Week 4

This week I have been busy working on my research project.  We have a long list of patients who fit the criteria for this retrospective study and we have been working on going through one of the patient records databases and pulling additional information about these patients.  Once we have all this information, we will be able to make sure that these patients are actually eligible for inclusion in the study and can start analysis.  

I was also able to see some patients with Dr. Goodman this week.  One of the patients was a man whom I had seen with Dr. Goodman last week.  He had come in last week complaining of various joint pain with severe pain in his neck/shoulder region.  Upon examination, Dr. Goodman thought that his pain was originating in the soft tissue/muscle so she prescribed him a muscle relaxant.  However, he came back in this week with the same complaints and said that the muscle relaxant did nothing for his pain.  With this new information, Dr. Goodman decided to prescribe him prednisone for his pain and ordered an MRI of his neck to try and find the source of his pain.  I also saw a patient whose RA was flaring.  Her RA is normally well managed but today she had several swollen joints and severe pain in her knees and ankles to the point that she could barely walk.  It turns out that she was flaring because she had not been taking her medication.  Unfortunately, she has schizophrenia and lives in a psychiatric care facility which does not do a good job of taking care of her and making sure she takes her medications.  Dr. Goodman recommended that the patient come in to see her more frequently to make sure she takes her medications and hopefully prevent future flares before they become so severe. So hopefully that works out for this patient. 

 Also attended a few seminars/conferences this week.  I went to the sports medicine research conference where I got to learn about some of the research they have going on focused on the knee.  They are about to start an interesting project on trochlear dysplasia. They are using cadavers for this study which do not have trochlear dysplasia because these are hard to find.  Instead they are going to 3D print dysplastic trochleas and attach these to their cadavers for the study.  They had an interesting discussion about the need for high resolution when printing. To get this kind of resolution they need a high resolution MRI or preferably a CT scan of a patient with trochlear dysphasia. However, because of the radiation associated with CT they decided that they would just have to make due with the MRI imaging.  

At the CAP conference this week several patients were discussed. We heard a follow up on the patient with JIA from last week. She has now heard the options from the CAP surgeons and is waiting to be seen by the spine and foot and ankle doctors before making a decision.  Sadly, she seems to be convinced that she will be in the 1% success and will walk again.  But all the doctors are convinced otherwise, so hopefully hearing from the other doctors will help her realize the severity of her case.  We also heard the case about a woman with RA and severe pain in her right foot. This foot is flat and various joints are fused making it difficult for her to walk. She has been dealing with the pain for so long that her gait is now abnormal and she has a remodeled stress fracture on her fibula that may need to be addressed. The surgeons discussed the different options to repair her foot but said that based on her condition the corrected foot will be very difficult to maintain.  Her other joint issues which change her gait will change how she loads the foot and ankle which could cause the bones to return to this fused state.  The doctors recommended that she first be seen by the foot and ankle surgeons. 

At grand rounds this week I heard a talk from the director of Developmental Therapeutics at MSKCC.  His focus is on the use of genomics to produce more specific cancer therapies.  In the majority of cases, a patient's tumor is biopsied and the DNA from this sample is tested for 410 known cancer-related genes.  This information allows the oncologist to make more informed treatment decisions.  The speaker also mentioned some ongoing work in cell-free tumor DNA. Cancer cells are often apoptotic and there is an increased amount of cell-free DNA in patients with cancer. If a method of isolating the cell-free tumor DNA from the other cell-free DNA in the blood, the need for a tumor biopsy could be eliminated.