Friday, July 2, 2010

Zavrel - Week 3

In my third week of immersion at the Weill Cornell Medical College, I was able to see more patients at the Center for Sleep Medicine, go on rounds in the neurological intensive care unit (ICU), and made substantial inroads into my summer research project.

I was able to be present for rounds - or perhaps more technically correct, consultations - between patients and Dr. Alan Segal, a neurologist at the Center for Sleep Medicine. In the course of these rounds, I expanded my knowledge of sleep disorders and treatment. For instance, I learned that often times sleep disorders are first identified during a visit to the hospital for a non-related issue such as surgery. While the patient is unconscious, nurses and doctors may notice labored breathing, gasping, and depressed saturated blood oxygen levels, symptoms of sleep apnea. They then refer the patient for further assessment by sleep experts. Patient family members - children and spouses - are often aware of sleep disorders, being awakened or otherwise disturbed by snoring, cessation of breathing, and gasping for air. Indeed, one patient brought his 10 year-old son along with him. The child was able to provide a description of his father's symptoms that assisted in the diagnosis of probable obstructive sleep apnea (official diagnosis to be provided by a polysomnography study). I was also impressed by the diversity of patients suffering from sleep disorders or presenting with complaints of poor sleep: men and women, young and old, extroverted and aloof. It amazed me how people who seemingly shared nothing in common could present with startlingly similar symptoms. For instance, a hard-charging investment banker in his 20s and an unemployed woman in her 40s both complained of excessive daytime somnolence (EDS), falling asleep at inappropriate times, and unfulfilling sleep. The young man was on no medication and was quite adamant that he wished to remain that way, flatly rejecting the option of medicine to help him. The woman was on a slew of psychotropic drugs and saw nothing wrong with adding another to the litany she was on. Lastly, the young man conformed to a regimented lifestyle, retiring at the same time each night and rising at the same time each morning. The woman, on the other hand, lived a most erratic, irregular lifestyle, napping throughout the day. Despite the multitude of differences, their complaints were quite similar.

I was invited to go on rounds with Dr. Segal in the neurological ICU at New York Presbyterian Hospital. Again, I was struck by the diversity of patients. Young people who had suffered physical trauma in freak accidents rested in rooms adjacent to wizened alcoholics experiencing withdrawal-induced seizures. It was also a very somber environment, with several patients determined to be clinically brain dead and their relatives convening to decide whether care should be withdrawn.

The majority of my week was spent on my summer research project, an electromechanical physical therapy device with the aim of reducing the severity of sleep apnea in patients. The treatment currently in vogue - CPAP - is expensive and some patients can never acclimate to wearing a mask at night. I spent a good portion of the week deciding exactly which components to use and placing orders for those parts not on hand. I had to anticipate the needs of the clinicians and patients using the device, and so had to account for how data would be recorded, stored, and transferred for later display and analysis. In the coming week, all of the requisite components should arrive, making it possible to fabricate a prototype, which if successful, will serve as the template for several other devices to be used in a limited clinical study.

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