Week 3: Research, Surgery, and more Surgery

     This week, I ran real-time reverse transcription polymerase chain reaction (qRT-PCR) for the gene that encodes neuronatin, NNAT, with Lauren Havel in Dr. Mattel's lab. http://www.ncbi.nlm.nih.gov/pubmed/23328481. RT-PCR is used to clone expressed genes by reverse transcribing the RNA of interest into its DNA complement through the use of reverse transcriptase. The newly synthesized cDNA is amplified using traditional PCR. qRT-PCR sounds laborious and complicated; however, the process was actually quite simple and the machines did most of the work. Waiting between each step was the longest part. First, we made cDNA from the RNA of LM2 (lung metastatic cell line) untreated, LM2 scrambled, miR-708, LM2 wildtype (+ control), and MCF7 wildtype (- control). Then we amplified the cDNA using PCR to give us the normal fold expression of each RNA to be used with nanoparticles at a later time. Unfortunately, the particles will not be ready until the end of July so I have to find a different research project to do.

     Next, I visited with Dr. Alex Swistel in the OR and watch him perform surgery on four patients. Although Dr. Swistel is the lead surgeon, he has a team with him that helps him perform a successful surgery. He has the anesthesiologist, the techs that hand him instrument, the lead nurse, and the residents he teaches the surgery to. At the beginning of each surgery, the team would perform a Time Out lead by attending surgeon on consent immediately prior to incision. All team member must participate, all activities must stop respecting the zone of silence. Some of the patients were undergoing right breast lumpectomies with needle localizations and sentinel node biopsies with poss axillary dissection. The other patients were undergoing left breast excisional biopsies with needle localization. Dr. Swistel was very engaging during all surgeries and pointed out interesting skin marks, incisions, patient complications, and surgery techniques to me. He and the team was very funny and made me feel comfortable during the procedures. We even got into a conversation about one of the techs assisting in a parathyroidectomy under hypnosis with local anesthesia later on in the week! Unfortunately, the surgery was later cancelled.

     Then, I shadowed Dr. David Otterburn in the OR for a DIEP Flap, a type of breast reconstruction in which blood vessels called deep inferior epigastric perforators (DIEP), and the skin and fat connected to them are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles. Surgeons do not take pectoral muscle or the nipple anymore and use body fate because it grows/shrinks with you and if it get infected you can use antibiotics. The surgery was a multi-step process that is usually a minimum of 8 hours. Dr. Otterburn was the attending surgeon but had a team of three residents help him complete the surgery. As a team, they cut out some of the third rib to get to the main artery in the chest, remove flap with the veins from lower abdomen to connect to the artery in the chest, close her abdomen up and stitch new belly buttion, put the flap in chest with connecting veins and arteries to construct the new breast, and use a laser with fluorescent dye to make sure blood vessels in flap were getting adequate flow. The surgery was long but I learned a lot from Dr. Otterburn and his team creating a very similar atmosphere as Dr. Swistel.

     All in all, I had a very exciting week that had a mix of research and plenty of surgery. I know for one thing though, I do not plan on getting surgery anytime soon. Although it was amazing to watch, surgery is so invasive and can have many complications. These past few weeks have taught me to really start checking my breasts and doing self-exams so I can detect any changes early. But, I do admire the sense of humors the doctors and patients maintain despite such unfavorable conditions. It pays off to have a positive attitude.