Last week, I was unsure of how my immersion experience would play out. I was caught in a bureaucratic tangle, and my mentor, Dr. Kennedy, was absent. On Friday, when I discovered my mentor only had two surgeries planned for the month of June, and he was going to be out of town for the entire month of July, I decided enough was enough.
I contacted Yi, and he put me in touch with a doctor he collaborates with, Dr. Susan Gauthier, a neurologist at Weill Cornell specializing in Multiple Sclerosis (MS). She has been very helpful with regard to incorporating me into her research as well as shadowing in her clinic.
Evidence suggests iron could be an in vivo MRI marker of the progression of the white matter lesions that characterize MS, due to its strong paramagnetism and apparent correlation with inflammation associated with the lesions. Additionally, edema and demyelination lead to changes in the myelin water fraction at the lesion sites.
Quantitative susceptibility mapping (QSM) is a contrast technique for MRI. Susceptibility refers to the degree of magnetization that the material or tissue undergoes as a function of an applied magnetic field. QSM processes the MRI data so that ideally, the output intensity of a given voxel is linearly proportional to the susceptibility of the tissue in that voxel. Thus, paramagnetism from iron is detectable in the QSM images. For my project, I will be helping with the coregistration and analysis of the QSM data as it relates to the changes in myelin water fraction in MS patients.
I met with Sneha Pandya, who works in the Fiel Building in association with Dr. Gauthier. She showed me the scripts with which the imaging data is extracted, converted, processed, and mapped. I will be meeting with Yan Zhang this next week for further demonstration of the processing and to integrate me into the project.
In the clinic, I observed Dr. Gauthier as she met with six patients in her clinic. She utilized a measured approach to address the concerns of the patients that clearly demonstrated her expertise in the field and her experience in communicating with the patients. There was a consistent structure to the appointments, yet each patient presented their own unique circumstances and questions that required an individual approach. Dr. Gauthier used her electronic notes from previous visits as a reference for each patient's situation, citing recent MRI results and past setbacks as evidence for different treatments tailored to each patient.
Multiple sclerosis is a disease that can present symptomatically in a variety of forms, since the lesions can occur in different regions of the brain. Additionally, patients often present with other conditions. One patient raised the possibility that they suffered from pseudobulbar affect; Dr. Gauthier relied on her expertise to assess the claim and ultimately prescribe a medication. Another patient asked questions with regard to pregnancy; Dr. Gauthier scrutinized the medical record as well as the current prescriptions before suggesting a course of action. A different patient had a history of partial blindness in one eye due to the disease, another suffered from degenerating spinal disks, a third had fibromyalgia, a fourth had short term memory loss. It quickly became apparent that diseases such as MS require nuanced approaches that take into account the individual's condition, and a universal treatment method is unreasonable.
I also took time outside of Dr. Gauthier's clinic to shadow Dr. Jason Spector in the OR alongside Terence, Aaron, and Jason. I watched two surgeries involving cleaning, debridement, and potential skin grafting. One patient underwent general anesthesia, while another required local anesthesia due to age.
I quickly realized why so many BMEs view him as a great mentor. Dr. Spector took the time to describe the Integra skin graft, as well as his potential collaboration with Abe Stroock (Chemical Engineering at Cornell) for an improved material with microspheres. He also invited me to return to shadow him anytime I wish, and had no qualms with four shadowers in his surgical suite. The surgical team was noticeably in good spirits, and I think it can be traced to Dr. Spector. I will make sure to watch him at least a couple more times before the end of the term.
Next week, I plan on shadowing Dr. Kennedy in surgery at HSS, continuing the QSM project, and shadowing Dr. Gauthier in the clinic once more. Future potential shadowing opportunities include Dr. Schneider (with Jacob), Dr. Rodeo (with Liz), Dr. Bostrom (with Mandy), and Dr. Potter (with Victor). I am happy to say this week has gone well, and look forward to next week.
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