Saturday, June 19, 2010

Summer Immersion Week 1

It has certainly been an interesting and enlightening week to start off immersion term. At the beginning of the week I met with my clinician mentor, observed residents review neurology cases with fellows and attending physicians and saw patients with my clinician mentor, Dr. Gauthier. Dr. Gauthier is a clinician in neurology that helps patients who have multiple sclerosis, MS. During the presentations by the residents I observed how doctors present cases. From these few presentations I could begin to get a sense of how physicians approach cases. The presentation began with general facts about the patient, how old they were and general lifestyle then went on to describe the patients’ symptoms and then how the physician evaluated these symptoms. In this presentation format, as facts in the case were revealed this often eliminated some possibilities as to the cause; for example in one of the cases the lack of a fever suggested that the symptoms were not the result of an infection. As someone who tends to watch medical dramas it also struck me how similar presentations in these fictitious reproductions resembled the manner in which cases were presented in the hospital. In addition to the symptoms that the patient reports, neurologists also utilize imaging modalities to assess the underlying cause of the symptoms in the patients. A primary source of information for the diagnosis of MS appears to be the MRI images that are taken of the patient when they report their symptoms. From the images that were taken of the patients’ head and neck the doctors quickly identified points in the image that identified the disease that was causing the patients’ symptoms. In this particular aspect of the diagnosis it is strange how subjective this measure of assessing a disease is; since the nature, size and location of apparent lesions is the primary marker of a particular disease though the quantitative measures of these lesions is not critical to making the diagnosis.

In MS it appears that imaging is important in not only diagnosing the disease but in also maintaining health after the diagnosis. I have learned that MS is a chronic disease of the central nervous system that patients can live with for a very long time and maintain a relatively normal lifestyle. While observing how Dr. Gauthier meets with patients who have had the disease for many years it is clear that MRI images and the patient testimony of their current symptoms are critical to helping physicians to assess the current state of the disease; such as whether or not new possibly symptomatic lesions are forming. The focus of these meetings were quite different from the presentation of a case that I just described, here the focus was to maintain the health of the nervous system either through slight changes in lifestyle or medication and determining what the best course of action would be for the patient.

Later in the week I had the opportunity to observe a catheter based x-ray angiography with other students in the program. This was my first experience in the OR observing a procedure, which was very exciting for me and a little unnerving at the same time since the patient was conscious, though sedated, during the procedure. This procedure also used a very interesting form of imaging to visualize the arterial system of the patient, real time x-ray imaging. The angiography was performed using a catheter that was threaded through the femoral artery down into the thigh and lower leg of the patient. I gained an appreciation ironically for both the robustness and the fragility of the vascular system while watching the surgeon during the process of guiding the tip of essentially what appeared to be a flexible wire through the vascular system of the patient’s lower extremities. By injecting a contrast material through the catheter into the arterial system, the agent would mark the flow through the vasculature and reveal possible areas of stenosis. What was even more interesting was how easily the surgeon could manipulate the catheters and wire thin tools in the space in the arteries to repair the narrowing of vessels using stents.

It has been an excellent start to the summer and I look forward to learning more about how physicians use technology to aid in the diagnosis and treatment of disease.

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