Friday, June 18, 2010

Weill Week 1: Prepping for Spine Work

This week consisted of many meetings and orientation. Being the first week in Manhattan, I felt the need to orient myself, and spent a lot of time exploring the surrounding areas, finding food, moving in, etc. Monday, we hit the ground running by meeting Dr. Wang to talk about what we would get out of the immersion term. We then got our IDs created, and started Bioethics training in the afternoon. The focus was on ethics in animal research and discussing past cases that highly influenced the development and understanding of the importance of ethics. On Tuesday, I was supposed to meet a fellow that worked with my clinician, but an emergency came up and we were unable to meet. Tuesday concluded with the second part of our Bioethics training, in which we discussed human research.

On Wednesday, I was finally able to meet my physician, as well as the fellow I will also be working closely with this summer. Dr. Roger Hartl is the Chief of Spinal Surgery at Weill Cornell, and also works with the New York Giants. He attended medical school in Munich, Germany, and completed his residency at Weill Cornell. He has published extensively on spine repair methodologies, and his multidisciplinary nature led to a collaboration with Dr. Lawrence Bonassar at Cornell University Ithaca campus to design a tissue engineered solution to degenerated disc disease. As Dr. Bonassar is my P.I., I thought it would be prudent to also work with Dr. Hartl to learn as much as possible about this research area from the view of a surgeon.

We discussed various ideas regarding my time here, and planned to set up a more concrete schedule on the following monday. In the meantime, I shadowed Dr. Harry Gebhard, one of Dr. Hartl's fellows who was also trained in Munich. Harry took me on a tour of the hospital, medical school, HSS, and other facilities. I was taken to see the 7T small animal MRI, a truly impressive device capable of amazing resolution during scans. I also found out that very few centers in the U.S. have such a scanner, and I hope that I will be able to use this scanner during my future research. Additionally, I was given some literature to help me understand more about the type of work going on in spine surgery solutions.

On Thursday, I was able to be apart of what were called "Rounds." In the Rounds, various interesting clinical cases were discussed. Of particular interest was the case of a 52 year old woman, presenting with tiredness in her arms and pain in her shoulders. When the x-rays were looked at, it was easy to see multiple levels of disc degeneration, and well as one bulging disc that didn't appear to be causing any of the symptoms. The doctors discussed possible solutions to the problems, and went with a multi-level fusion while using a Pro-Disc disc replacement on the herniated disc. This discussion was particular interesting for a variety of reasons. This was my introduction to various medical jargon that I will have to learn and become familiar with over the next few weeks. Also, age as a factor in treatment was discussed. At 52, not being particularly old, it was decided that fusing too many vertebrae would detract from the patients quality of life, hence the use of the pro-disc. Had this happened in a 32 or on the other end of the spectrum, a 72 or 82 year old, the treatments may have been much different. The use of certain disc replacement solutions off-label was also discussed. This lead to a discussion about the FDA and how spine solutions were more advanced in Europe as opposed to the U.S.. These discussions also showed me just how eager some doctors were to push innovation in spine surgery, which was surprising to me as I had been told in my undergraduate career that doctors were quite set in there ways and did not necessarily like innovation. Maybe a little bit of both is true. Following rounds, I met with Dr. Frayer, and we had our first immersion group meeting of the term. It was interesting to hear what other students were doing, as I hope to rotate through various surgeries while I am here. The week ended with a brief exchange with my mentor about potentially working on a review paper with a Dr. Dimitri Sigounas. The details will hopefully be hashed out next week, and I will also hopefully begin to observe some spine surgeries.

Though I did not have a chance to observe surgery yet, it was still quite a full week. Additionally, I do not believe surgery will be the highlight of my time here, though I would like to see just how a Pro-Disc is placed inside the joint space. Hearing the opinions of various doctors on barriers to innovation was the highlight of my week. It really motivates the research I have done and will be doing during my Ph.D.. Hopefully, I will be able to maintain a relationship with Dr. Hartl throughout my research career. But first, I need to make it through the summer!

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