for more details: http://web.mit.edu/invent/www/ima/fogarty_video.html). For the first case, the IVC filter was used to allow blood to flow through the vessel, while maintaining the thrombus within that spot. In the second case, a small balloon was inflated within a vessel to expand a stent (a very small metal cage used to push plaque aside to allow adequate blood flow to resume) within the plaque filled artery.
In both cases, blood flow was obstructed in some shape or form from the body. However, two very different devices were used.
Why were these different devices employed? What key differences could there be between plaques and thrombi, and what effects can they have on our health? What would happen if the thrombus were to move?
Observing Dr. Karwowski in surgery was simply amazing; the IVC surgery took an astounding 50 minutes to complete (I have had Biology 101 labs that have taken longer!), while the other surgery took about 3-4 hours to complete. Both were a complete success, although it is unclear in the second surgery if adequate blood flow would improve the foot ulcers. Other measures may need to be taken; unfortunately a foot amputation might be in store for the patient if the infection continues to spread.
I will touch up on seeing patients, along with my potential research projects within my next entry. For now, enjoy some food suggestions around Manhattan!
Quality Places to Eat:
ZaZa Restaurant: Excellent lobster ravioli, sweet outdoor seating in their garden in the back!
Bamboo Sushi: Super fresh sushi, a minute walk from Olin Hall, and great lunch specials!
Not So Quality:
O'Flanagan's: Great bar, sweet karaoke, but I would avoid the overpriced, average bar food.
I will try to do a better job next time!